The prostate is a small gland that sits under a male's bladder and supplies important substances to aid in reproduction. Cancer of the prostate is common, affecting 1 in 6 men, according to the Prostate Cancer Foundation. Many treatment options exist for prostate cancer, which should be discussed with a radiation oncologist, urologist, and medical oncologist for the best course of therapy.
Active Surveillance
Also referred to as "watchful waiting," active surveillance is the monitoring of prostate cancer without the use of any therapies. Active surveillance is generally reserved for individuals in the early stages of prostate cancer, but other factors like comorbidities (one or more diseases in addition to the primary disease) play a role in choosing to forgo treatment. In active surveillance, close monitoring of the prostate with PSA blood tests, digital rectal exams, and repeated biopsies is adhered to, in order to detect further progression of the cancer. Along with personal factors such as life expectancy, individuals with low grade and early stage prostate cancer are the primary candidates for active surveillance.
Radiation Therapy
Radiation therapy is the use of high-powered energy beams to kill the tumor cells of the prostate. Several versions of radiation therapy exist including external beam, proton, and brachytherapy. External beam radiation therapy is the most common, which involves the use of computers to map and directly target the beam to the tumor while limiting surrounding tissue damage. Brachytherapy involves the injection of small metal pellets to deliver radioactive iodine or palladium to the prostate to kill the tumor cells. Proton therapy allows for the most precision in killing tumor cells, but the machines are very expensive and not all institutions have them.
Surgery
The surgical procedure to remove all or part of the prostate is referred to as a prostatectomy. The most common type is a radial retropubic prostatectomy in which the entire prostate and tumor is removed from behind the pubic bone through incisions in the abdomen. Several surgical techniques are used to ensure safety, quick recovery, and preservation of erectile function. Nerve-sparing is a technique employed to limit the destruction of surrounding nerves to limit the damage to erectile function, and laparoscopic techniques use multiple small incisions and specialized machinery to remove the prostate with increased safety and reduced recover time.
Hormone Therapy
The main fuel for the growth of prostate tumor cells is the natural hormone testosterone. Hormone therapy, also called androgen-deprivation therapy (ADT), is used to stop the release of testosterone, or prevent its action on cells. A surgical ADT therapy option is an orchiectomy, which is the removal of the testes, which produce approximately 90 percent of testosterone. Pharmaceutical approaches include the use of LHRH (GnRH) agonists or anti-androgens, which are injected to stop the release of testosterone, or to block its actions on prostate tumor cells, respectively.
Chemotherapy
Chemotherapy is the use of chemicals to kill or prevent the growth or division of cancer cells. Few chemotherapy medications are approved by the FDA for prostate cancer, and until recently, chemotherapy had only been aimed at symptom relief in advanced or metastatic prostate cancer. However, ongoing research is being conducted for the use of chemotherapy to prolong life in individuals no longer responding to other therapies, according to the Prostate Cancer Foundation.
