Prostate Cancer Treatment and Support

Prostate cancer treatment is based on your symptoms and personalized to your needs. One or more of the therapies discussed below may be recommended to treat the cancer or help relieve your symptoms. 

Your doctor will discuss the best options to treat your prostate cancer. Several factors will be considered, such as:

• Your age and general health
• Stage and grade of cancer
• Whether or not the cancer has spread
• Your tolerance for possible side effects related to treatment

Treatment Options for Prostate Cancer

Active Surveillance

Active surveillance is an approach that involves closely monitoring the cancer without any active treatments. This is common for older men, men with low-grade tumors and/or men with additional health problems.  Approximately 70% of men can maintain this approach for up to 10 years without requiring additional treatment.

Surgery

The most common surgery for prostate cancer is a radical prostatectomy. This is a removal of:

• The entire prostate gland
• Both seminal vesicles (the glands that make semen fluid)
• Part of the urine tube that passes through the prostate

The two main types of surgery are:

• Open: A large incision is made in the lower abdomen to access the prostate.
• Robot-assisted (laparoscopic): This minimally invasive option involves making several small incisions in the abdomen, then using an endoscope (small camera) and robotic instruments to perform the procedure. This common technique usually results in fewer complications and shorter hospital stays.

Radiation Therapy

Radiation therapy is often recommended as it can be less invasive than surgery. Banner MD Anderson Cancer Center provides some of the most advanced radiation treatments for prostate cancer, including:

• Intensity-modulated radiotherapy (IMRT): External radiation that targets the tumor, avoiding the surrounding healthy organs.
• Low dose rate (LDR) brachytherapy: Tiny radioactive seed-like implants are placed in the prostate where they deliver a lower dose of radiation to the tumor. These implants are permanently left in the body.
• High dose rate (HDR) brachytherapy: Radioactive implants are placed in the prostate and deliver a higher dose of radiation directly to the tumor. These implants are removed after treatment.

Hormone Therapy

Hormone therapy is usually used for advanced, high-grade tumors or for patients with cancer that has spread outside the prostate gland. About one-third of prostate cancer patients will require hormone therapy, also known as androgen deprivation therapy (ADT).

The most common types of hormone therapies for prostate cancer are:

• Anti-androgens: These oral medications block testosterone from interacting with cancer cells. 
• LHRH agonists/antagonists: These drugs affect the pituitary gland’s release of the hormone that controls testosterone production. This can be taken in pill form or injections that last from one to six months. LHRH agonists may cause a spike in your testosterone level before it takes effect. They may also be given temporarily in combination with anti-androgens.
• Orchiectomy: Orchiectomy is the surgical removal of the testicles and is an option if you need testosterone suppression for the rest of your life. Orchiectomies are permanent and irreversible.

Chemotherapy

Chemotherapy is usually reserved for treating prostate cancer that has spread to other organs. The number of chemotherapy treatments you need will vary, depending on the stage of the prostate cancer and how it responds to the treatment.

Theranostics

Theranostics merges diagnostic imaging and radiation therapy. Using PET scan imaging to identify specific biomarkers (or molecular targets) expressed by the tumor, health care providers can pinpoint cancer cells with great accuracy. Providers can then use advanced radiation therapy to directly target the tumor. Through this innovative treatment approach, patients are living longer with reduced side effects.

Learn more about theranostics. 

Additional Therapies for Prostate Cancer

For treatment of the primary prostate tumor:

• Cryotherapy: The tumor is frozen with a long, thin probe inserted into it. In some cases, a focal cryotherapy treatment may be chosen where only the area that contains the most aggressive cancer cells is treated. 
• High-intensity focused ultrasound (HIFU): A non-invasive outpatient procedure, HIFU uses highly focused ultrasound waves to target a single tumor or part of a large tumor in your prostate. The heat of the ultrasound waves kills the targeted cancer cells without harming the surrounding tissue.

For treatment of cancer that has metastasized (spread outside the prostate):

• Targeted therapies: Genetic analysis of the cancer’s DNA may identify specific medications likely to help treat your cancer.
• Radionuclide therapies: Radioactive medications can effectively target and treat prostate cancer cells that have spread to other parts of the body.
• Immunotherapy: Immunotherapy is a treatment that uses the patient's own immune cells to target cancer that has spread. Immune checkpoint inhibitors may be an option for patients that have mutations in their cancer cells.
• Clinical trials: You may qualify for opportunities to participate in select cancer clinical trials, conducted by top research institutions who collaborate with Banner MD Anderson Cancer Centers. If available, your oncologist will share these options with you.

What Are the Side Effects of Prostate Cancer Treatment?

Side effects will vary based on the type of treatment you receive and is mostly related to treatment of the primary tumor. The most common side effects are:

• Urinary incontinence, leakage or painful urination
• Irregular bowel movements
• Erectile dysfunction (also known as ED or inability to maintain an erection) and/or fertility problems

Sex and Fertility After Prostate Cancer

Sex during and after prostate cancer surgery or treatments can be difficult. Erectile dysfunction (ED) may be a problem after prostate cancer treatment and can be temporary or permanent.

Additionally, some prostate cancer treatments involve removal of the seminal vesicles and/or cutting the tube that transports semen. If you want to have children in the future, talk to your doctor about banking your sperm before your treatment.

If you have more questions about your sexual health during and after cancer treatment, talk to your provider or contact our sexual wellness clinic.

Prostate Cancer Treatment Support

Undergoing cancer treatment is not easy. Banner MD Anderson offers integrative oncology and psycho-oncology to help you, your caregivers and loved ones manage the emotional effects of diagnosis and treatment.

Your provider can share available options for supportive care during and after your prostate cancer treatment. 

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