Prostate cancer is the most common cancer in men after skin cancer, but no one treatment is perfect for every man. Some prostate cancers grow very slowly and don’t pose much of a health threat. Other prostate cancers are aggressive and grow quickly. Generally, doctors base treatment on the cancer’s stage and grade and a man’s age and health. And, fortunately, there are more treatment options—and more advancements being made—for prostate cancer today than ever before. If prostate cancer becomes part of your life, finding a doctor and healthcare team you trust is an important first step. By working closely with your doctor, together you can decide which of these treatment options are best for you. Watchful Waiting or Active Surveillance Watchful waiting means your doctor will rely on new or changing symptoms as well as test results for signs the tumor is growing. You need to contact your doctor if you starting experiencing symptoms, such as problems with urination. Your doctor may use the prostate-specific antigen (PSA) test to help monitor the tumor. A higher PSA level is one sign of tumor growth, but it can also be due to a benign condition not caused by the tumor. Still, your doctor may use it to determine if you need more testing. Active surveillance, on the other hand, is a more involved type of monitoring. It includes a PSA test and digital rectal exam within six months of your initial diagnosis, ultrasounds, and biopsies. The goal of either approach is to delay or avoid unnecessary treatment and allow men to maintain their quality of life. They are suitable for men who don’t have symptoms or who have slowly growing, early stage tumors. Many men with this type of prostate cancer will die from other causes later in life and may never need treatment. If you’re uncomfortable waiting, talk with your doctor about beginning treatment. Surgery Surgery involves removing or destroying all or part of the prostate. There are many types of prostate surgery, including both open and minimally invasive procedures. In some cases, surgery may include removing surrounding tissues and lymph nodes. This is called a radical prostatectomy. Complications from prostate surgery include erectile dysfunction and urinary incontinence. Newer, nerve-sparing prostate surgical procedures can greatly lower complication rates. One form of surgery, called cryosurgery, uses very cold gases to destroy the prostate. Most doctors do not use this approach as the first treatment for prostate cancer, but it may be an option if the cancer has returned after other treatments have been used. Cryosurgery is less invasive than radical prostatectomy so there is usually less blood loss, less pain, a shorter recovery, and a shorter stay in the hospital. Unfortunately, doctors aren’t sure about the long-term effectiveness of this procedure. Surgery is often performed for early stage tumors that have not spread beyond the prostate. In these cases, surgery has a high likelihood of cure. Sometimes, doctors offer less invasive procedures for late stage tumors to help relieve symptoms. In these cases, surgery usually does not offer a cure. Radiation Radiation therapy uses high-energy waves or particles to destroy cancer. For prostate cancer, it includes either external beam radiation or brachytherapy. Brachytherapy delivers radiation internally from implants called seeds. External beam radiation delivers radiation from a machine outside the body. Two very precise types are especially useful for prostate cancer: three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT). Radiation for early stage prostate cancer has about the same cure rate as surgery. Doctors may also use radiation for later stage cancers. It is useful to shrink the tumor before surgery and to kill any remaining cancer after surgery. In advanced stages, radiation can help relieve symptoms where the cancer has spread. Hormone Therapy Hormone therapy deprives prostate cancer of testosterone—the male hormone it needs to grow. Other names for this include androgen deprivation therapy and androgen suppression therapy. Surgery to take out the testicles will remove the source of testosterone. Medicines can accomplish nearly the same effect by lowering testosterone levels or blocking its action. Doctors use hormone therapy for cancers that have spread beyond the prostate. It is also useful when prostate cancer comes back after surgery or radiation. Sometimes, doctors combine it with radiation or use it before radiation to shrink the tumor. Chemotherapy Chemotherapy—or chemo—uses potent medicines to treat cancer. Chemotherapy is usually a systemic treatment, meaning it goes throughout the body to kill cancer cells or stop them from growing. The chemo drugs for prostate cancer come as a pill, a shot into a vein, or an infusion into a vein. Doctors use these medicines in cycles that last for a few weeks. Chemotherapy is not standard therapy for early stages of prostate cancer. Doctors use it when cancer has spread beyond the prostate and hormone therapy hasn’t helped. Chemotherapy does not offer a cure for prostate cancer, but it can help relieve symptoms and prolong life. Biologic Therapy Biologic therapy for prostate cancer involves a vaccine that boosts the body’s immune system to fight the cancer. The technology uses a man’s white blood cells to produce the vaccine, so the vaccine is unique for each man. The vaccine treats advanced prostate cancer that has spread to other organs and is not responding to hormone therapy. It does not offer a cure, but can prolong life. Treatment Options When Prostate Cancer Spreads In some cases, prostate cancer may spread to the surrounding tissues, particularly the bones. Cancer that has spread to the bone and certain types of hormone therapy can weaken bones, which often leads to pain. Treatments for bone pain include: Pain medicine External radiation therapy Strontium-89 (a radioisotope) Targeted therapy with a monoclonal antibody Bisphosphonate therapy Corticosteroids New Prostate Cancer Treatment Options on the Horizon As advances in technology and medicine are made, new treatment options may emerge. High-intensity focused ultrasound and proton beam radiation therapy are two treatments currently being studied in clinical trials. High-Intensity Focused Ultrasound High-intensity focused ultrasound (HIFU) is a technique that uses heat to destroy cancerous areas on or around the prostate gland. When high frequency sound waves are concentrated on body tissues, those tissues heat up and die. In HIFU, doctors insert an ultrasound probe into the patient’s rectum and from that position, the ultrasound can direct beams accurately at the prostate. Results from trials suggest that HIFU can be a successful treatment for prostate cancer. Proton Beam Radiation Therapy Proton therapy, also called proton beam therapy, is a type of radiation treatment that uses protons rather than X-rays to treat cancer. Once the protons reach the target, they deposit the specified radiation dose to the tumor. With proton therapy, there is no radiation dose beyond the tumor unlike X-rays. Whereas, X-rays continue to deposit radiation doses as they pass through the patient's body which means that radiation is also damaging nearby healthy tissues, potentially causing side effects. Although early results are promising, so far studies have not shown that proton beam therapy is safer or more effective than other types of radiation therapies for treating prostate cancer. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive and they aren’t available at many cancer centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time as well. Making the Right Decision Talk with your doctor about the treatment options available for the stage and grade of your prostate cancer. It’s also important to consider your risk of cancer progressing. Your doctor will look at various measures to advise you about that. Other considerations include your age and general health along with side effects, such as sexual problems. Once you’ve decided on a course of action, think about where you will receive your care. Picking a hospital or treatment center is just as important as choosing the right doctor. Find out whether the best treatment for you is available locally or not. Think about whether you are willing to travel to a center of excellence for prostate cancer treatment.