How is early-stage prostate cancer treated?

After reading this article, you will know

• what early-stage prostate cancer is
• who is eligible for active surveillance
• when surgery or radiation therapy is helpful
• if it’s possible to cure prostate cancer
• what side effects can occur

Early-stage prostate cancer can go into remission with the right treatments. These prostate cancer treatments work best if the cancer is still contained within the prostate. Together, you and your treatment team will choose the right course of action for you.

What is early-stage prostate cancer?

The prostate is a gland surrounded by a solid layer of connective tissue. This layer also serves as a marker to determine how far the disease has spread. In the early stages of prostate cancer, the cancer cells are confined to the main body of the prostate. The tumor is said to be localized.

Your treatment team will also check how fast the tumor grows. The following tests will help them with this:

• The PSA test measures the level of a protein molecule that is released into the blood by the prostate. A high PSA level can indicate prostate cancer, but other factors, such as inflammation or infection, can also cause it.
• The Gleason score is another way to measure how aggressive your tumor is. Your treatment will take a small piece of your tumor and look at it under a microscope. They will compare how the tumor cells look when compared to normal prostate cells. The greater the difference, the higher the Gleason score. A Gleason score of 6 means your tumor will grow very slowly. A higher score means your tumor is more likely to grow faster and spread.

Note:

Please keep in mind that statistics on survival rates and chances of recovery are only presented to provide you with a general idea of current findings. They do not apply to your specific situation. Always talk to your treatment team about the stage of your disease and your personal prognosis. This is the only way you can get information that is specific to your situation.

How and when is early prostate cancer treated?

Your treatment team will talk to you about the best way and time to treat you. You have three general options to pick from:

Option 1: Close monitoring of early prostate cancer – active surveillance

This means you have to go for checkups regularly. At first, you may have a PSA test approximately every three months and potentially a biopsy every 12 or 18 months. The checkups may be less often if the tumor doesn’t grow for two to three years. But if the cancer grows fast or the PSA level increases quickly, your treatment team will suggest prostate cancer treatment. During active surveillance, the cancer is not treated right away. This can be stressful for some people.

Waiting may be the best choice if the tumor is likely to grow very slowly and has a low chance of spreading. In these cases, treating the early cancer might do more harm than good. Active surveillance is possible if:

• the PSA level is less than 10 ng/ml
• the Gleason score is not greater than 6
• the tumor is still small and is limited to less than half of a prostatic lobe

Option 2: Curative therapies – surgery and radiation therapy

Surgery and radiation therapy have proven to be effective treatments for early prostate cancer. The goal is to cure the disease. They are useful when:

• (further) waiting would allow cancer to get worse
• your general physical condition is good
• you want the treatment

You and your treatment team will choose the best treatment for your situation. They will weigh the benefits and risks of each treatment and help you pick the best one.

Surgery

Surgery is when your treatment team tries to physically remove all the cancer cells from your body. This is called a prostatectomy. You will be under anesthesia during the surgery, and you may stay in the hospital for a few days. Your treatment team uses different surgical methods depending on the location and size of the tumor.

Surgery can help you get better. It can put cancer in remission for a long time and cure about 7 out of 10 people who have it. But surgery is not easy and can cause some side effects later. You might have trouble holding your urine or getting an erection.

Radiation therapy

Radiation therapy uses high-energy radiation to damage cancer cells and cause them to die. There are two types of radiation therapy, internal and external:

External beam radiation therapy (percutaneous radiation therapy)

This uses a machine outside your body to send high-energy rays to your prostate. The rays kill cancer cells and stop them from spreading. The device aims the rays carefully so they minimize the harm to healthy cells. You will need to have this treatment several times a week for many weeks.

External beam radiation therapy can work as well as surgery to eliminate cancer. It can cure about 7 out of 10 people, and most others live for at least five years or longer.

But this treatment can also cause some side effects. Right after the treatment, you may have digestive and bladder issues. Later on, you may have trouble getting an erection. You can also experience issues holding urine, or you might experience inflammation in your digestive system.

Internal radiation therapy (brachytherapy)

This treatment uses a small source of radiation inside your prostate. The source is a tiny capsule or pin that affects only a small area of tissue in your prostate. Your treatment team places the capsules in the tumor with thin needles. If your tumor has a low chance of spreading, they use capsules that last longer. The radiation goes away completely after a few weeks, but the capsules stay in your body.

This treatment can work as well as external beam radiation or surgery for low-risk tumors. This means your chances of getting better or living longer are very good.

The side effects are also similar but less common than external beam radiation. You may have issues with your digestive system and bladder. Later on, you may have trouble getting an erection and holding your urine. Also, your urethra may get narrower due to swelling.

Combined internal & external radiation therapy

This is used if your tumor has a medium or high chance of spreading. In this case, you may receive combined internal and external radiation therapy. This means putting radioactive sources inside your prostate for a short time. They provide a high dose of radiation, called a boost, and then they are removed.

But it is not clear if this combination works better than external radiation therapy or surgery alone for medium or high-risk tumors. This is still being studied. The combination of internal and external radiation may also cause more side effects.

Radiation therapy with anti-hormone treatment

Anti-hormone therapy lowers the level of testosterone hormone in the body. This can help radiation therapy kill more cancer cells. Anti-hormone therapy can be done before, during, or after radiation therapy. In some cases, this can increase the effectiveness of the radiation.

Option 3: Relief of discomfort without a cure

Sometimes, your treatment team will only treat the cancer symptoms. They do not treat the cancer itself. This can help you feel better and enjoy life. Your treatment team may suggest this option for the following reasons:

• You are too weak for complex treatment.
• Treatment will not help you live longer or improve your quality of life because of your age or other health problems.

There are two ways of doing this:

1. Watchful Waiting means that the cancer isn’t treated but monitored carefully. Instead, any discomfort that you have is treated. Treatment depends on your symptoms and your current situation. The tumor is and remains untreated with this type of treatment. This can be a psychologically stressful situation.
2. Anti-hormone treatment without prior therapy as supportive care. Sometimes, you may have symptoms from prostate cancer, but other treatments are not good for you. In this case, you can try anti-hormone treatment instead of just ‘watchful waiting’.
   This treatment works by lowering the level of testosterone in your body. Testosterone is a male hormone that makes prostate cells grow faster, especially cancer cells. Anti-hormone treatment cannot cure you, but it can slow down cancer growth. This treatment is usually suggested when you have symptoms.
   A large study showed that men who do not have symptoms do not really benefit from the therapy compared to those men who do not get the treatment. The treatment can be done in three ways:
   • Using medication that stops testosterone production.
   • Removal of the testicles.
   • Administration of antiandrogens, which prevent testosterone from reaching the cancer cells.

Note:

The three types of anti-hormone therapies also have different side effects because of the different ways they work. With antiandrogens, the most common side effect is breast enlargement. Other side effects of the various medications can include:

• lack of motivation
• hot flashes
• osteoporosis (decrease in bone density)
• loss of sexual interest and potency
• muscle loss
• increase in body fat
• anemia

In summary

• Active surveillance with regular growth checks may be an option for small and low-risk prostate tumors.
• Surgery can completely remove the cancerous tissue and usually offers a good chance of a cure.
• Radiation therapy, which can be given externally or internally, may be comparably successful.

What you can do

• Take care of your body and mind by eating well, exercising regularly, avoiding harmful substances, and getting enough sleep.
• Find out about the advantages and disadvantages of the therapy options.
• Reach out to others who can offer emotional, practical, or financial help, such as family, friends, support groups, counselors, or charities.
• Talk to your treatment team and get detailed advice when deciding on or against a treatment.
• Why not try one of the Journeys in Mika? You can find content on mindfulness, exercise, and nutrition.