Prostate Cancer Treatment Options

With early diagnosis, when the cancer is confined to the prostate itself, men usually have a range of treatment options. Sometimes, if the cancer is slow-growing, this includes postponing treatment entirely. Only a patient and his or her physician can determine which treatments are most appropriate.

This decision depends on a combination of factors:

  • The type of cancer and stage at which the disease is diagnosed
  • The patient’s age and general health
  • The patient’s personal preferences

MarinHealth Oncologists and Urologists will consult with you to help you make the decision that’s best for you.

Active Surveillance

Prostate cancer is typically slow growing. If the cancer is low risk and not likely to spread, our specialists may recommend delaying treatment. Active surveillance, also known as watchful waiting, is not right for everyone, and we have established protocols to determine when it should be used. Active surveillance is a collaborative program that includes regular physician follow-up, and the services of our Integrative Wellness Center, including nutrition, exercise, and more. If there are no worrisome changes, active surveillance can continue indefinitely, with a check-in every six months. More than 50 percent of our patients on active surveillance are still being watched five years later without additional need for treatment.

Radiation Therapy

Radiation therapy works by damaging the DNA within cancer cells and destroying their ability to reproduce. Cancer cells are more vulnerable to radiation therapy than healthy cells because of their constant growth and limited ability to repair radiation damage.

There are three methods of radiation therapy used to treat prostate cancer:

  • External beam radiation therapy targets a tumor with high-energy beams.
  • Brachytherapy is a form of internal radiation therapy in which “seeds” of radioactive material are placed inside the body, in and around the tumor. Brachytherapy delivers a high dose of radiation directly to the tumor while minimizing radiation to the surrounding tissue. Excellent long-term results are comparable to surgery, with a very low risk of incontinence.
  • Where appropriate, external beam radiation therapy and brachytherapy may be combined to attack cancer cells with a double punch.

Hormone Therapy

The male hormone testosterone fuels the growth of prostate cancer cells. Hormone therapy works by cutting off the body’s supply of testosterone.

Two different types of drugs may be used:

  • LHRH agonists and antagonists interrupt signals to the pituitary gland in the brain, thus causing the testicles to stop producing testosterone.
  • Antiandrogens block the action of testosterone on normal and prostate cancer cells.

Hormone therapy is generally only used for advanced or recurrent prostate cancer. It may be used for a variety of treatments:

  • For metastatic prostate cancer—prostate cancer that has spread outside of the prostate gland
  • In combination with radiation therapy for aggressive (high-risk) forms of prostate cancer
  • To keep the prostate cancer under control when radiation and/or surgical treatments have failed
  • For newly diagnosed older patients who are not candidates for, or choose not to have, surgery or radiation therapy
  • To shrink the size of the prostate gland prior to brachytherapy treatment

Surgery

Radical prostatectomy is a surgical procedure that includes removal of the entire prostate gland, the attached seminal vesicles, and adjacent lymph nodes. The bladder and urethra are then reattached and a catheter is left in place to drain urine while healing takes place.

Traditionally, this surgery has been performed through a large open incision. However, Surgeons at MarinHealth Medical Center can operate robotically using the da Vinci® SI Surgical System. This advanced technology enables us to achieve excellent cancer outcomes while maximizing continence and sexual function.

Because robotic surgery is minimally invasive, it has some important advantages over open surgery, including:

  • Less blood loss
  • Fewer complications
  • Shorter hospital stays
  • Minimal scarring
  • Faster recovery for patients

Our surgeons use various techniques, including athermal nerve-sparing, bladder neck preservation, musculofascial reconstruction, and extended pelvic lymph node dissections to remove all stages of prostate cancer with as minimal impact to quality of life as possible.

Surgeries typically take three hours, and most patients are discharged the day after surgery with very little pain.

Chemotherapy

The use of medication to interfere with the growth and replication of cancer cells is called chemotherapy. It is typically administered intravenously or orally. Chemotherapy has evolved since it was first introduced, and we can now better control nausea and other side effects.