Watchful Waiting

Early stage cancer may not cause problems. Some cancer is also slow growing and may not need immediate treatment. The prostate will be monitored over time. You will need to track any changes in symptoms. The doctor will do tests or other follow up appointments. Watchful waiting may be appropriate for:

• Early stage prostate cancer that is growing slowly
• People of an advanced age
• People with serious health problems where the risks of treatment outweigh the benefits

Surgery

Types of surgery that may be needed include:

• Pelvic lymphadenectomy—removal of lymph nodes in the pelvis to determine if they contain cancer
• Radical retropubic prostatectomy—removal of the entire prostate and nearby lymph nodes through an incision in the belly
• Radical perineal prostatectomy—removal of the entire prostate through an incision between the scrotum and the anus
• Transurethral resection of the prostate (TURP)—removal of part of the prostate with an instrument inserted through the urethra (may be done to relieve symptoms)

Prostate cancer surgery may cause side effects, like erectile dysfunction, problems controlling urine flow, or control of stool. Special surgery techniques may decrease the risk of these side effects in some. Some examples include nerve-sparing surgery, robotic surgery, and laparoscopic surgery.

Radiation Therapy

Radiation therapy can kill cancer cells and shrink tumors. Examples include:

• Conformal radiation therapy—Conformal radiation therapy uses 3-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
• Intensity-modulated radiation therapy (IMRT)—IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.

Hormone Therapy

Hormone therapy may be used if prostate cancer has spread or has returned after being treated. The goal of hormone therapy is to lower the levels of male hormones called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth.

Hormone therapy may include:

• Luteinizing hormone-releasing hormone (LHRH) analogs
• Luteinizing hormone-releasing hormone (LHRH) antagonists
• Anti-androgens
• Estrogen therapy—rarely used now unless other treatments are not working
• Antifungal medications
• Antineoplastic agents

A type of surgery called orchiectomy may be done to help control hormones. The testicles makes androgens. This surgery removes the testicles.

Other Treatment Options

Other options may include:

• Cryosurgery—this involves using an instrument to freeze and destroy prostate cancer cells
• Chemotherapy—mainly used to relieve symptoms of metastatic cancer
• Immunotherapy—a drug treatment that builds your immune system so that you can better fight cancer cells
• Targeted therapies—focus on the cancer cells, rather than attacking both the cancer cells and the healthy cells
• High-intensity focused ultrasound—an endorectal probe (a probe that is inserted into the rectum) is used to destroy cancer cells with ultrasound energy