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The choice of treatments will depend on many factors, including how fast the cancer is growing, how much it has spread and the patient's age and health. Weighing the benefits and potential side effects of treatments is an important consideration. Several treatment options including surgery and radiation therapy are used to treat prostate cancer at Mayo Clinic.
Surgery is the mainstay of prostate cancer treatment. As a single treatment method, surgery is an effective way to treat cancer that is confined to the prostate gland. Surgeons use special techniques to cut the prostate free while trying to spare muscles and nerve bundles that control urination and sexual function. Two methods are used for a radical prostatectomy, retropubic and perineal surgery.
Radiation therapy uses high-powered X-rays or other radiation to kill cancer cells. Cancer cells are generally more sensitive to the harmful effects of radiation compared to normal tissues. Radiation may be used in the treatment of most stages of prostate cancer, with and without surgery.
During the past several years Mayo Clinic radiation oncologists and physicists have developed and tested a method of using special imaging devices to precisely track the internal movement of the prostate on a daily basis while patients are receiving external radiation treatments. This procedure involves using gold markers implanted in the prostate to track the position of the prostate and move the radiation beams accordingly. These markers are implanted in the prostate in a procedure similar to taking a biopsy. This approach allows a reduction in the radiation treatment field size and, thus, reduces the amount of radiation given to the rectum and bladder. It also allows more radiation to be safely delivered to the prostate which, in turn, is associated with increased cure rates.
Intensity modulated radiation therapy (IMRT) uses precisely shaped radiation beams to deliver high dose and accurate treatment which yields high cure rates and lower rates of side effects compared to older forms of external radiotherapy.
Radiation therapy is also commonly employed after surgery to treat the prostate bed (the area around the area where the prostate used to be). This may be done because an examination of the prostate under the microscope after surgery showed that microscopic amounts of cancer cells may have been left behind.
These treatments are given to reduce the chances that the cancer will grow back. In this circumstance, radiation treatments would usually be given no sooner than 2 to 3 months following the surgery and last for 6 to 7 weeks. Radiation may also be given if the PSA level starts to rise some months or years after surgery.
Brachytherapy involves injection of rice-sized radioactive seeds into the prostate to kill the cancer. In permanent prostate brachytherapy, implanted seeds are left in place for weeks or months.
About 75 percent of men with advanced prostate cancer choose hormone therapy to cut off the supply of male sex hormones that make prostate cancers grow faster.
Another way to kill prostate cancer is to freeze the prostate, a process called cryotherapy. Short-term results are encouraging, but long-term survival rates appear lower than with surgery or radiation. In addition, impotence results 90 percent of the time.
Watchful waiting may be an option for men in their 70s or older or men in poor health. It may be an option when the cancer is small and slow growing.
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