Understanding Prostate Cancer Treatment Options

Prostate cancer treatment has advanced significantly, offering a range of options tailored to individual needs. The best approach depends on factors like the cancer’s stage and type, the patient’s age and overall health, and potential side effects. While standard treatments exist, clinical trials provide opportunities to access and contribute to the development of improved therapies. This article provides an overview of current treatment options, from hormone therapy and chemotherapy to targeted immunotherapy and surgical interventions.

Medication Options

A cancer care team often prescribes medications to manage prostate cancer, aiming to block hormones, kill cancer cells, or boost the immune system.

Hormone Therapy

Also known as androgen deprivation therapy (ADT), hormone therapy works by removing or blocking the action of male sex hormones (androgens) that fuel prostate cancer growth. Common medications include:

• Luteinizing hormone-releasing hormone (LHRH) agonists: Such as leuprolide (Lupron, Lupron Depot, Eligard, Prostap, Viadur), goserelin (Zoladex), degarelix (Firmagon), and relugolix (Orgovix), which stop the testicles from producing testosterone.
• Antiandrogens: Like apalutamide (Erleada), darolutamide (Nubeqa), flutamide (Euflex, Euflexin), and enzalutamide, which block the effects of androgens.
• Abiraterone acetate (Zytiga): This medication prevents cancer cells from producing androgens.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing them or preventing their division. Docetaxel (Taxotere) is the most common chemotherapy drug used for prostate cancer, often administered with steroids. Cabazitaxel (Jevtana) may be used if docetaxel is no longer effective.

Targeted Therapy

Targeted therapies identify and attack specific targets on cancer cells. PARP inhibitors, such as olaparib (Lynparza), block an enzyme involved in DNA repair and are recommended for some men with mutations in genes like BRCA1 or BRCA2.

Immunotherapy

Immunotherapy harnesses the body’s own immune system to fight cancer. Sipuleucel-T (Provenge) is an immunotherapy option used for prostate cancer that has spread.

Surgical Options

Surgery may be recommended for men with otherwise good health whose tumor hasn’t spread beyond the prostate gland.

• Radical Prostatectomy: This involves removing the entire prostate, surrounding tissue, and seminal vesicles, performed through an abdominal or perineal incision, or using laparoscopic or robot-assisted surgery.
• Pelvic Lymphadenectomy: This procedure removes lymph nodes in the pelvis to check for cancer cells.
• Transurethral Resection of the Prostate (TURP): Tissue is removed from the prostate using a tool inserted through the urethra, often to relieve urinary blockage before other treatments.

Cryosurgery or cryotherapy, which uses freezing to destroy cancer cells, is currently available only in clinical trials.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells.

• External Radiation Therapy: Radiation is delivered from a machine outside the body, using techniques like conformal radiation (shaping beams to the tumor) and hypofractionated radiation (larger doses over fewer days). Proton therapy is a more precise form of external radiation that may reduce side effects.
• Internal Radiation Therapy (Brachytherapy): Radioactive seeds, needles, or wires are placed directly into or near the cancer.
• Radiopharmaceutical Therapy: A radioactive substance is injected into the bloodstream to treat cancer that has spread to the bone, such as with radium-223.

Watchful Waiting and Active Surveillance

These approaches defer immediate treatment but differ in their monitoring intensity. Watchful waiting involves monitoring without treatment until symptoms develop, typically for older men with limited life expectancy or advanced cancer. Active surveillance closely monitors early-stage cancer in healthy men who wish to avoid immediate treatment side effects, postponing radiation or surgery until signs of progression appear.

Managing Erectile Dysfunction

Erectile dysfunction is a common side effect of prostate cancer treatment. After two years, 3 to 6 in 10 men may regain their pretreatment sexual function, varying with the treatment type. Options include oral medications, locally applied therapies, penis pumps, and implants.

The Role of Clinical Trials

Clinical trials are vital for evaluating modern treatments and improving existing ones. They play a crucial role in securing FDA approval for new drugs and expanding treatment options. Trials span the entire prostate cancer experience, from localized disease to advanced stages, and even include lifestyle interventions. Participating in a clinical trial can provide access to cutting-edge therapies and contribute to advancements in prostate cancer care.