Treatment for prostate cancer

Key takeaways:

• Treatments for prostate cancer include surgery (prostatectomy), radiation therapy, chemotherapy, and immunotherapy.
• There is no "one standard" treatment that would work for everybody, and treatment plans for prostate cancer would depend on different factors such as age, underlying medical conditions, how far the cancer has spread, and organs that have been affected.
• If you have received a diagnosis of prostate cancer, it is always best to work hand-in-hand with your healthcare team and be part of your treatment decision-making to ensure you get the best treatment tailored to your body's health needs.

Prostate cancer is one of the most common cancers affecting Black males. It is a cancer of the prostate gland and occurs when cells in the prostate start dividing abnormally. Prostate cancer also affects older adults more.

There are different treatment options for prostate cancer. But, doctors recommend treatment for each individual based on factors like age, stage of cancer, organs affected, and side effects of the treatment.

Treatments for prostate cancer include:

1. Surgery (Prostatectomy)

Prostatectomy is a type of surgery commonly used to treat prostate cancer. It is a surgery used to treat some conditions affecting the prostate. In a prostatectomy, some parts or all of the prostate are removed.

There are different types of prostatectomy, including:

Radical Prostatectomy/ Surgery

This surgery is done when cancer has not spread to other organs. Radical prostatectomy involves completely removing prostate glands, cancer cells, and sometimes the seminal vesicles. It is done by making an incision on the body to gain access to the prostate. There are various types of radical prostatectomy, differentiated by the type of incision:

• Perineal prostatectomy/surgery: In this type of prostatectomy, the surgeon will locate the region between the anus and testicles and make an incision. They remove the prostate through the incision, and sometimes, they may also make a different incision in the abdominal wall and remove the nearby lymph nodes.
• Retropubic prostatectomy/Surgery: In this type of radical prostatectomy, the surgeon will make an incision in the abdominal wall. They will remove the prostate and sometimes nearby lymph nodes through the incision.
• Laparoscopic prostatectomy/Surgery: This type of prostatectomy requires up to 6 incisions. The surgeon will make up to 5 incisions in the abdomen and remove the prostate through the incisions. Surgeons often use a camera and lighted tube for guidance as they make the incision.

Open (simple) prostatectomy

In an open prostatectomy, doctors do not remove the whole prostate gland; rather, they remove the affected parts. Aside from treating prostate cancer, this type of surgery is also used to treat an enlarged prostate.

2. Radiation therapy

Radiation therapy, also known as radiotherapy, is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink cancer tumors. Radiation kills cancer cells, especially at high doses, by destroying the DNA of those cancer cells.

Once a cell's DNA is destroyed or damaged, it stops dividing and dies. Radiation treatment does not kill the cells immediately; it may take weeks or months before they begin to die off. The cells will also keep dying even when the therapy ends.

Radiation therapy is of two types, and the type to be used for treatment depends on so many factors, like the size of the tumor, the type of cancer (in this case, prostate cancer), the closeness of the prostate tumor to nearby organs, the patient's medical history, the general state of their health, and age.

External and internal beam radiation therapy are the two types of radiation therapy.

External beam radiation therapy

This type of radiation, also called teletherapy, is done outside the body. It is a local type of treatment, making it more common than internal radiation. It is done with a machine that is situated outside the body.

The machine will send radiation to the cancer cells in your body and only target the part of your body where the cancer is located—in this case, the prostate gland. The machine for this treatment is often big and noisy, although it does not touch patients' bodies.

Internal beam radiation therapy

As the name implies, the treatment (source of radiation) is done inside the body. This radiation therapy can be of two types, solid source (or brachytherapy) and liquid source (systemic therapy).

Brachytherapy is a local treatment that targets the part of your body where the cancer cells have affected. In the treatment with a solid source (brachytherapy), the doctor will place seeds, ribbons, or capsules that have a radiation source inside the patient's body. The seeds, ribbons, or capsules will keep giving off radiation that will kill the cancer cells.

The liquid source, or systemic therapy, is done through swallowing or injection. The treatment will travel in the blood to tissues all over a patient's body, locating and killing cancer cells.

3. Medications

Medications are also used to treat prostate cancer. Medications for treating prostate cancer come in different forms and have different mechanisms of action. For instance, they can be used as part of chemotherapy (e.g., docetaxel), immunotherapy (e.g., sipuleucel-T), or hormonal therapy (e.g., leuprolide and degarelix). No one medication will work for everyone, and for that reason, oncologists prescribe medications that will best target each person's health needs.

Before prescribing any medication, doctors will often consider many things, including your cancer stage, age, overall health status, other medications you are taking, and any underlying medical condition.

4. Chemotherapy

Chemotherapy is often used when prostate cancer has spread to nearby organs and tissues in the body. Chemotherapy uses drugs to shrink and kill cancer cells and is especially used for treating prostate cancer in the advanced stage (stage 4). The drugs are administered as pills, through a vein, or sometimes both.

Chemotherapy drugs for treating prostate cancer include:

• Estramustine (Emcyt)
• Cabazitaxel (Jevtana)
• Docetaxel (Taxotere)
• Mitoxantrone (Novantrone)

5. Immunotherapy

Cancer cells have ways of hiding to evade the immune system, but a strong immune system is more capable of fighting cancer than a weak one. Immunotherapy is a prostate cancer treatment option that uses medications to help the immune system fight off malignant cells.

Unlike surgery and radiotherapy, which aim to kill cancer cells, immunotherapy trains and prepares the immune system to fight cancer. The approved immunotherapies for treatment are cancer vaccines and checkpoint inhibitors. Sipuleucel-T (Provenge) is an example of an approved vaccine for prostate cancer. Pembrolizumab (Keytruda) and dostarlimab (Jemperli) are both examples of checkpoint inhibitors.

6. Hormonal therapy

Hormone therapy is aimed at stopping or reducing the production of male sex hormones (androgens), of which the primary one is testosterone. This is because androgens help cancer cells grow. So, using hormone therapy, medical professionals aim at reducing androgen levels or blocking their actions. This type of prostate treatment can inhibit the growth of the cancer cells, causing them to die off or begin to grow slowly.

Hormone therapy is often used when prostate cancer is in the advanced stage. There are different hormone therapy options for treating prostate cancer, such as:

• Luteinizing hormone-releasing hormone agonists: These are medications that will stop the body from producing testosterone, and they include triptorelin (Trelstar), leuprolide (Lupron), histrelin (Vantas) and goserelin (Zoladex).
• Testosterone blockers: These are known as anti-androgens or androgen receptor antagonists. They prevent or block testosterone from acting on the cancer cells. Examples of drugs that act as testosterone blockers are Bicalutamide (Casodex), Flutamide (Eulexin), and Nilutamide (Nilandron).
• Orchiectomy- A type of surgery done to remove the testicles. Removal of the testicles significantly reduces testosterone levels.

Things to consider when making prostate cancer treatment decisions

There are different options for treating prostate cancer. But, there are things to consider before deciding on a prostate cancer treatment, such as:

• Age and expected lifespan: Age is one major factor that can influence a person's prostate cancer treatment. Some treatments that might benefit older patients 70 years and above may not be the best treatment approach for younger people.
• Stage and grade of cancer: Cancers sometimes grow slowly, and the stage and grade of prostate cancer may influence the treatment approach that will be used. The treatment used for early-stage cancer may differ from that used for advanced, highly metastatic cancer.
• The severity of cancer symptoms: If a person's cancer symptoms are severe, the treatment may be more advanced or aggressive and may involve other therapies to help relieve the symptoms.
• Organs affected: Before making a prostate cancer treatment decision, doctors often run different tests to check how far the cancer has spread and if nearby organs have been affected. Treatment may involve removing a nearby organ, treating organ damage, or preventing the spread of cancer to a nearby organ.
• Other underlying health conditions; The treatment approach for a person with other underlying medical condition(s) may not be the same for someone with no other diagnosed medical condition. In the case of the former, the healthcare team may have to recommend a treatment option that does not affect the treatment the patient is already receiving.
• Possible side effects: Most prostate cancer treatments are not without side effects. Some examples of such treatment side effects include erectile dysfunction and urinary incontinence. It will be best to discuss what to expect with your treatment, including possible side effects, with your oncologist before the treatment starts.
• Your opinion and that of your healthcare team: Having an open discussion with your healthcare team before receiving treatment for prostate cancer is often helpful, as it gives them the room to tell you all you need to know about prostate cancer and to suggest the treatment approach they believe best for you. You have a say regarding your treatment; however, you have better chances of coming up with the best decision when you listen to your healthcare team and work hand-in-hand with them.

Who treats prostate cancer?

Even though there are key experts involved in every medical treatment, medical practitioners often work as a team to treat medical conditions like prostate cancer. Three main types of healthcare practitioners are involved in the treatment of prostate cancer:

Medical oncologist

Medical oncologists are medical specialists that treat prostate cancer using therapies like hormone therapy and chemotherapy. They also handle any other issues that may arise with cancer.

Urologists

Urologists are medical specialists that treat disorders that affect the male reproductive system and also handle problems of the kidneys, ureters, bladder, and urethra (i.e., the urinary tract)

Radiation oncologists

These are medical specialists that use radiation therapy to treat cancer. During treatment, they will deliver the treatment plan, treat any side effects that may arise, and monitor the patients as they go through the treatment.

Getting help through your cancer treatment

Receiving a prostate cancer diagnosis can weigh down on a person. It can be a challenging period in a person's life, and one could need as much support as possible. If your loved one has received a prostate cancer diagnosis, reach out to them and offer them support. Show them you care. Be sensitive to their emotional needs and speak to them with empathy.

If you have been diagnosed with prostate cancer, understand that there are different treatment methods that are very helpful and can even lead to complete remission. Also, a diagnosis does not mean a person is on the verge of death. More than 90% of people with prostate cancer live for up to 5 years after diagnosis - many live much longer.

In the meantime, connect with your loved ones and allow them to support you. Make choices to stay healthy. Eat foods that will help boost your immune system, such as fruits and vegetables, and always keep in touch with your medical team. Joining a support program or group such as Road to Recovery may also help you during your treatment and recovery period.

Wrap up

Different treatment options for prostate cancer include medications, surgeries, radiation therapies, and chemotherapies. Treatments will not be the same for everyone, as there are different things to consider before making a treatment decision for prostate cancer.

It is always helpful when patients discuss their care with their medical team and make decisions together. This will help clear patients' doubts, answer their questions, and give them a general overview of what to expect during their treatment.