Prostate Cancer Treatments You Should Know About

About 70% of prostate cancers are caught at an early stage when they're limited to the prostate. When prostate cancer is advanced, you'll likely need lifelong treatment. Work with your doctor to understand your cancer stage and treatment options to help you choose the best one for you. Ask questions so you'll know what to expect.

Surgery is a common treatment for prostate cancer, especially when you have an early-stage, localized tumor. Your surgeon may remove the tumor tissue with some normal prostate tissue around it. Another type of surgery for prostate cancer is called a radical prostatectomy, in which your surgeon will remove the entire prostate gland and some surrounding tissue. The surgical option your doctor recommends may depend on:

• Your tumor's size and stage 
• Your life expectancy
• Your overall health

Your recovery from surgery will depend on the method your surgeon uses. Open surgery involves removal of all or part of your prostate through an incision. Minimally invasive surgery uses smaller incisions or holes. It's most often done with a robot to help guide small surgical tools. Side effects of radical prostatectomy include: 

• Urinary incontinence 
• Erectile dysfunction

Talk to your doctor about how to manage any side effects of prostate surgery.

Radiation therapy uses high-energy beams to kill cancer cells and is often used for localized tumors or after surgery to eliminate any remaining cancer cells. There are two types of radiation therapy: external and internal (brachytherapy). External radiation therapy uses a machine outside the body to direct the rays toward the cancer, while internal radiation therapy involves placing small radioactive "seeds" inside or near the cancer. 

Radiation therapy can come with a variety of common side effects including:

• Urinary problems, such as frequent urges to pee or a burning sensation
• Diarrhea, frequent pooping, or trouble holding your poop or bleeding
• Erectile dysfunction, which may improve with medicine
• Fatigue

Your side effects are likely to go away or get better with time.

Proton beam radiation is a specialized form of radiation therapy that uses tiny particles to target and destroy cancer cells by disrupting their DNA. Doctors can use it to treat almost any prostate cancer, including those with complex shapes. This type of radiation therapy is more costly than others. You'll likely need to go to a center that specializes in it. 

Proton therapy requires your care team to come up with a precise plan to target and treat your prostate cancer. They'll take pictures of your prostate and use software to map its exact location. They'll mark your body in just the right spots. They'll also fit you for a positioning device to keep you still during the treatment. You may have proton therapy each weekday for several weeks. Each session will take about an hour, with treatment lasting 20 minutes.

Prostate cancer cells need male hormones to grow, so hormone therapy, also known as androgen deprivation therapy, works by blocking male hormones including testosterone or lowering their levels to slow down or stop cancer growth. This treatment is often used when prostate cancer is advanced in combination with other therapies. 

Side effects of hormone therapy include:

• Hot flashes
• Fatigue
• Mood changes
• Weight gain
• Changes in your penis or testicle size
• Loss of muscle
• Reduced sexual desire
• Erectile dysfunction
• Bone thinning
• Increased risk for diabetes and heart disease

Ask your doctor about how to manage or reduce these side effects.

Radiopharmaceuticals, also known as medicinal radiocompounds, are drugs infused with radioactive substances. They can help manage metastatic or advanced prostate cancer that doesn't respond to hormone therapy. Radiopharmaceuticals can treat prostate cancer that has spread to:

• Bones
• Internal organs
• Lymph nodes

You'll receive these medicines in an IV. Radiopharmaceuticals may come with side effects including:

• Nausea and vomiting
• Fatigue
• Dry mouth
• Loss of appetite
• Constipation
• Anemia
• Diarrhea
• Swelling

You may also need to take precautions to avoid exposing others depending on which type of radiopharmaceutical you take.

Chemotherapy involves taking medication orally or through an IV to attack rapidly growing cancer cells and shrink tumors. It is often used for prostate cancer that has spread beyond the prostate and is not responding to hormone therapy. Chemotherapy medicines for advanced prostate cancer include:

• Cabazitaxel (Jevtana)
• Carboplatin (Paraplatin)
• Docetaxel (Taxotere)
• Mitoxantrone (Novantrone)

You'll receive chemotherapy as an IV infusion. Your care team will deliver it slowly into your veins over about an hour. You may have treatment every three weeks for several cycles. Ask your doctor about which side effects to watch for based on the chemotherapy medicine you're receiving.

Immunotherapy boosts the body's immune system to fight prostate and other cancers. It's often used to treat advanced prostate cancer that isn't responding to hormone therapy. Immunotherapy medicines for prostate cancer include:

• Pembrolizumab (Keytruda)
• Sipuleucel-T (Provenge)

You'll receive immunotherapy medicines as an infusion on a set schedule. Your care team will monitor you for any side effects or complications. Treatment side effects may include:

• Fatigue
• Diarrhea
• Flu-like symptoms
• Skin reactions
• Nausea and vomiting
• Constipation
• Muscle and joint pain

Targeted therapy may be an option if your prostate cancer carries specific mutations in genes, including BRCA1 and BRCA2. About 1 in 4 advanced prostate cancers has a genetic change like this. Targeted therapies for advanced prostate cancer include:

• Niraparib and abiraterone (Akeega)
• Olaparib (Lynparza)
• Rucaparib (Rubraca)
• Talazoparib (Talzenna)

Ask your doctor about biomarker testing and the pros and cons of each of your treatment options. 

You'll take these medicines orally each day, often along with hormone therapy. Side effects include:

• Nausea or vomiting
• Diarrhea
• Fatigue
• Appetite loss
• Anemia
• Constipation
• Rash
• Abnormal liver tests
• Low platelet counts
• Cough
• Shortness of breath

Bisphosphonate therapy doesn't treat the cancer. It instead helps ease pain and prevent fractures when prostate cancer has spread to your bones. It works by strengthening the bones and reducing the risk of bone complications. 

You'll have an IV injection every few weeks. You may also need to take a vitamin supplement to boost calcium and vitamin D. Side effects include:

• Flu-like symptoms
• Bone or joint pain
• Kidney problems
• Osteonecrosis of the jaw (ONJ)

When choosing a treatment option, it's essential to consider the risks, potential side effects, and your overall health and preferences. Discussing your options with your doctor can help you choose the best treatment plan.