Prostate Cancer Treatment: What You Need To Know

According to the American Cancer Society, prostate cancer is the second most common cancer in American men, with about one in eight men diagnosed with it in his lifetime.

It may be time to schedule a prostate cancer screening if you:

• Are 50 years old or older
  
  
• Are 45 years old or older, African American, or have a family history of prostate cancer

Screening may involve a blood test called a prostate-specific antigen (PSA) and a digital rectal exam to feel the prostate for abnormalities. You and your health care provider should decide together if prostate screening is right for you.

If you have received a prostate cancer diagnosis, the good news is that, now more than ever, there are multiple treatment approaches for prostate cancer.

The National Comprehensive Cancer Network recommends several treatment approaches. These range from active surveillance for lower-risk prostate cancer, to a combination of surgery and/or radiation therapy and/or systemic therapy for higher-risk prostate cancer. Large studies have shown equal cure rates between these different options, depending on the situation. Your prostate cancer providers will talk to you about the risks and benefits of each option. Here are some basics about the major approaches.

Active Surveillance

Active surveillance (AS) means getting PSA testing and physical exams with your urologist. It is a way of keeping a close eye on your prostate cancer without actually treating it. This can be an excellent option, especially for men with lower-risk prostate cancer. About half of men who choose this option are able to avoid treatment down the line. Ask your prostate cancer providers if AS is a good option for you.

Surgery

Surgery is done by your urologist, and is an excellent option especially in younger, healthy men. It typically involves removing the entire prostate and is the only way to see what the true extent of cancer is inside the prostate. Today, the robotic assisted prostatectomy allows surgeons enhanced vision, control, and precision and translates to less pain, shorter hospital stays and faster recovery. Speak to your urologist about the possible side effects of surgery and recovery.

Radiation Therapy

Radiation therapy (RT) is another excellent treatment option. It is non-invasive, and typically uses high-energy X-rays targeting the prostate, and sometimes additional areas around it. It is typically given daily, Monday through Friday. There are many different RT regimens, ranging from just five treatments to 44 treatments, for a variety of clinical situations. You meet with your doctor every week while you are on treatment to review any side effects and to help manage them. RT is well-tolerated in the vast majority of men, and serious long-term complications are rare. Speak to your radiation oncologist about the possible side effects of RT and recovery.

Systemic Therapy

Systemic therapy is treatment that goes throughout the whole body and can be important to reduce the chances of prostate cancer spreading outside of the prostate, especially to the bones. It is often an option in men with higher-risk prostate cancer. It is typically given in the form of androgen deprivation therapy (ADT), sometimes called “hormonal therapy.” This therapy comes in different forms, and decreases your testosterone levels, which helps prevent the prostate cancer from spreading. In recent years, certain types of ADT have shown newly discovered benefits, especially in men with high-risk prostate cancer. It can be given over a period of four months, up to even three years, depending on the clinical situation. Ask your prostate cancer providers if ADT can benefit you.

Making your decision

So, what treatment might be the best for you? It can be a complicated decision. Your doctors will help you weigh the risks and benefits of these approaches to prostate cancer to help you decide which is best for you.

Antony Koroulakis, MD, is a board-certified radiation oncologist at Luminis Health.