By Dr Ananya Mandal, MD
Prostate cancer is a slow growing cancer that may not cause symptoms for years. In cases where the cancer is detected early, an approach called watchful waiting or active surveillance may be adopted if the cancer appears to be slow growing and is confined to a small area of the prostate.
In other cases, immediate surgery to remove the tumour may be recommended and followed up with other forms of therapy such as radiotherapy or chemotherapy.
Some examples of the treatment options in prostate cancer include:
- Watchful waiting or active surveillance
- Surgical removal of the prostate
- Radiation therapy
- Hormonal therapy
The healthcare team in prostate cancer
The team that manages patients with prostate cancer may be made up of multiple specialists including a urologist or specialist in urology, an oncologist or cancer specialist and a radiotherapist who specializes in radiotherapy techniques. Other members of the team may include nurses, nutritionists, social workers and counsellors.
An outline of the treatment approach to prostate cancer is given below:
Since prostate cancer is a slow growing cancer, treatment is often delayed if the cancer is caught in the early stages and the patient is instead regularly monitored for progression of the cancer. Monitoring involves blood tests to check for levels of prostate-specific antigen (PSA, a marker for prostate cancer), digital rectal exams (DREs) to feel for abnormalities of the prostate gland through the wall of the rectum, and regular ultrasound scans which can show whether the cancer is growing.
Surgical removal of the prostate
Sometimes prostate cancer may be treated when caught in the early stages. Radical prostatectomy may be performed in which the entire prostate gland as well as some of the surrounding tissue and the seminal vesicles are removed.
Transurethral resection of the prostate (TURP) is a minimally invasive procedure that may be performed in order to relieve symptoms in those with advanced prostate cancer.
Radiotherapy uses high-energy rays to kill cancer cells. External beam radiation may be delivered by a machine that moves around the patient's body directing the beams at the prostate cancer or sources of high-dose radiation may be implanted inside the prostate gland, a treatment known of as brachytherapy.
This involves the use of extremely cold temperature to freeze cancer cells and kill them.
The male hormones or androgens fuel the growth of cancer cells in the prostate and hormonal therapy is designed to prevent this hormone dependent growth. The most important hormone for the growth of prostate cancer is testosterone, which is mainly produced in the testicles. Medications used in hormonal therapy can either stop the body producing testosterone or prevent the hormone form reaching the cancer cells. Another form of hormonal therapy is orchiectomy or removal of the testicles to quickly reduce the level of testosterone produced.
Chemotherapeutic drugs are anti-cancer agents that kill cancer cells. These are used when the prostate cancer has spread outside the prostate gland or when a patient is not responsive to hormonal therapy.
Reviewed by Sally Robertson, BSc