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Search Search. Prostate Cancer. Prostate Cancer Treatment. Prostate Cancer Prevention. Prostate Cancer Screening. Genetics of Prostate Cancer. Key Points Prostate cancer is a disease in which malignant cancer cells form in the tissues of the prostate.
Signs of prostate cancer include a weak flow of urine or frequent urination. Tests that examine the prostate and blood are used to diagnose prostate cancer. A biopsy is done to diagnose prostate cancer and find out the grade of the cancer Gleason score. Certain factors affect prognosis chance of recovery and treatment options.
Weak or interrupted "stop-and-go" flow of urine. Sudden urge to urinate. Frequent urination especially at night. Trouble starting the flow of urine. Trouble emptying the bladder completely.
Pain or burning while urinating. Blood in the urine or semen. A pain in the back, hips, or pelvis that doesn't go away. Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia. Physical exam and health history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual.
Digital rectal exam DRE : An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas. Enlarge Digital rectal exam DRE. The doctor inserts a gloved, lubricated finger into the rectum and feels the rectum, anus, and prostate in males to check for anything abnormal.
PSA is a substance made by the prostate that may be found in higher than normal amounts in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH an enlarged, but noncancerous, prostate. Transrectal ultrasound : A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate.
The probe is used to bounce high-energy sound waves ultrasound off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound may be used during a biopsy procedure. This is called transrectal ultrasound guided biopsy. Enlarge Transrectal ultrasound. An ultrasound probe is inserted into the rectum to check the prostate. The probe bounces sound waves off body tissues to make echoes that form a sonogram computer picture of the prostate.
Transrectal magnetic resonance imaging MRI : A procedure that uses a strong magnet, radio waves , and a computer to make a series of detailed pictures of areas inside the body. A probe that gives off radio waves is inserted into the rectum near the prostate. This helps the MRI machine make clearer pictures of the prostate and nearby tissue. A transrectal MRI is done to find out if the cancer has spread outside the prostate into nearby tissues. This procedure is also called nuclear magnetic resonance imaging NMRI.
Transrectal MRI may be used during a biopsy procedure. This is called transrectal MRI guided biopsy. The stage of the cancer level of PSA, Gleason score, Grade Group , how much of the prostate is affected by the cancer, and whether the cancer has spread to other places in the body.
Whether the cancer has just been diagnosed or has recurred come back. Whether the patient has other health problems. The expected side effects of treatment. Past treatment for prostate cancer. The wishes of the patient. Key Points After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body. Bone scan : A procedure to check if there are rapidly dividing cells , such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. Enlarge Bone scan. A small amount of radioactive material is injected into the patient's bloodstream and collects in abnormal cells in the bones.
As the patient lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen or film. MRI magnetic resonance imaging : A procedure that uses a magnet, radio waves , and a computer to make a series of detailed pictures of areas inside the body.
CT scan CAT scan : A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Pelvic lymphadenectomy : A surgical procedure to remove the lymph nodes in the pelvis. Seminal vesicle biopsy : The removal of fluid from the seminal vesicles glands that make semen using a needle.
A pathologist views the fluid under a microscope to look for cancer cells. ProstaScint scan : A procedure to check for cancer that has spread from the prostate to other parts of the body, such as the lymph nodes. The radioactive material attaches to prostate cancer cells and is detected by a scanner. The radioactive material shows up as a bright spot on the picture in areas where there are a lot of prostate cancer cells.
The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. The cancer spreads from where it began by getting into the blood.
The cancer travels through the blood vessels to other parts of the body. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor metastatic tumor in another part of the body. The cancer gets into the blood, travels through the blood vessels, and forms a tumor metastatic tumor in another part of the body. Grade Group 1 is a Gleason score of 6 or less.
Grade Group 2 or 3 is a Gleason score of 7. Grade Group 4 is a Gleason score 8. Grade Group 5 is a Gleason score of 9 or The PSA level is lower than 10 and the Grade Group is 1; or is felt during a digital rectal exam and is found in one-half or less of one side of the prostate.
The PSA level is at least 10 but lower than 20 and the Grade Group is 1; or is found in more than one-half of one side of the prostate or in both sides of the prostate.
Cancer has spread to nearby lymph nodes. Prostate cancer often spreads to the bones. Key Points There are different types of treatment for patients with prostate cancer. Eight types of standard treatment are used: Watchful waiting or active surveillance Surgery Radiation therapy and radiopharmaceutical therapy Hormone therapy Chemotherapy Targeted therapy Immunotherapy Bisphosphonate therapy There are treatments for bone pain caused by bone metastases or hormone therapy.
New types of treatment are being tested in clinical trials. Cryosurgery High-intensity—focused ultrasound therapy Proton beam radiation therapy Photodynamic therapy Treatment for prostate cancer may cause side effects. Patients can enter clinical trials before, during, or after starting their cancer treatment. Follow-up tests may be needed. Radical prostatectomy : A surgical procedure to remove the prostate, surrounding tissue , and seminal vesicles.
Removal of nearby lymph nodes may be done at the same time. The main types of radical prostatectomy include: Open radical prostatectomy : An incision cut is made in the retropubic area lower abdomen or the perineum the area between the anus and scrotum.
Surgery is performed through the incision. It is harder for the surgeon to spare the nerves near the prostate or to remove nearby lymph nodes with the perineum approach. Radical laparoscopic prostatectomy : Several small incisions cuts are made in the wall of the abdomen. A laparoscope a thin, tube-like instrument with a light and lens for viewing is inserted through one opening to guide the surgery.
Surgical instruments are inserted through the other openings to do the surgery. Robot-assisted laparoscopic radical prostatectomy : Several small cuts are made in the wall of the abdomen, as in regular laparoscopic prostatectomy. The surgeon inserts an instrument with a camera through one of the openings and surgical instruments through the other openings using robotic arms. The camera gives the surgeon a 3-dimensional view of the prostate and surrounding structures.
The surgeon uses the robotic arms to do the surgery while sitting at a computer monitor near the operating table. Leakage of urine from the bladder or stool from the rectum. Shortening of the penis 1 to 2 centimeters. The exact reason for this is not known. Inguinal hernia bulging of fat or part of the small intestine through weak muscles into the groin. Inguinal hernia may occur more often in men treated with radical prostatectomy than in men who have some other types of prostate surgery, radiation therapy , or prostate biopsy alone.
It is most likely to occur within the first 2 years after radical prostatectomy. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Conformal radiation is a type of external radiation therapy that uses a computer to make a 3-dimensional 3-D picture of the tumor and shapes the radiation beams to fit the tumor.
This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer. Sometimes, active surveillance may be an option for prostate cancer with a Gleason score of 7.
There is also growing use of genomic testing to help find out if active surveillance is the best choice for a person with prostate cancer see more in Latest Research. Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
Watchful waiting. Watchful waiting may be an option for older adults and those with other serious or life-threatening illnesses who are expected to live less than 5 years. If the prostate cancer causes symptoms, such as pain or blockage of the urinary tract, then treatment may be recommended to relieve those symptoms.
Patients who start on active surveillance who later have a shorter life expectancy may switch to watchful waiting at some point to avoid repeated tests and biopsies. In addition, many doctors recommend a repeat biopsy shortly after diagnosis to confirm that the cancer is in an early stage and growing slowly before considering active surveillance for someone who is otherwise healthy.
New information is becoming available all the time, and it is important to discuss these issues with the doctor to make the best decisions about treatment. Local treatments get rid of cancer from a specific, limited area of the body.
Such treatments include surgery and radiation therapy. For early-stage prostate cancer, local treatments may get rid of the cancer completely. Surgery involves the removal of the prostate and some surrounding lymph nodes during an operation.
A surgical oncologist is a doctor who specializes in treating cancer using surgery. For prostate cancer, a urologist or urologic oncologist is the surgical oncologist involved in treatment.
Radical open prostatectomy. A radical prostatectomy is the surgical removal of the entire prostate and the seminal vesicles. Lymph nodes in the pelvic area may also be removed. This operation has the risk of affecting sexual function. Nerve-sparing surgery, when possible, increases the chance that a man can maintain his sexual function after surgery by avoiding surgical damage to the nerves that allow erections and orgasm to occur.
Orgasm can occur even if some nerves are cut because these are separate processes. Urinary incontinence is also a possible side effect of radical prostatectomy. To help resume normal sexual function, drugs, penile implants, or injections may be recommended.
Sometimes, another surgery can fix urinary incontinence. Robotic or laparoscopic prostatectomy. This type of surgery is less invasive than a radical prostatectomy and may shorten recovery time. The surgeon then directs the robotic instruments to remove the prostate gland. In general, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects are similar to those of a radical open prostatectomy. Talk with your doctor about whether your treatment center offers this procedure and how it compares with the results of the radical open prostatectomy.
Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles. Transurethral resection of the prostate TURP. TURP is most often used to relieve symptoms of a urinary blockage, not to treat prostate cancer. In this procedure, with the patient under full anesthesia, which is medication to block the awareness of pain, a surgeon inserts a narrow tube with a cutting device called a cystoscope into the urethra and then into the prostate to remove prostate tissue.
Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Typically, younger or healthier patients may benefit more from a prostatectomy. Younger patients are also less likely to develop permanent erectile dysfunction and urinary incontinence after a prostatectomy than older patients.
Learn more about coping with the sexual side effects of prostate cancer in the Coping With Treatment section. Radiation therapy is the use of high-energy rays to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
External-beam radiation therapy. External-beam radiation therapy is the most common type of radiation treatment. The radiation oncologist uses a machine located outside the body to focus a beam of x-rays on the area with the cancer.
One method of external-beam radiation therapy used to treat prostate cancer is called hypofractionated radiation therapy. This is when a person receives a higher daily dose of radiation therapy given over a shorter period, instead of lower doses given over a longer period. Extreme hypofraction radiation therapy is when the entire treatment is delivered in 5 or fewer treatments. According to recommendations from ASCO, the American Society for Radiation Oncology, and the American Urological Association, hypofractionated radiation therapy may be an option for the following people with early-stage prostate cancer that has not spread to other parts of the body:.
People with low-risk prostate cancer who need or prefer treatment instead of active surveillance. People with intermediate or high-risk prostate cancer receiving external-beam radiation therapy to the prostate but not to the pelvic lymph nodes. People who receive hypofractionated radiation therapy may have a slightly higher risk of some short-term side effects after treatment compared with those who receive regular external-beam radiation therapy.
This may include gastrointestinal side effects. Based on current research, people who receive hypofractionated radiation therapy are not at a higher risk of side effects in the long term. Talk with your health care team if you have questions about your risk for side effects. Learn more about these recommendations for hypofractionated radiation therapy for prostate cancer on a different ASCO website. Brachytherapy, or internal radiation therapy, is the insertion of radioactive sources directly into the prostate.
These sources, called seeds, give off radiation just around the area where they are inserted and may be left for a short time high-dose rate or for a longer time low-dose rate. Low-dose-rate seeds are left in the prostate permanently and work for up to 1 year after they are inserted.
However, how long they work depends on the source of radiation. High-dose-rate brachytherapy is usually left in the body for less than 30 minutes, but it may need to be given more than once. ASCO recommends the following brachytherapy options:. People with low-risk prostate cancer who need or choose an active treatment may consider low-dose-rate brachytherapy. Other options include external-beam radiation therapy or a radical prostatectomy.
People with intermediate-risk prostate cancer who choose external-beam radiation therapy with or without hormonal therapy should be offered either a low-dose-rate or high-dose-rate brachytherapy boost in addition to the external-beam radiation therapy.
For a brachytherapy boost, a lower dose of radiation is given for a shorter period of time. Some patients with intermediate-risk prostate cancer may be able to receive only brachytherapy without external-beam radiation therapy or hormonal therapy.
Patients with high-risk prostate cancer who are receiving external-beam radiation therapy and hormonal therapy should be offered a low-dose-rate or high-dose-rate brachytherapy boost.
Intensity-modulated radiation therapy IMRT. IMRT is a type of external-beam radiation therapy that uses CT scans to form a 3D picture of the prostate before treatment.
A computer uses this information about the size, shape, and location of the prostate cancer to determine how much radiation is needed to destroy it. With IMRT, high doses of radiation can be directed at the prostate without increasing the risk of damaging nearby organs.
Proton therapy. Proton therapy, also called proton beam therapy, is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Current research has not shown that proton therapy provides any more benefit to people with prostate cancer than traditional radiation therapy.
It can also be more expensive. Radiation therapy may cause side effects during treatment, including increased urinary urge or frequency; problems with sexual function; problems with bowel function, including diarrhea, rectal discomfort or rectal bleeding; and fatigue. Most of these side effects usually go away after treatment. While uncommon, some side effects of radiation therapy may not show up until years after treatment. See Follow-up Care for more information about long-term side effects.
Focal therapies are less-invasive treatments that destroy small prostate tumors without treating the rest of the prostate gland. These treatments use heat, cold, and other methods to treat cancer, mostly for low-risk or intermediate-risk prostate cancer. Focal therapies are being studied in clinical trials. Most have not been approved as standard treatment options. Cryosurgery, also called cryotherapy or cryoablation, involves freezing cancer cells with a metal probe inserted through a small incision in the area between the rectum and the scrotum, the skin sac that contains the testicles.
It is not an established therapy or standard of care to treat newly diagnosed prostate cancer. Cryosurgery has not been compared with radical prostatectomy or radiation therapy, so doctors do not know if it is a comparable treatment option.
Its effects on urinary and sexual function are also not well known. High-intensity focused ultrasound HIFU is a heat-based type of focal therapy. During HIFU treatment, an ultrasound probe is inserted into the rectum and then sound waves are directed at cancerous parts of the prostate gland. This treatment is designed to destroy cancer cells while limiting damage to the rest of the prostate gland.
HIFU may be an attractive option for some people, but knowing who may benefit most from this treatment is still unknown. HIFU should only be performed by a specialist with a lot of expertise. You will need to carefully discuss with your doctor if HIFU is the best treatment for you. Systemic therapy is the use of medication to destroy cancer cells. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Common ways to give systemic therapies include an intravenous IV tube placed into a vein using a needle or in a pill or capsule that is swallowed orally.
Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements.
Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases. Because prostate cancer growth is driven by male sex hormones called androgens, lowering levels of these hormones can help slow the growth of the cancer.
The most common androgen is testosterone. Hormonal therapy is used to lower testosterone levels in the body, either by surgically removing the testicles, known as surgical castration, or by taking drugs that turn off the function of the testicles, called medical castration. Which hormonal therapy is used is less important than the main goal of lowering testosterone levels. This treatment can be referred to with other names, including androgen-deprivation therapy ADT.
Another way to stop testosterone from driving the growth of prostate cancer is to treat it with a type of medication called an androgen axis inhibitor. These medications can stop the body from making testosterone or stop testosterone from working.
Androgen axis inhibitors include androgen receptor inhibitors and androgen synthesis inhibitors, which are both described in more detail below. Some of the situations in which this therapy may be used include:. People with NCCN-based intermediate-risk and high-risk, localized prostate cancer who are having definitive therapy with radiation therapy are candidates for hormonal therapy. Definitive therapy is a treatment given with the intent to cure the cancer. People with intermediate-risk prostate cancer should receive hormonal therapy for at least 4 to 6 months.
Those with high-risk prostate cancer should receive it for 24 to 36 months. Hormonal therapy may also be given to those who have had surgery and microscopic cancer cells were found in the removed lymph nodes. It is done to eliminate any remaining cancer cells and reduce the chance the cancer will return.
This is known as adjuvant therapy. Although the use of adjuvant hormonal therapy is controversial, some specific patients appear to benefit from this approach. It was the first treatment used for metastatic prostate cancer more than 70 years ago. Even though this is a surgical procedure, it is considered hormonal therapy because it removes the main source of testosterone production, the testicles.
The effects of this surgery are permanent and cannot be reversed. Bilateral orchiectomy is not commonly used in practice. LHRH agonists. LHRH stands for luteinizing hormone-releasing hormone. Medications known as LHRH agonists prevent the testicles from receiving messages sent by the body to make testosterone. Unlike orchiectomy, the effects of LHRH agonists are often reversible, so testosterone production usually begins again once treatment stops. However, testosterone recovery can take from 6 months to 24 months, and for a small number of patients, testosterone production does not return.
LHRH agonists are injected or placed as small implants under the skin. Depending on the drug used, they may be given once a month or once a year. When LHRH agonists are first given, testosterone levels briefly increase before falling to very low levels. This flare may increase the activity of prostate cancer cells and cause symptoms and side effects, such as bone pain if the cancer has spread to the bone.
LHRH antagonist. This class of drugs, also called a gonadotropin-releasing hormone GnRH antagonist, stops the testicles from producing testosterone like LHRH agonists, but they reduce testosterone levels more quickly and do not cause the flare associated with LHRH agonists. The FDA has approved degarelix Firmagon , given by monthly injection, to treat advanced prostate cancer.
One side effect of this drug is that it may cause a severe allergic reaction. Relugolix is different from other LHRH antagonists in 2 ways.
First, it has a lower risk of causing serious heart problems in patients with preexisting heart disease. Second, when treatment with relugolix is stopped, testosterone production is restored within weeks, rather than months, which may be helpful for those undergoing intermittent hormonal therapy see below.
Androgen receptor AR inhibitors. In effect, AR inhibitors stop testosterone from working. Older AR inhibitors include bicalutamide Casodex , flutamide available as a generic drug , and nilutamide Nilandron and are taken as pills. These medications are also sometimes called anti-androgens. AR inhibitors are not usually used by themselves to treat prostate cancer. Apalutamide is approved by the FDA for the treatment of non-metastatic castration-resistant prostate cancer and for metastatic castration-sensitive prostate cancer in combination with hormonal therapy.
Darolutamide is approved for the treatment of non-metastatic castration-resistant prostate cancer. Enzalutamide is a nonsteroidal AR inhibitor that is approved to treat metastatic and non-metastatic castration-resistant prostate cancer as well as metastatic castration-sensitive prostate cancer. Androgen synthesis inhibitors. Although the testicles produce most of the body's testosterone, other cells in the body can still make small amounts of the hormone that may drive cancer growth.
These include the adrenal glands and some prostate cancer cells. Androgen synthesis inhibitors target an enzyme called CYP17 and stop cells from making testosterone. Abiraterone acetate Zytiga. Abiraterone acetate is taken in the form of a pill. This surgery has mostly been replaced with robotic assisted laparoscopic surgery.
After the prostate has been removed, the urinary tract and the bladder are reconstructed. A catheter is passed through the urethra into the bladder to drain the urine while the new connections heal.
One or two suction drains may be left in the pelvic cavity after surgery. They are brought through the lower belly to drain fluid from the wound. They help lower the risk of infection. The drains are usually removed before you are discharged from the hospital. After surgery, your surgeon will review the final pathology report. Together you will make plans for next steps. The main benefit of a radical prostatectomy is the prostate with cancer is removed.
This is true as long as the cancer hasn't spread outside the prostate. Surgery also helps the healthcare provider know if you need more treatment. The goal of surgery is to get a PSA value of less than 0. Surgery is often a good choice if prostate cancer has not spread beyond the prostate. Surgery always comes with risks. Some complications from surgery can happen early and some later. Bleeding or infection can happen with any major operation, so you will be monitored to prevent or manage these problems.
Not everyone has the same side effects for the same amount of time. With surgery and with radiation therapy , there are two main side effects to consider: erectile dysfunction ED and urinary incontinence a loss of urine control.
For some men, surgery can relieve pre-existing urinary obstruction. Most men with these side effects find ways to manage them over time.
All men have some form of erectile dysfunction after prostate surgery. Erectile dysfunction is the inability of a man to have an erection long enough for satisfying sexual activity. Nerves involved in the erection process surround the prostate gland, and they can be affected by surgery.
They can also be affected by radiation treatment. These nerve bundles help control blood flow to the penis. The length of time ED lasts after treatment depends on many things, including how firm your erections are before treatment.
Sometimes, it may take one year or longer to recover erectile function. In the meantime, your doctor may have ED treatment options for you.
If it's possible, nerve-sparing surgery may help prevent long-term damage. Older men have a higher chance of permanent ED after this surgery. For more information on how prostate cancer surgery can affect your erections, read our After Treatment: Erectile Dysfunction Issues After Prostate Cancer Treatment section. It may surprise you to know that men are still able to have an orgasm climax , even after a radical prostatectomy.
An erection is not needed to climax. There will be very little, if any, fluid with an orgasm. In addition, you can no longer cause a pregnancy after surgery. This is because the prostate, seminal vesicles, and connections to the testicle were removed and the vas deferens was divided during surgery.
Planning for fertility preservation in advance of surgery is an option for men who want to have children. Read our Fertility Preservation fact sheet to learn more on this. It is important to know that sexual desire is not lost with this surgery or radiation treatment.
The exception to this is if hormones are also given as part of treatment, usually given temporarily with radiation therapy. Incontinence is the inability to control your urine. After prostate cancer surgery, you may experience one or more type of Incontinence. Stress Incontinence - is urine leakage when coughing, laughing, sneezing or exercising.
It is the most common type of urine control problem after radical prostatectomy. Overactive Bladder Urge Incontinence - is the sudden need to go to the bathroom even when the bladder is not full because the bladder is overly sensitive.
This type of incontinence is the most common form after radiation treatment. Mixed Incontinence - is a combination of stress and urge incontinence with symptoms from both types. Because incontinence may affect your physical and emotional recovery, it is important to understand your treatment options.
For more information on how prostate cancer surgery can affect incontinence, read our After Treatment: Incontinence Issues After Prostate Cancer Treatment article. Updated January Radiation therapy uses high-energy rays to kill or slow the growth of cancer cells.
Radiation can be used as the primary treatment for prostate cancer in place of surgery. It can also be used after surgery if the cancer is not fully removed or if it returns. Radiation therapy mostly involves photon beams or proton beams.
Photon beams make up traditional x-rays. They carry a very low radiation charge and mass, and can scatter to nearby health tissue.
On the other hand, proton beams have more charge and heavy mass and can target deep tissue. A physician can direct proton radiation treatment to the specific site of cancer, minimizing damage to nearby healthy tissue. Before you begin, it helps to ask your doctor s why they recommend one type of radiation therapy over another. Photon-based external-beam x-rays may damage nearby healthy tissue. That damage can cause side effects. Some newer 3DCTR machines have imaging scanners built into them.
It allows higher doses of radiation to be delivered to cancer cells while protecting surrounding healthy tissue. It uses a machine called a synchrotron or cyclotron to speed up and control the protons.
High-energy protons can travel deeper into body tissue than low-energy photons. With proton therapy, radiation does not go beyond the tumor, so nearby tissue is not affected.
There are fewer side effects. Intensity-modulated proton beam therapy IMPT is a new way to deliver targeted PBT, but these machines are expensive and are not offered everywhere. Stereotactic Body Radiation Therapy SBRT delivers large doses of radiation to exact areas, such as the prostate, with advanced imaging.
The entire course of treatment is given over a shorter period, for just a few days. With any radiation treatment, the side effects should be discussed with you before you begin. With brachytherapy, radioactive material is placed directly into the prostate using a hollow needle. LDR brachytherapy is when your doctor uses a thin needle to insert radioactive "seeds" the size of a rice grain into the prostate.
These seeds send out radiation, killing the prostate cancer cells nearby. In LDR, the seeds are left in the prostate even after treatment is finished. HDR brachytherapy is when your doctor puts radiation into your prostate using a slightly larger hollow needle to insert a thin catheter.
This catheter stays in your body until treatment is done. The radiation source stays in your prostate for a short period of time. Once your treatment is done, all radioactive material is removed. You may need to stay in the hospital overnight.
Sometimes radiation therapy is combined with hormone therapy to shrink the prostate before starting. Or, hormone therapy may be combined with external beam therapy to treat high-risk cancers. The benefit of radiation therapy is that it is less invasive than surgery.
Whether the radiation is given externally or internally, this treatment is effective for early stage prostate cancer. Some need both types of radiation combined to treat their cancer. The main side effects of radiotherapy are incontinence and bowel problems. Urinary problems usually improve over time, but in some men they never go away. Erectile dysfunction, including impotence, is also possible. Many men feel tired for a few weeks to months after treatment. If hormone therapy is used with radiation, sexual side effects are common.
These can include loss of sex drive, hot flashes, weight gain, fatigue, decreased bone density and depression. Fortunately, these side effects can be managed and usually go away when hormone therapy is stopped. It helps to work with your radiologist before you begin treatment to prepare for any known side effects in advance. Follow-up visits with your healthcare team will help you address any new problems. Download our fact sheet on Radiation for Prostate Cancer [pdf] to learn more. Cryotherapy , or cryoblation, for prostate cancer is the controlled freezing of the prostate gland.
The freezing destroys cancer cells. Cryotherapy is done under anesthesia. This treatment is for men who are not good candidates for surgery or radiotherapy because of other health issues. For this procedure, the prostate is imaged and measured. Special needles called "cryoprobes" are placed in the prostate under the skin. The needles are guided by ultrasound, to direct the freezing process.
A catheter will be used in the hospital until you can urinate on your own. After cryotherapy, a patient is monitored with regular PSA tests and in some cases a biopsy. Cryotherapy has been found to have some side effects.
You may experience incontinence and other urinary or bowel problems at first. Erectile dysfunction is likely. Worth noting is the risk of a fistula.
A fistula is a channel that forms after surgery between the urethra and the rectum. This may cause diarrhea or bladder infections. It can be used for the whole gland. This uses a needle-thin probe to circle the tumor with a special solution that kills the tumor by freezing it. This uses a "NanoKnife" to pass an electrical current through the tumor. The electricity creates very tiny openings called pores in the tumor's cells, leading to cell death. For men with small, localized prostate tumors , focal therapy may be an option.
Focal therapy is a general term for a few methods. They kill small tumors inside the prostate, without destroying the whole gland or healthy tissue nearby. There are a few types of focal therapy in clinical trials. Ideally, focal therapy would lead to fewer side effects including changes in urinary function.
The long-term benefits of focal therapy are not yet known. Research is being done to study this further. Right now, the FDA has approved this method to destroy prostate tissue, but not clearly to treat prostate cancer. Because many of these treatments are so new, insurance coverage is not often available.
Prostate cancer cells use the hormone testosterone to grow, similar to our need for food. Hormonal therapy is also known as androgen deprivation therapy ADT. It uses drugs to block or lower testosterone and other male sex hormones that fuel cancer. ADT essentially starves prostate cancer cells of testosterone. ADT is used to slow cancer growth in cancers that are advanced or have come back after initial local aggressive therapy.
It is also used for a short time during and after radiation therapy. Surgery: Removes the testicles and glands that produce testosterone with a procedure called an orchiectomy.
Medication: There are a variety of medications used for ADT. There are two types that are used at first. One is the injection of luteinizing hormone releasing hormone LH-RHs inhibitors.
These are also called either agonists or antagonists. They suppress the body's natural ability to turn on testosterone production.
A second type which is often given with the first type are called non-steroidal anti-androgens. These pills block testosterone from working. These therapies have been used for many years and are often offered as the first option for men who can't have or don't want other treatments. Hormone therapy usually works for a while maybe for years until the cancer "learns" how to bypass this treatment. There are new medications available in recent years that may be used after other hormone therapy fails.
This condition is called "castration-resistant prostate cancer" CRPC. For more information on this, review our Advanced Prostate Cancer website article. To block the production of androgens in CRPC patients, there are a few options. The drug Abiraterone Zytiga , given with prednisone, is one option that blocks an enzyme called CYP17, to stop these cells from making androgens.
This medication blocks signals in cells that tell it to grow and divide. Like other hormone therapies, these options also only work for a while. When they stop working, chemotherapy may be an option. Hormone therapy has been linked to heart disease, diabetes and the loss of bone. You should discuss these risks with your doctor before you begin this treatment for prostate cancer.
Hot flashes and fatigue are also short-term side effects of hormone treatment. The same is true for the loss of sexual drive. Chemotherapy uses drugs to destroy cancer cells anywhere in the body. It is used for advanced stages of prostate cancer. It is also used when cancer has metastasized spread into other organs or tissue. The drugs circulate in the bloodstream. Because they kill any rapidly growing cell, they attack both cancerous cells and non-cancerous ones.
Dose and frequency are carefully controlled to reduce the side effects this may cause. Often, chemotherapy is used with other treatments. It is not the main treatment for prostate cancer patients. Many chemotherapy drugs are given intravenously with a needle in a vein.
Others are taken by mouth. They are given in the healthcare provider's office or at home. You generally do not need to stay in the hospital for chemotherapy.
They are often given once per month for several months. Over the last 10 years, chemotherapy has helped many patients with CRPC.
Recently, chemotherapy has also been found to help patients with advanced prostate cancer when given at the same time as standard hormone therapy. Yet, chemotherapy may only works for a while. The side effects from chemotherapy should be considered. Side effects depend on the drug, the dose and how long the treatment lasts.
The most common side effects are fatigue feeling very tired , nausea, vomiting, diarrhea and hair loss. A change in your sense of taste and touch is also possible. There is an increased risk of infections and anemia because of lower blood cell counts. Most of these side effects can be managed, and lessen once treatment ends. Immunotherapy stimulates your body's immune system to find and attack cancer cells. There are several approaches used in immunotherapy. Most of these are now in clinical trials and have not yet been approved for routine use.
It has been shown to help slow cancer growth in men with advanced prostate cancer. For this treatment, the medical team must remove immature immune cells from the man with advanced prostate cancer. Then the cells are re-engineered to recognize and attack prostate cancer cells, and put back into the body. While cancer doctors are excited about the potential of immune therapies, clinical trials have not yet shown clear successful results.
So far, most immunotherapy approaches have only mild to moderate side effects. Clinical trials are research studies involving real patients to test if a new treatment or procedure is safe, effective and maybe better than established options. The goal is to learn which treatments work best for certain illnesses or groups of people. Clinical trials follow strict scientific standards.
These standards help protect patients and produce more reliable study results. Are you interested in participating in a clinical trial for prostate cancer? Ask your doctor if you qualify for a specific prostate cancer trial.
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