Depending on the stage of cancer, age of the patient, and the overall fitness levels of the patient, there are various prostate cancer treatment options available such as:
A) Active surveillance and watchful waiting
In some patients particularly with an early stage and grade of the disease, prostate cancer grows very slowly. So much so that they may never need any treatment for the disease. For such patients, their urologists may recommend either watchful waiting or active surveillance for a period of time.
WATCHFUL WAITING: No treatment is advised and no further tests are recommended. Patients are treated if only any symptoms show up due to an enlarged prostate.
ACTIVE SURVEILLANCE: No treatment is indicated but the patient is kept under observation. A PSA test and digital rectal examination are done every 6 months and once a year a repeat prostate biopsy is done. If the results signify an increase in the quantum of the disease then the treatment is initiated.
B) Prostate cancer surgery (radical prostatectomy)
In the early stages and grades of prostate cancer, surgery for removal of the prostate gland is an option. The entire prostate gland and seminal vesicles are removed and in selected cases, lymph node dissection is done. This can be done by:
- Open surgery
- Laparoscopic surgery
- Robot-assisted laparoscopic surgery
C) Radiation therapy
In this treatment modality, high energy rays or particles are used to kill the cancer cells.
- It is used as the first line of treatment for cancer confined to the prostate
- As a first-line treatment along with hormonal therapy for tumors that have spread outside the prostate involving adjacent organs such as seminal vesicles
- After surgical removal of the prostate (radical prostatectomy) if the biopsy report suggests that some amount of tumor is still left behind (positive margins), then Intensity Modulated Radiation Therapy (IMRT) or Image-Guided Radiation Therapy (IGRT) are used to guide radiation delivery specifically to diseased cells to kill the cancerous tissue.
D) Hormonal therapy
Prostate cancer cell growth is stimulated by androgens secreted in the body mainly by the testicles but also in a small amount by the adrenal glands. Androgen deprivation therapy is used to deprive the cancer cells of the stimulus to grow. A combined androgen blockade is given that is both androgen deprivation (medical or surgical castration) as well as the use of anti-androgens.
Hormone therapy is usually used if:
- The disease has spread outside the prostate that is the disease has metastasized.
- If the disease comes back after the surgery or radiation therapy.
Chemotherapy drugs are anti-cancer drugs given either orally or by injections. They are mainly used when prostate cancer has spread beyond the prostate involving other parts of the body. The intent is not to cure the patient but to halt the further spread of disease and to palliate symptoms caused by the spread of the disease.
F) Treating prostate cancer spread to the bones
Prostate cancer tends to spread to the bones. This can lead to bone ache, which can be very severe. Also, pathological fractures can happen in the affected bones. In such cases, drugs called bisphosphonates are used to relieve the pain, halt the spread of the disease, and strengthen the bones to prevent pathological fractures. At times, even radiation therapy needs to be used to decrease the pain.