PATIENT ALERT: Masks are now optional in our VOA offices. If you are immunocompromised or feeling ill, masking is strongly encouraged. Thank you. CLICK HERE for more details. For more information on the nationwide shortage of two platinum-based anticancer drugs, CLICK HERE.
After receiving a prostate cancer diagnosis, your urologist may talk to you about prostate removal surgery (prostatectomy). Although surgery is often recommended as a first step in the cancer treatment process, there are side effects that can be avoided for many patients by skipping or delaying a prostatectomy. If your cancer is in its early stage, there’s often time to make a decision about your treatment options.
Prostate cancer treatment options other than surgery are common and readily available. Start by consulting with an oncologist, or a prostate cancer specialist. They can talk you through other treatments that may be effective for you.
What Are the Reasons for Avoiding or Delaying Prostate Cancer Surgery?
A primary reason prostatectomy isn’t often the best choice is because of the long-term side effects it can produce, such as urinary incontinence and erectile dysfunction. These can be short-term; however, some people experience these side effects for the rest of their lives. Because of this, it’s a good idea to consider other prostate cancer treatments that keep the prostate intact when possible.
Determining the Right Prostate Cancer Treatment Plan
If you’ve received a prostate cancer diagnosis, the next step is to meet with an oncologist. The oncologist, along with the rest of the cancer care team, will review the results from your biopsy and other factors, such as your age, the stage of cancer, the symptoms you’re experiencing (if any), your overall general health, and your Gleason score before making the best recommendation.
Understanding The Gleason Score
The Gleason score is the grading method that assigns a number to the biopsied cells compared to healthy cells. It helps the oncologist understand the cancer’s growth rate and how far it has progressed. The lower the number, the closer to normal the cell tissue is, and the higher the number, the more aggressive the cancer is.
The stage describes whether the prostate cancer has spread and, if so, how far. Prostate cancer stages are very complex, with 4 main stages. Each stage can be further divided (A, B, etc.) based on grade group, PSA level, and cancer location. Here is a basic overview of how each stage works:
Stage I: The cancer is growing slowly and is contained to the prostate.
Stage II: The cancer is still within the prostate but has advanced further than stage I.
Stage III: The cancer may have spread beyond the prostate into nearby tissues.
Stage IV: The cancer has spread past the prostate to other areas of the body.
Your oncologist will use this information to design a treatment plan that may not include surgery. Some men, like those who have low-grade cancer and have not yet reached stage IV, usually don’t need to begin treatment right away.
Active Surveillance for Prostate Cancer: Watch and Wait Before Any Treatment Begins
Since prostate cancers typically grow slowly, many men consider delaying their cancer treatment rather than starting it right away. This approach is called active surveillance. During active surveillance, your cancer will be closely monitored, looking for signs that it is progressing or getting worse. This is usually done with additional blood tests; however, a repeat prostate biopsy might be needed in some cases. When the cancer begins to worsen, you should begin treatment.
Surgery Alternatives for Prostate Cancer
Once it’s time to move forward with treatment for prostate cancer, there are other alternative methods to a surgical procedure. Your prostate cancer doctor might recommend one of the following treatments to stop the growth of your cancer.
Radiation Therapy for Prostate Cancer Treatment
Radiation therapy has proven to be very effective in treating prostate cancer. There are two types of radiation therapy your oncologist might recommend: external beam radiation therapy or brachytherapy (internal radiation).
External beam radiation therapy (EBRT) is the most common radiation therapy used to kill cancer in the prostate. Due to its precision, minimal damage is caused to nearby organs, such as the bladder or rectum. There can be some side effects while going through treatment, including bowel and bladder issues. Most men with prostate cancer can receive a higher dose of radiation during each treatment, which is referred to as hypofractionated radiation therapy. This shortens the length of overall treatment by a few weeks.
Low-dose brachytherapy delivers radiation from inside the body using seeds that are surgically placed within the prostate. Radiation kills the cancer cells as the seeds break down over a few months.
High-dose brachytherapy (HDR) also delivers radiation from inside the body. With HDR, the radiation is placed in a tube and inserted into the body for a short period of time. This is repeated over the course of a few days.
In some cases, more than one type of radiation therapy can be used to stop the growth of the cancer cells most effectively.
Hormone Therapy for Treating Prostate Cancer
Sometimes, male hormones like testosterone fuel the growth of prostate cancer, causing it to spread to other parts of the body. In cases such as this, your doctor may recommend hormone therapy to slow it down. Standard hormone therapy options include luteinizing hormone-releasing hormone agonists (LH-RH), which prevent the production of testosterone, and antiandrogens, which block the action of male hormones.
Targeted Therapy: A New Option for Advanced Prostate Cancer
Targeted therapy drugs are designed to counteract specific genetic mutations or proteins found in the cancer. Several targeted therapies are available to treat advanced prostate cancer.
Chemotherapy for Treating for Prostate Cancer
Chemotherapy uses drugs that spread through the body, destroying cancer cells. This type of treatment is used if prostate cancer has spread outside the prostate gland. It can be used early after diagnosis, in combination with hormone and targeted therapy (usually in patients with large amounts of cancer), or later in the disease course when the cancer no longer responds to hormone or targeted therapy.
Additional Prostate Cancer Treatment Through Clinical Trials
Clinical cancer research has made great advancements when it comes to treating prostate cancer. With clinical trials, new and better treatment options are now available for more patients.
If a prostate cancer clinical trial is available to you, one of our Virginia Oncology Associates clinical research specialists will meet with you and discuss your participation options. You’re never obligated to participate in a clinical trial, but they can offer access to the latest treatment options for cancer patients.
Determining the Best Prostate Cancer Treatment Plan
If you or a loved one was recently diagnosed with prostate cancer and you’re considering treatment options, it’s a good time to request a consultation with an oncologist.
The oncologists at Virginia Oncology Associates are here to talk with you about the best treatment plan for your individual needs. If you have additional questions, our specialists have gathered answers to commonly asked questions about prostate cancer. We also offer second opinions so you can feel confident in the recommended course of action. Request an appointment at one of our cancer centers in the Hampton Roads and Northeastern North Carolina areas.