Prostate Cancer Treatment

Prostate cancer treatment is continuously being researched. Currently, there are several standard treatment options available, as well as new approaches that are currently being studied in clinical trials.

In this article, we’ll guide you through the different treatment options for prostate cancer, as well as their possible side effects, the differences between certain treatment options, and some recommended lifestyle changes during prostate cancer treatment.

What are the different treatment options for prostate cancer?

Prostate cancer treatment can consist of a single therapy or a combination of therapies. Treatment options can vary from person to person and are aimed at either curing the condition or treating symptoms.

Usually, a multidisciplinary approach is needed for the treatment of prostate cancer. This means that doctors, nurses, physiotherapists, and counselors from different medical disciplines work together and determine the most appropriate approach in a so-called tumor conference. There are many treatment options for prostate cancer:

• Watchful waiting
• Active surveillance
• Prostate surgery
• Radiation therapy
• Hormone therapy
• Chemotherapy
• Targeted therapy.

Active surveillance

Active surveillance is a strategy to monitor prostate cancer that is considered non-aggressive and is likely to grow slowly. As soon as growth accelerates, potential curative treatments are determined. This approach is an option if the tumor is small, limited to the prostate, and does not cause any symptoms.

These are the essential aspects of active surveillance:

• Regular testing and monitoring: Patients will undergo regular PSA tests (PSA = prostate-specific antigen), rectal examinations as well as biopsies. The goal is to detect signs of growth or any changes to the tumor as early as possible.
• Decision to treat: Once there are signs that the cancer is growing or becoming more aggressive, doctors can recommend active curative treatment. Treatment is commenced based on test results as well as the patient’s personal preferences.
• Patient consultation: Patients who opt for active surveillance need to work closely with the medical team and undergo regular screenings. This approach requires good communication and understanding of potential risks and benefits.

Watchful waiting

Watchful waiting is another strategy for monitoring prostate cancer. However, there are certain differences compared to active surveillance. The latter intends to monitor the cancer’s progress in order to start curative treatment as soon as possible. Watchful waiting on the other hand is a less intense way of monitoring the tumor. It is usually chosen for people who would like to avoid aggressive cancer treatments due to their age or other medical complications. The option to treat only becomes relevant, once the cancer causes noticeable problems. It is essentially a palliative treatment strategy, aimed at easing the symptoms of the condition.

These are the essential aspects of watchful waiting:

• Target group: Watchful waiting is usually recommended for older patients or people who have short life expectancy due to other medical conditions; in these cases, the risks of aggressive cancer treatment might outweigh the potential benefits.
• Monitoring: Monitoring of the cancer’s progress is done less frequently and less aggressively compared to an active surveillance approach. While there might be regular PSA tests there usually are no repeated biopsies.
• Reacting to symptoms: Unlike active surveillance – where treatment may be initiated once the tumor shows signs of growth – watchful waiting aims to treat symptoms once they occur and have an impact on the patient’s quality of life. Treatment generally is palliative instead of curative.
• Decision-making: Whether watchful waiting is an adequate treatment strategy usually depends on the patient’s quality of life, their life expectancy as well as their personal preferences. The goal of this approach is to make the remaining lifespan as comfortable as possible while avoiding the side effects of more aggressive treatment options.

Prostate surgery

Prostate cancer surgery to remove the tumor may be done if the cancer has not spread to surrounding tissues. This surgery is called radical prostatectomy and involves removing the prostate gland, the seminal vesicles, and surrounding tissues. The nearby lymph nodes are also removed in some cases. There are different types of surgeries that your medical team will give you further information on when appropriate.

Radiation therapy

Radiation therapy for prostate cancer usually refers to one of two main treatment approaches: percutaneous irradiation or brachytherapy. Both approaches come with their own advantages and disadvantages based on the patient’s personal situation.

Percutaneous irradiation, also known as external radiation therapy, includes treating the prostate from the outside with high-energy radiation. Brachytherapy, also known as internal radiation therapy, on the other hand, involves insertion of radioactive material into the prostate.

Hormone therapy

Hormone treatment for prostate cancer targets male sex hormones (also called androgens). This treatment prevents the prostate cancer cells from growing. This is also referred to as androgen deprivation therapy.

Chemotherapy or targeted therapy

With chemotherapy and targeted therapy, drugs are administered orally or via infusion. These drugs target cancer cells and kill them and prevent them from growing.

Prostate cancer treatments in clinical trials

Prostate cancer can also be treated with newer treatments that are undergoing clinical trials. These include:

• Cryosurgery – this kills cancer cells by freezing them.
• High-intensity-focused ultrasound therapy – this kills cancer cells using ultrasound.
• Proton beam radiation therapy – this destroys cancer cells using protons.
• Photodynamic therapy – this uses a drug combined with a laser to target and destroy cancer cells.

How does the stage of prostate cancer affect treatment?

Once prostate cancer has been diagnosed, the stage and grade of the cancer will also be determined. Type, size, and spread of the tumor determine what the most appropriate treatment option may be. There are 4 different stages of prostate cancer:

• Stage 1: the cancer is not palpable and only found in the prostate itself
• Stage 2: the cancer is palpable but is still only present in the prostate itself
• Stage 3: the cancer has advanced more and spread to nearby organs
• Stage 4: the cancer has also spread to the lymph nodes or to other parts of the body

Knowing the stage is important for prostate cancer prognosis and finding the appropriate treatment strategy.

Grading with the Gleason Score

The so-called Gleason score is a method to determine the aggressiveness of prostate cancer. Samples from the prostate are examined under a microscope in order to measure how much the cancer cells deviate from healthy prostate cells

The cells are then graded on a scale from 1 to 5:

Grade 1: Cancer cells are very similar to healthy prostate cells and are growing slowly.

Grade 5: Cancer cells differ very significantly from healthy cells and are likely to grow rapidly.

Calculating the Gleason score

Pathologists determine the two most common cell patterns in a sample. The Gleason score is the sum of the point value of these two most common patterns.

Gleason score of 6 or lower (e.g. 3+3): The tumor is considered to be not very aggressive.

Gleason Score of 7 (e.g. 3+4): This value can be interpreted in different ways. For example, 3+4=7 means that the majority of cells appear to be somewhat abnormal; however, a score of 4+3=7 indicates a larger quantity of more aggressive cells.

Gleason score 8-10 (e.g. 4+4 or 5+3): The cancer is likely to be aggressive and spread rapidly.

Why the Gleason score is important

The Gleason score is an important tool for doctors to determine the appropriate treatment strategy. A low Gleason score might indicate that monitoring might be a sufficient treatment approach for the time being, while a higher Gleason score might call for more active methods such as surgery or radiation therapy.

With the help of the Gleason score, doctors can gauge the adequate intensity of the cancer treatment in order to increase the likelihood of curing or controlling the cancer.

What kind of side effects can occur during prostate cancer treatment?

The side effects of prostate cancer treatment depend on which therapy you’ve had. The most common side effects of prostate cancer surgery and radiation therapy include impotence and incontinence.

Radiation therapy can also cause cancers in organs situated nearby, such as the bladder or the intestines.

Hormone therapy for prostate cancer can also cause some side effects, including:

• Hot flashes
• Erectile dysfunction
• Low libido
• Loss of muscle
• Bone loss
• Weight gain

What is the difference between radiation therapy and chemotherapy for prostate cancer?

Both radiation therapy and chemotherapy aim at cancer cells in order to kill them and to cure cancer, or prevent them from growing and getting worse.

Usually, prostate cancer is treated through a combination of multiple approaches. Which strategy may be most appropriate is determined by the treating medical team and the patient.

Radiation treatment for prostate cancer targets the cancer cells using radiation, while chemotherapy targets the same cells using drugs that can be administered via the mouth or an injection.

How does hormone therapy work in treating prostate cancer?

Hormone treatment for prostate cancer affects male sex hormones. Male sex hormones, such as testosterone and dihydrotestosterone are necessary for cell growth in the prostate, but can also cause cancer cells to grow, especially in the early stages of prostate cancer. By blocking these hormones using medication the growth of prostate cancers can be reduced.

How is the decision made between active surveillance and aggressive treatment?

The decision between active surveillance and aggressive treatment is made based on a number of criteria such as age, the stage of the cancer, the symptoms present as well as the personal wishes of the patient.

For older people that have a slow-growing prostate tumor which doesn’t cause any symptoms, an active surveillance approach is often recommended. During this time, the PSA-levels are regularly checked and the prostate regularly punctured to notice any changes swiftly. This way, therapy can be initiated as soon as possible if, for example, the Gleason score changes.

What lifestyle changes are recommended during prostate cancer treatment?

There are certain lifestyle changes that can be modified in order to improve the outcome of prostate cancer:

• Maintain a healthy, balanced diet high in fiber, low-saturated fat and a variety of fruit and vegetables.
• Avoid tobacco consumption
• Exercise regularly
• Reduce stress and increase psychological well being