The prostate cancer treatment that’s right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of cancer, your symptoms, and your general health. Your prostate cancer doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Choose a type of prostate cancer treatment below to learn more: 

Active Surveillance

You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early-stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.

Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.

If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. Treatments you’ll receive may include surgery, radiation therapy, or another approach.

Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.

Another approach for smaller prostate tumors that don't show symptoms is watchful waiting. Watchful waiting is similar to active surveillance in that your oncologist will monitor the tumor and avoid treatment until it's necessary. This hands-off approach means that you won't require as many tests, especially when compared to the more frequent testing involved in active surveillance. 

If you choose active surveillance or watchful waiting but grow concerned later, you should discuss your feelings with your prostate cancer specialist.

Radiation Therapy for Prostate Cancer

Radiation therapy is an option for men with any stage of prostate cancer. Men with early-stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

  • Internal radiation (implant radiation or prostate seed brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months and don’t need to be removed once the radiation is gone. This type of internal radiation is known as prostate seed brachytherapy. 
  • External radiation: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to target cancer and lessen the damage to healthy tissue near the prostate.

Compass Oncology's radiation oncologists also offer an approach to radiation therapy called hypofractionated radiation therapy that administers the same amount of radiation in a shorter time period. This more advanced technology precisely delivers the rays of radiation where the cancerous cells are by treating them with a higher dose while sparing nearby organs and tissues. The same results can be achieved in 4-5 weeks instead of receiving 6-8 weeks of treatment by giving a higher dose of radiation at each session. The total treatment sessions depend on where the cancer is located, its size, and the patient’s overall health. 

Both internal and external radiation can cause impotence. Often, this improves for most men after treatment has ended. You can talk with your doctor about ways to help cope with the side effects of radiation therapy. 

SpaceOAR™ Hydrogel can reduce other side effects of radiation treatments for prostate cancer. Dr. Faisal Siddiqui is a board-certified radiation oncologist at Compass Oncology who specializes in SpaceOAR™ placement and is recognized as a Center of Excellence for SpaceOAR Hydrogel.

SpaceOAR_Center-of-excellence-compass-oncology

Talk to your doctor or visit our SpaceOAR™ Hydrogel webpage to learn more.

Find the latest radiation therapy for prostate cancer treatment options at Compass Oncology. Our radiation oncologists are located in Portland and Tigard, Oregon, and Vancouver, Washington, so it’s convenient for local residents to receive radiation therapy close to home. 

Find a Radiation Oncologist

Hormone Therapy for Prostate Cancer

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.

A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment. Prostate cancer that has spread outside of the prostate to other body parts is usually treated with hormone therapy. Some men find hormone therapy to be effective in controlling the cancer for two or three years, but others men have a shorter response to it. After some time, prostate cancers grow with little or no male hormones, making hormone therapy ineffective when used alone. If this happens, your oncologist may suggest chemotherapy or another treatment method. Often, continuing with hormone therapy is recommended because it may still be effective against some cancer cells.

Hormone therapy uses drugs or surgery:

  • Drugs: Your doctor may suggest a drug that can block natural hormones:
    • Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
    • Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
    • Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.
  • Surgery: Surgery to remove the testicles is called orchiectomy.

After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles, the major source of male hormones. Because the adrenal gland makes small amounts of male hormones, you may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade (also called combined androgen blockade). However, studies have shown that total androgen blockade is no more effective than surgery or an LH-RH agonist alone.

Find a Prostate Cancer Specialist in portland-vancouver

PSMA Therapy for Advanced Prostate Cancer

Metastatic prostate cancer or advanced prostate cancer starts in the prostate gland and spreads to other parts of the body. Long-term survival from prostate cancer, meaning 5 to 10 years after diagnosis, is high when it is diagnosed early and found in only the prostate and nearby parts of the body. However, the survival rate is significantly shorter after being diagnosed with advanced prostate cancer. 

Men with metastatic castration-resistant prostate cancer (mCRPC), an advanced stage of prostate cancer, have access to a promising treatment that combines new diagnostic imaging with a therapy recently approved by the US Food and Drug Administration that targets and destroys prostate cancer cells.

What Advanced Prostate Cancer Patients Can Expect

Eligible patients will be scheduled for an imaging exam and an injection of a new tracing agent called Pylarify®, which provides clearer and earlier visibility of tumors than other imaging technologies. 

Next, eligible patients will receive a therapy called Pluvicto™ over the course of 6-9 months. Pluvicto™ is a targeted therapy that releases radiation to target PSMA expressed on prostate cancer cells, destroying them while sparing healthy surrounding tissue.

The combination of Pylarify® and Pluvicto™ is a breakthrough for advanced prostate cancer patients whose cancer has spread or grown resistant to other forms of treatment. Until recently, these men had limited treatment options, but advances in imaging technology and recent clinical trial studies of Pluvicto™ have shown “significantly extended survival among patients with metastatic castration-resistant prostate cancer.”  

Surgery to Remove the Prostate

Surgery is an option for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

  • Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
    • Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
    • Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
  • Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
  • Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
  • Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study. See the section on Taking Part in Cancer Research.
  • TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.

If your prostate is removed, you will no longer produce semen. You’ll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery. 

Read our blog about prostate removal surgery and the side effects to learn what to expect from life after prostate removal.

Immunotherapy for Prostate Cancer

Immunotherapy boosts the body’s immune system to help destroy cancer cells. The use of immunotherapy for prostate cancer has seen much promise and potential for changing how this disease is treated. 

According to the American Cancer Society, one promising approach for the future might be to combine a checkpoint inhibitor with a prostate cancer vaccine. This combination could strengthen the immune response and help a vaccine be more effective.

Chemotherapy

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

Prostate Cancer Clinical Trials

A clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. We currently have several clinical trials open for prostate cancer patients diagnosed at various stages of the disease. Consult with your cancer care team at Compass Oncology to learn more about clinical trials for prostate cancer and if one is right for you.

About Clinical Trials for Prostate Cancer

The Latest Prostate Cancer Treatments Available at Compass Oncology

If you or a loved one have been recently diagnosed with prostate cancer, the oncologists at Compass Oncology are here to help you navigate your cancer treatment journey. We offer the latest prostate cancer treatments available with personalized treatment plans tailored to you. Our cancer centers are located throughout the Portland and Vancouver metro area. 

Find a Compass Location Near You