Treating Prostate Cancer: Know Your Options Beyond Surgery

Author: Patrick Richard, MD

When you are diagnosed with prostate cancer, your first thought might be how your condition will affect your life. Some prostate cancer treatments, such as surgery, can have lasting side effects, but you may not need treatment right away. In some cases, your doctor might simply monitor the cancer before recommending active treatment (active surveillance).

Weighing Your Options for Prostate Cancer Treatment

Around 1 in 8 American men will be diagnosed with prostate cancer at some point during their life. It’s the second most common cancer in men behind skin cancer and it is more common among older men. The good news is that prostate cancer has a relatively high survival rate. This is partly because the cancer often grows very slowly and is usually detected early before it has spread to other parts of the body. 

Have you or a loved one been diagnosed with prostate cancer? Get our free guide for on how to evaluate your treatment options. 

What is the most successful treatment for prostate cancer?

That depends on the individual patient. To determine the best course of action in your case, oncologists consider several factors, including:

• Possible side effects of treatment
• The stage of the cancer
• Whether it is a new or recurring cancer 
• Your age, overall health, and preferences
• Life expectancy

“After getting a diagnosis of prostate cancer, many patients have a lot of questions about what to expect and whether it’s necessary to pursue aggressive treatments,” said Dr. Patrick Richard, radiation oncologist at Rocky Mountain Cancer Centers. “Everyone’s experience is different, and it’s important to learn all you can from your doctor about your specific type of prostate cancer and the various types of treatment.

At RMCC, we perform a detailed assessment of each patient’s prostate cancer case to assess individual baseline risk and how our treatments may or may not benefit. In addition, most cases are presented at our multidisciplinary prostate cancer conference where all our prostate experts can give evidence-based recommendations to guide the most appropriate treatments for our patients.”

Staging Prostate Cancer

The stage of prostate cancer indicates how serious the cancer is and whether it has spread beyond the prostate. Doctors and pathologists use several key pieces of information to determine the stage:

• The extent of the main tumor
• The grade group based on the Gleason score, which shows how cancer cells taken during a prostate biopsy look in comparison to normal tissue. The Gleason score is measured on a scale of 2 to 10. A score of 6 or less is low-grade, 7 is intermediate grade, and 8 to 10 is high grade. 
• Whether the cancer has metastasized, or spread to other parts of the body
• Whether the cancer has spread to nearby lymph nodes

“While the stage of prostate cancer indicates how serious the cancer is, it isn’t the only factor used to determine whether prostate cancer is likely to grow and spread,” Dr. Richard said.

What You Need to Know About Surgery to Remove the Prostate

Surgery can  be a good option to treat prostate cancer before it spreads beyond the prostate gland. The main surgery for prostate cancer is a radical prostatectomy, a procedure most commonly performed laparoscopically – which means the surgeon removes the entire prostate through a small incision using tiny telescoping tools. A prostatectomy can also be performed using robotic-assisted surgery, which can minimize pain and blood loss and lead to a faster recovery than traditional open surgical methods.

“For some people, surgery can be curative,” Dr. Richard said. “But it can also have extensive side effects, so it’s not necessarily the right option for everyone who has early-stage prostate cancer.”

Possible side effects of prostate removal surgery include:

• Erectile dysfunction. In some cases, the nerves that control erections, located on either side of the prostate, must be removed during surgery, resulting in an inability to get erections naturally. Even when both nerves aren’t removed, there is still a chance for erectile dysfunction.
• Inguinal hernia. Men who have a prostatectomy are at higher risk of developing inguinal, or groin, hernias.  
• Loss of fertility. Although men who have their prostate removed still make sperm, they are no longer able to release the sperm, which means a loss of fertility. This is not a concern for many older men, but men who would like to have children might want to consider “banking” sperm prior to surgery.
• Lymphedema. This is a rare side effect in which the removal of lymph nodes causes fluid to pool in the legs or genital area, leading to swelling and pain.
• Urinary incontinence. This means you have leakage, are unable to control urination, have trouble fully emptying your bladder, or have sudden urges to urinate. For most men, this side effect improves in the weeks and months following surgery.

Beyond the Operating Room: Other Prostate Cancer Treatments to Consider

Surgery isn’t the right choice for everyone. Your doctor may recommend other forms of treatment, including:

• Chemotherapy. While not a standard treatment for low-grade prostate cancer, chemotherapy is sometimes used when the cancer has spread and can be given in conjunction with hormone therapy. 
• Hormone therapy. This treatment reduces levels of male hormones called androgens, which can fuel prostate cancer cells. Doctors may recommend hormone therapy if your cancer has spread or has recurred after other treatments. In some cases, you may need surgery to remove the testicles, where androgens are produced.
• Immunotherapy. This type of medicine stimulates the immune system, helping it to kill cancer cells more effectively. Different kinds can be used to treat some prostate cancers. 
• Radiation therapy. Radiation kills cancer cells with high-energy rays directed at the cancer. This is often used for low-grade cancers as an alternative to surgery, with similar cure rates. It can also be combined with hormone therapy for higher-grade cancers or recurring cancers. 
• Targeted therapy. Targeted therapies attack cancer cells while preserving healthy cells. They work by changing the programming in cancer cells which causes them to grow and interact with other cells. 

Learn more about prostate cancer treatment options other than surgery.

Advanced Prostate Cancer Has New Treatment Options

Men with metastatic castration-resistant prostate cancer (mCRPC), an advanced stage of prostate cancer, now have access to a promising treatment that combines new diagnostic imaging technology with a therapy recently approved by the US Food and Drug Administration that targets and destroys prostate cancer cells. Called PSMA therapy, this is a recent treatment option that you can discuss with your oncologist to see if it's right for you.

Your oncologist understands the pros and cons of each treatment and how they can impact you now and in the future. Be sure to articulate your goals for treatment when you’re discussing your care plan so your doctor can recommend the right treatment for you.

Should You Wait Before Starting Prostate Cancer Treatments?

All treatments for prostate cancer have side effects. When the cancer is diagnosed at an early stage, doctors often recommend waiting before taking further action. This can mean one of two things:

1. Active surveillance. In this approach, the doctor monitors your cancer closely without administering treatment. Usually, you will visit the doctor every six months and get a PSA blood test to check for changes in your PSA level. You’ll also get a digital rectal exam at least once a year. In some cases, the doctor might recommend a prostate biopsy and imaging every one to three years as well. Based on the results of these tests, your doctor will determine if treatment becomes necessary.
2. Watchful waiting. This is a less intensive type of observation that requires fewer tests but focuses more on symptoms. If your symptoms worsen, your doctor will perform tests to determine if it’s time to begin treatment.

“Active surveillance and watchful waiting are often used for older men and those with low-grade cancers who want to avoid the side effects of cancer treatment,” Dr. Richard said. “Your doctor will continue to monitor you and be available for any questions and concerns you might have along the way. Because prostate cancer grows slowly, these can be appropriate options for many patients.”

At Rocky Mountain Cancer Centers, our cancer specialists are dedicated to creating a personalized care plan that is right for you. Find a prostate cancer doctor near you.