In cancer care, a multidisciplinary team, which consists of medical oncologists, surgeons, and radiation oncologists works together to prepare a treatment plan that combines different treatment options to treat prostate cancer.
The final recommendations that this team works out depend on several factors that include the type of prostate cancer, its stage, possible side effects, and the patient’s overall health and quality of life.
It also takes into account the possibility of recurrence and the survival rate of the type of treatment.
The facts that the medical team actively considers include the following:
- Whether you have symptoms
- The status of your PSA levels; are they rising rapidly?
- Type of prostate cancer
- Whether the prostate cancer has spread to the bones
- The quality of life you presently enjoy
- Your current urinary and sexual function
- Any other medical comorbidities you may have
The diagnostic procedure gives the doctor the full details of the cancer including the type, stage, and grade of the tumor.
The individualized plan, which the medical team typically prepares includes treatments based on evidence, supportive care to help reduce side effects and to improve the quality of the patient’s life by keeping him strong in body, mind, and spirit.
Prostate cancer is slow-growing cancer and more of its patients die of other causes than because of it.
And, because cancer treatments can cause bad side effects, due consideration is given in maintaining the quality of life of the patient.
A wait-and-watch policy is adopted first and the patient is regularly screened for any development that may need an aggressive approach.
Treatments used for prostate cancer can be local or systemic.
Local treatments focus on the organ or area where cancer has begun and is limited to. In this case, it will be the prostate gland. These treatments include surgery and radiotherapy.
Systemic treatments work across the body and are useful when cancer has spread to other parts of the body from the primary cancer tumor. They include hormonal therapy, targeted therapy, chemotherapy, immunotherapy, radiopharmaceuticals, and bone-modifying drugs
Local treatments for prostate cancer
If you have been diagnosed with prostate cancer that is restricted to the prostate and has not spread, the following treatment plan is initiated.
Every treatment has its downsides in the form of complications that can cause more problems than the disease itself. To prevent this and keep the patient’s life as comfortable as possible, your doctor may recommend active surveillance or watchful waiting.
Active surveillance
Prostate cancer treatments can seriously have an adverse effect on a person’s quality of life. Their side effects such as erectile dysfunction and urinary and fecal incontinence are well known. This causes serious inconvenience to the patient and his quality of life is significantly disturbed.
Moreover, many prostate cancers grow slowly and cause no symptoms or problems for years. For this reason, most men may consider delaying cancer treatment and staying under active surveillance to keep enjoying the quality of life.
During active surveillance, the patient is closely monitored for signs that may indicate the disease is worsening. If the cancer is found to be worsening, the doctor will begin treatment.
Active surveillance is usually advised for those
- With low-risk prostate cancer, which can be treated with surgery or radiation therapy if it gets worse
- In those patients with cancer that has not spread beyond the prostate
- In those patients with a Gleason score of 6 or below.
- In those men who have no symptoms
Patients who are on active surveillance are subjected to the following
- A PSA test every 3 to 6 months
- A digital rectal examination (DRE) at least once every year
- A second prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
At any time, if the above tests show signs that the cancer is progressing and/or the cancer is causing pain or blocking the urinary tract, the doctor will start local treatment.
However, if a patient on active surveillance develops a condition later, that will shorten his life expectancy, he will be switched to watchful waiting to avoid the inconvenience of repeated tests.
Watchful waiting
Watchful waiting is a more passive form of active surveillance. It is advocated in older adults who have no symptoms and are expected to live less than 5 years due to some serious comorbidity.
If prostate cancer starts causing symptoms, such as pain or urine blockage, then treatment is started to relieve those symptoms. In such circumstances, the treatment of choice is hormonal therapy.
Surgery
The three main types of surgeries used in prostate cancer are
- Radical prostatectomy
- Laparoscopic prostatectomy
- Robotic prostatectomy
All three types of surgeries involve the surgical removal of the entire prostate gland along with the neighboring draining lymph nodes and the seminal vesicles.
Each type of these surgeries comes with its own approach, benefits, risks, and outcome.
The choice of surgery depends on the status of the prostate cancer and on the discretion and expertise of the surgeon.
Read the full note on prostate cancer surgery.
Radiotherapy for cancer therapy
Radiotherapy is a prostate cancer treatment in which the patient’s prostate is exposed to high doses of radiation (high-energy rays or particles) to kill the cancer cells and shrink the malignant growth.
While giving radiation to the prostate, the radiation oncologist ensures that it causes minimal exposure to the nearby healthy tissues such as the bladder, rectum, and bowel.
Radiation is indicated in tumors that are contained within the prostate gland and have not spread.
Radiation is given in two ways:
- Externally from a machine placed outside the prostate. This is called external beam radiotherapy
- Internally from pellets placed inside the prostate gland. This is called brachytherapy.
Read the full note on radiotherapy for prostate cancer.
Systemic treatment options for advanced prostate cancer
In advanced prostate cancer, the malignancy has spread beyond the prostate to other parts of the body such as the lymph glands and bones. Systemic treatments consist of drugs that spread throughout the body to treat cancer cells wherever they may be.
Hormone therapy for prostate cancer
Hormone therapy is a systemic treatment for certain kinds of breast and prostate cancers. The cancer cells in these types of malignancies depend on sex hormones to grow.
In malignancy of the prostate gland, the androgens fuel the growth of the cancer cells. If the androgen levels fall, the prostate cancer tumor begins to shrink or grow more slowly.
However, hormonal treatment is a good supportive treatment. It can give symptomatic relief to the patient and increase his life by a few years.
The main androgens in the body are testosterone and dihydrotestosterone (DHT). Most of these hormones are made by the testicles.
Hormone therapy either directly stops the production of testosterone or blocks its action on the prostate cancer cells.
Read the full note on hormone therapy for prostate cancer.
Chemotherapy
Chemotherapy for prostate cancer makes use of anticancer drugs that are administered intravenously or orally. They travel across the body through the blood and act on the cancer cells wherever they have spread.
Chemotherapy is rarely used in early localized prostate cancer. It is mostly indicated in the treatment of advanced cancer of the prostate and in cases where cancer has recurred and especially when hormone therapy has not produced the desired results.
At times, it is used along with chemotherapy and radiotherapy.
Read more details and the drugs used in the full note on chemotherapy for prostate cancer.
Immunotherapy for prostate cancer
Immunotherapy also referred to as biologic therapy, aims to train the immune system to target malignancies. In recent years, immunotherapy has made a positive difference in treating metastatic cancer of the prostate.
Immunotherapy provides two FDA-approved treatment options.
- one is labeled a vaccine called Provenge (Sipuleucel-T)
- the other is an immunomodulator called Pembrolizumab (Keytruda®).
The immune system, which is our body’s primary defense mechanism, protects us from pathogens as well as cancer cells. Sometimes, the cancer cells escape this defense system and form tumors.
Immunotherapy activates the immune cells to fight against these cancer cells.
Read the full note on immunotherapy for prostate cancer.
Cryotherapy for Prostate Cancer
Cryotherapy (also called cryosurgery or cryoablation) is the use of freezing temperatures to kill prostate cancer cells.
To get the best results from cryotherapy when treating prostate cancer, it is necessary to properly select the patient. It is ideally suited in patients with tumors carrying a low risk.
Tiny needles are placed directly in the prostate cancer tumor under sonography guidance.
Argon or nitrogen gases are passed through the needles and exchanged with helium gases. This causes freezing and warming causing the tissue to die. The body then absorbs the dead tissue.
Read the full note on cryotherapy for prostate cancer.
Targeted drug therapy
This new therapy for cancer cells works on the fact that cancer cells carry some focused abnormalities. Treatment with targeted drugs blocks these abnormalities, which kills these cancer cells.
Targeted therapy drugs are usually recommended to treat prostate cancer that has advanced or recurred when hormone therapy has not produced the desired results.
Since targeted therapies work only in malignant cells with certain genetic mutations, cancer cells in prostate cancer patients may be studied in a laboratory to see if this therapy will help you.
These drugs mostly identify cancer cells without harming normal cells. They block the chemical signals that control the proliferation and functioning of the cancer cells and change the proteins in these cells so that the cells begin to die.
They act on the specific genes and proteins that govern the growth and survival of cancer cells. This has a much lesser ill effect on the patient’s overall health than chemotherapy.
Statistics and success rates
- Prostate cancer is the second most common cancer in men.
- It affects nearly 1.3 million men and kills more than 360,000 every year worldwide.
- That means it is responsible for 4% of all cancer deaths worldwide.
- In the United States, estimated new cases of prostate cancer are expected to be about 192,000 of which 33,000 will die in 2020.
- In its early stages, the five-year survival rate is close to 100%. Approximately 80 percent of all prostate cancers are detected in the local stages, which correspond to stages I, II, and III. Many men diagnosed and treated in these early stages will be free of this disease after five years.
- Once prostate cancer has advanced, the 5-year survival rate falls to less than 30%.
- Prostate cancer is still considered a deadly disease. It is the second leading cause of cancer death among men in the US, with 94 men dying from it every day.
