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Inspire  >  Prostate Cancer  >  Prostate Cancer Treatment and Prognosis

Prostate Cancer Treatment and Prognosis

By Team Inspire

Posted: Dec 1, 2020, 5:00:00 PM

The type of prostate cancer treatment you receive depends on many factors, including your Grade Group. Findings from tests to diagnose prostate cancer provide your doctor with this information. Many men with prostate cancer do not need immediate treatment, and some don’t ever need treatment at all.

Who treats prostate cancer?

If you have prostate cancer, you’ll receive care from several specialists:

  • Urologist: This doctor treats conditions that affect the male reproductive system, including the prostate and the urinary tract. 

  • Medical oncologist: This doctor specializes in drug-focused prostate cancer treatments, such as chemotherapy and immunotherapy.

  • Radiation oncologist: This doctor uses radiation therapy to treat prostate cancer.

How is prostate cancer treated?

Because prostate cancer is a slow-growing disease, some men don’t need treatment. If you do need treatment, options include:

  • active surveillance 

  • brachytherapy

  • external radiation therapy

  • focal therapy

  • prostatectomy 

  • systemic treatments

  • targeted therapy

  • clinical trials 

Active surveillance

If doctors stage the cancer as Grade Group 1 (a Gleason score of 6 or lower), you have a slow-growing (low-grade) cancer. Your doctor may recommend not treating the cancer immediately.

This recommendation may sound unsettling. But your doctor will closely monitor your prostate health and start treatment when appropriate. Some men never need treatment because the disease progresses so slowly.

Active surveillance involves more frequent testing. You may get:

  • prostate-specific antigen (PSA) tests every 6 months

  • digital rectal exams (DRE) every 6 months

  • imaging scans every 1 to 3 years

  • prostate biopsies every 1 to 3 years 

This approach works best for slow-growing cancer that’s only in the prostate (localized). In addition to your Grade Group, your doctor will also consider your PSA score. To qualify for active surveillance, the PSA score should be below 10 nanograms per milliliter (ng/mL). Your doctor may initiate treatment when you start having symptoms or if the cancer begins to grow.

A similar approach called watch-and-wait, watchful waiting, or observation involves less frequent testing. 

Brachytherapy

Brachytherapy is a type of internal radiation therapy. You may also hear it called seed implantation or interstitial radiation therapy. During this procedure, a radiation oncologist places radioactive pellets directly into the prostate around the cancerous tumor. These pellets (also called seeds) are about the size of a grain of rice.

Brachytherapy is more targeted than external radiation therapy. In brachytherapy, the radiation mostly hits the tumor, which helps preserve surrounding healthy tissue. Your doctor may recommend brachytherapy if you have an intermediate-grade tumor. Sometimes, doctors combine internal and external radiation treatments to keep cancer from spreading. When prostate cancer spreads, it’s called metastatic prostate cancer.

There are two types of brachytherapy:

  • Low-dose rate (LDR): Your doctor uses a thin needle to place about 100 radioactive pellets into the prostate near the tumor. The pellets give off low doses of radiation for weeks or months. They remain in place after treatment. You shouldn’t have any discomfort because the seeds are so small.

  • High-dose rate (HDR): With this therapy, your doctor temporarily places pellets that give off high amounts of radiation. You’ll get 1 to 4 treatments over a period of two days. You’ll have a catheter (thin hollow tube to drain urine) while you get the treatment. Because of the catheter and the high radiation, you’ll need to stay in the hospital during treatment and several days afterward. 

External radiation therapy

External radiation therapy uses a machine to deliver strong X-ray beams directly to the tumor. Your doctor may recommend this treatment if you have low- or intermediate-grade cancer. If cancer spreads to the bones (bone metastasis), this treatment can alleviate bone pain.

The most common external radiation therapy for prostate cancer is intensity-modulated radiation therapy (IMRT). The machine shapes the radiation beams to fit the tumor. It then moves around you as it delivers the radiation. Your doctor can adjust the radiation beams’ strength, or intensity, to target more of the cancer.

Focal therapy

Focal therapy uses extreme heat or cold to destroy cancer cells. You may get this treatment if the cancer is only in the prostate gland or the cancer returns after treatment. The different types of focal therapy include high-intensity focused ultrasound (HIFU), cryotherapy, laser ablation and photodynamic therapy.

Prostatectomy

A prostatectomy is surgery to remove the cancerous tumor and prostate gland. You may get this treatment if cancer is only in the gland. Your surgeon may perform the procedure laparoscopically through small incisions in the lower abdomen. Some surgeons use a robotic system to perform this procedure.

Systemic treatments

Systemic therapies circulate in blood to kill cancer cells. These therapies include chemotherapy, immunotherapy, and hormone therapy (also called androgen suppression). Your doctor may recommend one of these treatments if cancer comes back (recurrence) or spreads to other parts of the body.

Targeted therapy

Targeted therapy damages proteins in cancer cells to destroy the cancer with minimal damage to healthy cells. Your doctor may recommend poly ADP-ribose polymerase (PARP) inhibitors for advanced stage 4 prostate cancer. These medications include rucaparib (Rubraca®) and olaparib (Lynparza®).

Clinical trials

Clinical trials provide an opportunity to try therapies still in development. These therapies may focus on new prostate cancer treatments, ways to prevent cancer recurrence and spread, and methods to minimize treatment side effects. You can talk to your doctor to see if there’s a clinical trial right for you.

What’s the outlook for men with prostate cancer?

More than 3 million Americans are living with prostate cancer. It’s estimated that prostate cancer will claim the lives of 1 in 41 men every year. Prostate cancer is second to lung cancer as a leading cause of cancer deaths among American males.

But for most men, prostate cancer is a slowly progressing disease. Even if you are diagnosed, it’s unlikely that you’ll die from prostate cancer.

From the community: “It's overwhelming at first, but things become more clear as you move through the progression we all have. Most importantly is to become educated about the disease so you become a part of the team and make your own decisions as to what to do, when to do it, and why. Gleason Score, is very important, as it will place you in a risk group, which will dictate what treatments are typical under the standard of care for that associated risk group. The biggest thing you'll also see people post about is time, there is time to test, time to get 2nd opinion and more. PCa is not a fast moving cancer! Lastly, I'll try and bring it down a few jotches for you by letting you know first and foremost, that being diagnosed with Prostate Cancer is not a death sentence, not even close. 10 year survival is almost 100% (98%) and 15 year close behind that, for all PCa patients with the exception of a small percentage of patients who have an aggressive type. So take a breath, or two, or three.” – Inspire member

Sources

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.

Read more from Resource Center

What Is Metastatic Prostate Cancer?

Prostate cancer can spread to the bones, lymph nodes, or organs. Metastatic, or stage 4, prostate cancer requires more aggressive treatments.

What Are Prostate Cancer Symptoms and Staging?

Most men with prostate cancer don’t have symptoms. Sometimes, there is blood in urine. Doctors use the Gleason score to stage prostate cancer.

What Is Prostate Cancer and How Is It Diagnosed?

Prostate cancer forms in the prostate gland. It’s a slow-growing cancer that mostly affects older men. Tests can detect the disease early before it spreads.

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