What do the main medical treatments for prostate cancer entail?

“Watchful waiting” involves closely monitoring the patient’s condition and only using treatment to relieve symptoms and improve quality of life, without any intention of curing the disease. This option is typically reserved for older men who do not present with signs or symptoms. “Active surveillance” also involves closely monitoring the patient’s condition, but tests (e.g., PSA test, digital rectal exam, prostate biopsy) are frequently conducted, and treatment is given to try and cure the disease when test results change unfavorably. Active surveillance is typically utilized for men with very-low- to low-risk prostate cancer without serious health conditions.^[1]

In men, especially younger men, with intermediate- to high-risk prostate cancer, either radiation (external or interstitial) therapy or surgery (radical prostatectomy being the most common) are used to try and cure the disease. Surgery is reserved for patients with cancer confined to the prostate gland. Radiation therapy may be used as the first treatment for cancers that spread into nearby tissues, in patients who are not good candidates for surgery or whose cancer has come back after surgery, or to control advanced cancer.^[2] Potential complications after surgery include those typical of any major surgery (e.g., infection at surgery site), as well as erectile dysfunction, urinary incontinence, bowel problems, shortening of the penis, and inguinal hernia. Radiation shares the same potential complications as surgery, plus an increased risk of bladder and gastrointestinal cancer.^[3]

Other treatment options are not intended to cure prostate cancer and are typically reserved for advanced cancers. They include the following:

• Hormone therapy: uses surgery or drugs to reduce testosterone levels, which fuel prostate cancer cells. It may be used if radical prostatectomy or radiation cannot be used or were ineffective.^[4] Hormone therapy can also be used before radiation therapy to enhance treatment effectiveness. Potential side effects include reduced or absent sexual desire, erectile dysfunction, shrinkage of testicles and penis, hot flashes, breast tenderness and growth, and reduced bone mineral density.

• Chemotherapy: uses anti-cancer drugs injected into a vein or taken by mouth. It is sometimes used if cancer has spread outside the prostate gland and hormone therapy isn’t working.^[5] Potential side effects include hair loss, mouth sores, loss of appetite, nausea, vomiting, diarrhea, increased risk of infections, and fatigue.

• Targeted therapy: uses anti-cancer drugs or other substances to attack cancer cells while doing little damage to normal cells, typically less than chemotherapy or radiation.^[6] Potential side effects are similar to chemotherapy.

• Immunotherapy: aims to enhance the ability of the individual’s immune system to recognize and destroy cancer cells.^[7] Most commonly, a vaccine (Sipuleucel-T) is used to treat cancer that has spread to other parts of the body and is no longer responding to hormone therapy.

• Bisphosphonates: drugs that slow down the activity of osteoclasts (cells that break down bone) with the aim of reducing bone disease when the cancer has spread to other parts of the body. These drugs can also help to lessen the risk of bone fracture with hormone therapy.^[6]