Treatment and Medication Options for Prostate Cancer
Different types of treatment are available for men with prostate cancer. Some treatments are standard, while other treatments may be available to you through clinical trials to expand or improve the standard treatments that are currently available.
The choice of treatment often depends on the cancer’s stage, type, and location, the individual’s age and overall health, and the expected side effects.
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Medication Options
A cancer care team prescribes medications for prostate cancer to block hormones, kill cancer cells, or boost the immune system.
Hormone Therapy This treatment, also called androgen deprivation therapy (ADT), removes or blocks the action of male sex hormones called androgens that cause prostate cancer to grow.
Medications include:
- Luteinizing hormone-releasing hormone agonists, such as leuprolide (Lupron, Lupron Depot, Eligard, Prostap, Viadur), goserelin (Zoladex), degarelix (Firmagon), and relugolix (Orgovix), to stop the testicles from making testosterone
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- Antiandrogens, such as apalutamide (Erleada), darolutamide (Nubeqa), flutamide (Euflex, Euflexin), and enzalutamide, to block the action of androgens
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- Abiraterone acetate (Zytiga) to prevent cancer cells from making androgens
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Chemotherapy This treatment uses drugs to stop the growth of cancer cells, either by killing them or by stopping them from dividing. A person may take chemotherapy medications by mouth or receive them by infusion or injection into a vein or muscle.
For people with prostate cancer, the most common chemotherapy drug is docetaxel (Taxotere). A doctor often gives this along with steroids. They may prescribe cabazitaxel (Jevtana) if this isn’t effective.
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Targeted Therapy These drugs identify and attack specific targets on cancer cells. PARP inhibitors, such as olaparib (Lynparza), block an enzyme involved in DNA repair with links to prostate cancer. Doctors recommend them for some men with mutations in genes like BRCA1 or BRCA2.
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Immunotherapy This therapy uses an individual’s own immune system to fight cancer. Sipuleucel-T (Provenge) is a type of immunotherapy oncologists use to treat prostate cancer that has spread.
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Bone Health Therapy Doctors prescribe drugs like zoledronate (Reclast, Zometa).
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Surgery
Your doctor may recommend surgery to treat prostate cancer in men with otherwise good health whose tumor hasn’t spread from the prostate gland. Surgical methods might include the following:
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- Radical Prostatectomy A surgeon removes the prostate, surrounding tissue, and seminal vesicles. They can perform this procedure through a cut in the abdomen or perineum or by using keyhole (laparoscopic) or robot-assisted surgery.
- Pelvic Lymphadenectomy This procedure involves removing lymph nodes in the pelvis to check their tissue for cancer cells.
- Transurethral Resection of the Prostate (TURP) A surgeon removes tissue from the prostate using a tool they insert through the urethra. They may perform this to relieve symptoms like a blocked urine flow before trying other treatments.
- Cryosurgery or Cryotherapy This treatment is currently only available in clinical trials and uses an instrument to freeze and destroy prostate cancer cells.
Radiation Therapy
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells.
- External Radiation Therapy A machine outside the body sends radiation toward the cancer. Approaches include conformal radiation (shaping beams to the tumor) and hypofractionated radiation (larger doses over fewer days). Proton therapy is a form of external radiation therapy that is more precise than other formats and may reduce the side effects of radiation.
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- Internal Radiation Therapy Also known as brachytherapy, this uses radioactive seeds, needles, or wires placed directly into or near the cancer.
- Radiopharmaceutical Therapy A radioactive substance is used to treat cancer. For example, radium-223 (an alpha emitter) is injected into the bloodstream to treat prostate cancer that has spread to the bone.
Watchful Waiting and Active Surveillance
These approaches both involve deferring an immediate treatment but differ in their intensity of monitoring. They may be helpful for older men without symptoms or those with other medical conditions.
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Watchful waiting involves closely monitoring the condition without giving treatment until signs or symptoms develop. Doctors usually use it for men with limited life expectancy due to age or other health problems, usually for advanced prostate cancer.
During active surveillance, a cancer care team may follow early-stage cancer in healthy men who’d prefer to avoid the side effects of treatment but are still looking to cure the disease. Active surveillance essentially postpones radiation therapy or surgery until the first sign that the cancer is progressing.
Erectile Dysfunction Management
Nearly every man who has prostate cancer treatment will have some issues with getting or maintaining an erection, known as erectile dysfunction. After two years, between 3 and 6 in 10 men will have returned to their pretreatment sexual function, although this can vary with the type of treatment a man receives.
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Options for achieving an erection are available, including:
- Oral medications
- Locally applied therapies like prostaglandin, sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra)
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- A device known as a penis pump that pulls blood into the penis using a vacuum seal
- Implants under general anesthesia that allow a man to press a release button and achieve an erection
Which measure you use may depend on your preferences, other health conditions, and your doctor’s advice. Many people who’ve had prostate cancer treatment have active and fulfilling sex lives afterward.
