Risks and Benefits of Common Prostate Cancer Treatments

Prostate cancer is one of the most common types of cancer in men. Fast-growing tumors can spread to other parts of your body. This form of cancer can be hard to treat if it is not caught early. Slow-growing tumors may not require treatment at first, or at all.

Path to improved health

Below are the most common prostate cancer treatments. Each treatment type has different benefits, risks, and outlooks. Talk to your doctor about what option is best for you.

Watchful waiting

If you have slow-growing cancer, your doctor may recommend observation as the first phase of treatment. This also might apply to men who are older or have severe health issues. Watchful waiting involves monitoring changes in your symptoms and tumors. It can consist of regular rectal exams, blood or imaging tests, and/or biopsies. If your doctor detects changes, they likely will suggest a type of active treatment.

Surgery

Radical prostatectomy is a surgery to remove your entire prostate. This includes lymph nodes and seminal vesicles. Surgery typically is an option if your cancer is contained to your prostate and has not spread. The surgeon can remove your prostate through one large incision or laparoscopically. Laparoscopic surgeries are also known as minimally invasive surgeries. They are performed using a laparoscope (a small, thin tube with a camera on the tip that is used to see the inside of your body) through a small number of incisions. These types of surgeries lead to less pain and a quicker recovery time than more invasive surgeries.

Surgery does require a stay in the hospital. Recovery time varies from several weeks to months. Usually, you can return to work in about 1 month. During recovery, you will have a catheter to help you urinate until the cut heals. Most men regain bladder control within a few weeks after surgery.

The success rate for surgery is very high if all the cancer gets removed. Surgery also provides your doctor with information. They will know the exact size and state of your tumor. However, as with all surgeries, there can be complications. These include blood clots, internal damage, or a reaction to the medicine. After surgery, you could have bleeding or an infection. There is a chance of erectile dysfunction (impotence) or loss of bladder control.

Men who have surgery to treat prostate cancer are no longer able to have children naturally. Your body still creates sperm but does not release it. If you want to have a baby, talk to your doctor about storing sperm before surgery. Treatment also can alter your orgasms and increase your risk of getting a hernia in your groin.

Radiation therapy

Radiation kills cancer cells using high-energy rays. This treatment is an option for both low- and high-grade forms of prostate cancer. It can be done on its own or with surgery. It also is an option if not all cancer gets removed or if your cancer comes back.

There are two types of radiation therapy. External radiation is known as beam therapy. It uses a machine that is similar to an X-ray. You get it 5 days a week for 6 to 8 weeks. Each radiation session lasts about 10 minutes. Internal radiation is known as seed therapy, or brachytherapy. It is more intense and only is given 1 time. Seed therapy requires a hospital stay since it involves anesthesia (medicine that puts you to sleep). The increased dose of radiation can cause discomfort.

The success rate for radiation therapy is about the same as surgery. Since the prostate gland and lymph nodes are not removed, your doctor won’t know the exact size and state of the tumor. Beam therapy has milder side effects than seed therapy. These can include frequent urination or urinary burning or bleeding. Rectal pain, rectal bleeding, and diarrhea are possible during or following treatment. Over time, you might become infertile or have erectile dysfunction.

Chemotherapy

Chemotherapy kills cancer cells using powerful drugs. It is given through an IV (intravenous) drip. A course of treatment lasts several weeks or months. Chemotherapy often has intense side effects. Most common are nausea, fatigue, and hair loss. It mostly is used by men who have fast-growing or advanced prostate cancer. It can help prolong your life.

Cryotherapy

Cryotherapy kills cancer cells using cold gases to freeze them. It is an option for men who have early or recurring cancer. It can be used in combination with other treatment types. The goal of cryotherapy is to eliminate your prostate gland. This is like surgery but is less invasive. It destroys your prostate with cold temperatures instead of an incision and removal.

Your doctor will perform a transrectal ultrasound (TRUS) to monitor the process. It does require a stay in the hospital because anesthesia is used. Cryotherapy often is less painful than surgery and has a shorter recovery time. You will have a catheter to help you urinate while you heal. Most men regain control of their bladder and bowels within a few weeks.

The long-term success rate of this treatment is unknown. A wide range of side effects is possible. Mild ones include urinary or rectal bleeding or burning. A swollen scrotum or penis and erectile dysfunction is common.

Hormone therapy

Your doctor might prescribe medicine to lower your level of male hormones, or androgens. Your hormones, including testosterone, can cause prostate tumors to grow or spread. Hormone therapy often is used in combination with other treatments. It can be done for several months in the form of pills or injections.

Hormone therapy does not cure prostate cancer. It can help shrink your tumor or prevent future growth. It also can control symptoms of prostate cancer. Side effects include fatigue, decreased sex drive, and erectile dysfunction. Osteoporosis (weakened bones) can be a more severe side effect.

Things to consider

It is up to you and your doctor to decide what treatment options are best. It may be good to get a second opinion. You should take several factors into consideration, including:

• Grade and stage of cancer
• Age and lifespan
• Overall state of health
• Any medicines you take or other conditions you have
• Size of your prostate gland (enlarged glands are more sensitive to treatment)
• Lifestyle changes
• Recovery time

Your outlook for prostate cancer depends on these factors, as well. Ask your doctor what you can do to prolong and improve your quality of life.

Questions to ask your doctor

• Is my grade and stage of cancer treatable or curable?
• How do I know if I need treatment?
• How do I decide what treatment is best for me, or what treatment to start with?
• Are there any clinical trials available to me?
• How long does treatment last?
• How will treatment affect my daily life? Will I still be able to do my normal activities?
• Can treatment affect my sex life or ability to have children?
• What are the long-term effects of prostate cancer treatment?
• What is my chance of cancer returning after treatment?
• What happens if I choose not to get treatment?

Resources

American Family Physician: Prostate Cancer: Making Decisions About Treatment

American Society of Clinical Oncology: Prostate Cancer: Treatment Options