The type of treatment you will receive for prostate cancer depends on the stage of your cancer that is, whether the cancer is located just in the prostate gland (localized disease) or if it has spread to other tissues (advanced disease). Other factors will include how fast your cancer is growing (aggressiveness) and your overall health. Whether you’ve been recently diagnosed, have advanced disease or have had your cancer return after treatment, we can help you decide what treatment options are best for you. Your options include:
Active Surveillance for Prostate Cancer
Treatment may not be necessary in all cases after a prostate cancer diagnosis. In such instances, we might recommend active surveillance or watchful waiting where we monitor your cancer closely to observe changes in symptoms or test results. Such tests include regular prostate specific antigen (PSA) screening, digital rectal examinations (DREs) and prostate biopsies. For men under active surveillance, our goal is to ensure the cancer is confined to the prostate gland and does not have aggressive features. Once this changes and your cancer becomes more active, we will re-evaluate your treatment options and you may opt for another treatment type. You can benefit from active surveillance if:
- you have localized prostate cancer
- you have a slow-growing cancer
- your cancer does not have any symptoms
- you are advanced in age
- you have another serious health condition
Active surveillance can help prevent unnecessary treatment which spares one from side-effects of surgery and radiation treatment. However, some prostate tumours can spread or begin to grow aggressively during wait periods between tests and make them even more difficult to treat.
Surgery for Prostate Cancer
Surgery to remove the prostate is known as radical prostatectomy. During this surgery, tissues surrounding the prostate, seminal vesicles and lymph nodes are removed as well. Prostatectomy may be an option if:
- you have early stage disease and a high life expectancy
- your PSA levels keep rising
- you have locally advanced disease which can be treated in combination with other therapies.
Side effects of surgery may include urinary incontinence an erectile dysfunction.
Radiotherapy for Prostate Cancer
External beam radiotherapy (EBRT) for prostate cancer is when high-powered energy beams are directed to your prostate from a machine outside the body to kill cancer cells. The goal of EBRT is to completely damage and permanently kill cancer cells whereas healthy cells can repair themselves and recover.
Hormone therapy for Prostate Cancer
Hormone therapy is usually done to slow the growth or reduce the size of your prostate tumour. The male hormone testosterone (an androgen) is useful for the normal development of the prostate by binding to androgen receptors, AR. These ARs play a key role in stimulating prostate cancer cells to grow. Therefore, in hormone therapy, our goal is to reduce the production of testosterone and/or block its binding to ARs and cancer cells.
We may recommend hormone therapy:
- if you have advanced disease
- along with radiation therapy for high risk individuals to get better results
- if your cancer has returned after treatment (recurrence) or has spread to other tissues (metastatic disease)
Our oncologists may recommend drugs such as Goserelin (Zoladex), Bicalutamide (Casodex) and Abiraterone (Zytiga) depending on the type of hormone therapy best suited to you.
Surgery to remove the testicles also known as orchiectomy is another form of hormone therapy. Since most of the testosterone produced by the body is done by the testicles, this procedure greatly reduces the amount of testosterone in the body and helps slow growth of prostate cancer cells.
Side effects of hormone therapy include reduced sex drive, weight gain, erectile dysfunction and hot flashes
Chemotherapy for Prostate Cancer
Chemotherapy uses anti-cancer drugs to kill fast-growing prostate cancer cells. This is given either through an IV or orally. Docetaxel is an example of Chemo drug we use to treat prostate cancer. We may recommend chemotherapy if:
- your cancer is resistant or does not respond to hormone therapy
- you have metastatic disease
Other treatment options for prostate cancer are Immunotherapy, Brachytherapy and Cryotherapy.