Once prostate cancer has been diagnosed and staged, a prostate cancer patient will work with his physicians to develop a treatment plan. There are several treatment options available for prostate cancer, but a treatment plan must be made carefully. A treatment plan will consider many factors about an individual patient and his cancer, such as age, overall health, personal values and potential side effects.
Some of the most commonly used options in prostate cancer treatment include active surveillance, surgery, radiation therapy, chemotherapy and hormone therapy.
Active surveillance, which is also referred to as watchful waiting and expectant management, is an appropriate treatment option for men with slow-growing, low-grade prostate cancers that are unlikely to be life-threatening. During active surveillance, cancer is observed to monitor changes in prostate cancer. Active surveillance requires patients to receive routine prostate-specific antigen (PSA) testing, digital rectal exams (DRE) and prostate imaging. Biopsies may also be performed during a course of active surveillance.
There are several surgical procedures used to treat prostate cancer. The most commonly performed type of surgery is radical prostatectomy, which removes the prostate gland and surrounding tissue. Nerve-sparing surgery is often attempted to prevent men from losing ability to have an erection. Side effects to surgery include urinary incontinence and erectile dysfunction. Surgery is an option available to men with prostate cancer that has not spread beyond the prostate gland.
During radiation therapy, high-energy radiation is targeted toward cancerous prostate cells in an attempt to kill them and shrink tumors. External beam radiation therapy, the most commonly used type of radiation therapy, uses a machine called a linear accelerator to deliver radiation precisely to the location of a tumor. During brachytherapy, radioactive material is implanted directly into the prostate near cancerous cells.
Radiation therapy can be administered:
- As an initial treatment for low-grade cancers confined to the prostate gland.
- With hormone therapy as part of a first treatment for cancers that have spread beyond the prostate.
- After surgery if a cancer has not been completely removed or if cancer recurs.
Hormone therapy attempts to reduce levels of hormones called androgens, particularly testosterone and dihydrotestosterone. Hormone therapy will not cure prostate cancer, although it can help to shrink tumors or slow their growth. Hormone therapy is used:
- When surgery or radiation therapy are not viable treatment options.
- If cancer remains or recurs following surgery or radiation therapy.
- With radiation therapy to prevent cancer recurrence.
- To shrink a tumor prior to radiation therapy.
Chemotherapy uses ant-cancer drugs, which can be swallowed or injected, to treat prostate cancer. Chemotherapy is generally only administered to prostate cancer patients if cancer has spread beyond the prostate gland and hormone therapy is not working. Chemotherapy is unlikely to result in a cure, although it can help men with prostate cancer to extend their lives and maintain quality of life.
The Role of Prostate MRI in Cancer Treatment
Prostate imaging with MRI produces detailed visualizations of prostate cancer, as well as information about a cancer’s current growth and potential for more aggressive growth. Without this data available, it was previously more difficult to differentiate patients with low-grade, low-volume cancers from those with intermediate- or high-grade cancers. With prostate MRI, patients and physicians can make more informed decisions about an appropriate course of treatment.