Early-stage prostate cancer grows very slowly. It may take years before it causes any health problems, if at all.
Doctors can watch the cancer with PSA blood tests and a digital rectal exam every 3-6 months. They may also use a procedure called a prostate biopsy to see if the cancer is growing.
Radiation Therapy
In early stages, radiation is often used alone or with hormone therapy to treat cancer that has grown only inside the prostate. It can also be used to destroy cancer cells that have spread outside the prostate gland. Radiation treatments may cause side effects, such as a stronger urge to urinate; problems with erectile function; and rectal pain or bleeding. These side effects usually go away after treatment is over.
The type of radiation you receive depends on your risk group. A very low risk group has cancer that is small and only in the prostate. A lower risk group has cancer that is slightly larger but has not grown outside the prostate. An intermediate risk group has cancer that doctors can feel or see with an exam and covers more than half of one or both sides of the prostate. A high-risk group has cancer that has grown outside the prostate and into nearby tissues.
Doctors recommend surgery or radiation as the standard types of treatment for men in these groups. They might also recommend watchful waiting if the cancer is growing slowly and hasn’t caused symptoms or other health problems. Watchful waiting means you don’t get treatment, but it also means your doctor will closely monitor your condition. Your doctor may recommend PSA tests, digital rectal examination (DRE), or biopsies to check for the presence of cancer.
If you have low-risk or intermediate-risk prostate cancer, you can get external beam radiation treatment with a linear accelerator or brachytherapy. With brachytherapy, your doctor inserts small radioactive sources into the prostate. These seeds are about the size of grains of rice and give off radiation that targets the prostate. They stay in the prostate for a few weeks or months, depending on your treatment plan. Doctors can use a newer technique called focal therapy. With this treatment, doctors direct heat or cold at areas of the prostate that contain cancer cells to destroy them.
Another way to target prostate cancer cells is with a drug called radium-223 (Xofigo). This is a form of radiation that goes directly to the bone where tumors are growing. It is used to treat castration-resistant prostate cancer that has spread to the bones.
Surgery
Prostate cancers that don’t grow or spread outside the prostate can be treated with surgery. Doctors remove the prostate gland, or sometimes just some tissue around it. This treatment can cure the cancer. It can also relieve symptoms, like urinating often or feeling the need to urinate even when your bladder is empty. But it can’t stop cancer from coming back later. About 13 out of 100 American men will get prostate cancer at some point. And about two of them will die from it, according to the Centers for Disease Control and Prevention. Most of those men will have a very low-risk tumor that is small and only in the prostate, or hasn’t grown into other areas. These men might choose to monitor the cancer with PSA tests and rectal exams, or imaging tests every few months. This is called active surveillance.
Radiation therapy is also an option for men with early-stage prostate cancer. It can destroy cancer cells in the prostate, and can be used alone or with hormone therapy. Doctors may recommend external radiation, with a machine that focuses beams on the prostate, or internal radiation, using a catheter to deliver radiation directly into the prostate. They may also recommend brachytherapy, where they place tiny radioactive pellets inside the prostate.
Hormone therapy can reduce the risk of the cancer returning, and it may help relieve urinary or sexual problems that can occur with surgery or radiation. Some doctors suggest hormone therapy instead of surgery or radiation for people with lower-risk cancers. But other doctors might consider it for men with advanced cancers or recurrent (growing) prostate cancer.
When deciding on the best treatment for you, talk with your doctor about the goals of each option. Then discuss the possible urinary, bowel, sexual, and hormone-related side effects of each one. This type of talk with your doctor is called shared decision-making.
If you and your doctor decide on watchful waiting or hormonal therapy, he’ll check your progress regularly with PSA blood tests and a digital rectal exam, or a biopsy of the prostate to make sure the cancer isn’t growing fast and hasn’t spread. If he believes you are at higher risk of having a recurrence, he might recommend treatment right away, or switch to an active surveillance plan.
Hormone Therapy
If the cancer is in early stages and hasn’t spread beyond the prostate, your doctor may recommend monitoring your condition instead of treatment. This is called active surveillance and involves getting regular screenings and scans. If your cancer does start to grow, or if it starts causing symptoms, you and your doctor will discuss treatment options.
For localized prostate cancer in stage I or II, doctors usually offer radiation therapy (external-beam or brachytherapy) and surgery as standard treatments. They will consider your age, health and other factors to decide the best treatment for you.
Hormones like testosterone can make prostate cancer cells grow, so doctors use hormone therapy to stop these hormones from helping the cancer cells. You may get hormone therapy alone or with other treatment for prostate cancer. Hormone therapy is also used to prevent the cancer from coming back after you have had surgery or radiation. It is also sometimes used to treat cancer that has already spread to other parts of the body, but it’s less likely to work for advanced or recurrent cancer.
Radiation therapy kills cancer cells with high-energy X-rays or other types of radiation, but it can damage healthy tissue and cause side effects such as incontinence and erectile problems. Doctors can use newer methods of radiation to better protect surrounding tissue, such as using protons instead of X-rays. Brachytherapy delivers the radiation through pellets that your doctor places inside your prostate, but it may not be available at all medical centers.
Some patients with prostate cancer that has spread to other areas of the body benefit from treatment that stops the production of testosterone. This is known as castration-sensitive prostate cancer, and it can be treated with drugs that suppress the hormone or with surgery.
Many men with prostate cancer have problems after treatment, including incontinence, erectile dysfunction and bowel issues. Palliative care helps manage these and other side effects. It includes medical, emotional and social support. Doctors also can give you medications to ease symptoms. For example, they might prescribe medications to help with blood in your urine or to reduce bladder inflammation. They can also give you medicines that ease pain and bloating.
Other Treatments
If the cancer hasn’t spread beyond your prostate when you have it diagnosed, doctors may suggest watchful waiting. You’ll have PSA blood tests and rectal exams every 3-6 months, and your doctor will biopsy a sample of your prostate tissue to check for cancer cells. You’ll also take hormone medications to prevent cancer cells from growing. You can switch to active surveillance if you have a shorter life expectancy or your cancer grows quickly.
Most prostate cancers grow slowly and don’t spread. But if the cancer does spread, it’s more likely to cause symptoms, like a leaky bladder or the need to pee a lot. Your doctor can give you other treatments to relieve these symptoms and slow the growth of any remaining cancer cells.
These include surgery, radiation therapy, and medication. You might also try a new treatment called targeted therapy or immunotherapy. These therapies work with your immune system to kill prostate cancer cells and stop them from multiplying. They might be given with other treatments, or alone.
Prostate cancer cells need male sex hormones to grow, and this treatment stops them from getting these hormones. Your doctor might call it androgen deprivation therapy or androgen synthesis inhibitors. You can take this treatment by mouth or through an IV.
Another way to treat advanced prostate cancer is with chemo. Chemo drugs travel through your body and kill fast-growing cancer cells, including prostate cancer cells. You might get it alone or with other treatments, or if you’ve already received radiation and hormonal therapy.
Minimally invasive procedures for localized prostate cancer include laser surgery (laser focal therapy, TULSA-Pro, and cryotherapy), and radioactive seed implants (brachytherapy). These use irradiated seeds, which are smaller than other forms of radiation, to deliver high doses of radiation near the tumor site.
There are a few supplements and herbs that might help with prostate cancer or its symptoms, but more research is needed. Speak to your health care provider before taking any supplements or herbs, and always let your doctor know what you’re taking. Some herbs might interact with certain treatments, so your doctor will need to monitor you carefully.
