Prostate cancer is the second most common cancer in men worldwide. It affects cells in the prostate gland, a vital part of the male reproductive system. This article outlines the best treatment options available for prostate cancer.
Surgery
Surgery aims to remove the prostate and surrounding tissue. Several surgical approaches exist:
Radical Retropubic Prostatectomy
An open procedure where the surgeon makes an incision from the belly button to the pubic bone to remove the prostate and seminal vesicles. Performed under general, spinal, or epidural anesthesia.
Lymph nodes in the pelvis may also be removed. This older method is less common now, replaced by minimally invasive techniques. Nerve-sparing variants help preserve sexual function, but urinary incontinence remains a possible side effect.
Radical Perineal Prostatectomy
The incision is made between the scrotum and anus, not on the abdomen. This shorter procedure is rarely used due to:
- Higher risk of erectile dysfunction.
- Inability to remove pelvic lymph nodes.
Considered only if sexual function is not a concern and lymph nodes are unaffected.
Laparoscopic Prostatectomy
Minimally invasive surgery using small abdominal incisions. A camera and instruments are inserted through these keyhole cuts.
Compared to open surgery, it results in less pain, reduced bleeding, and faster recovery. Side effects (urinary incontinence, sexual dysfunction) are similar to open procedures.
Robotic Laparoscopic Prostatectomy
Also known as robotic prostatectomy, this uses robotic arms controlled by the surgeon. Small incisions allow precise movements.
Benefits include reduced blood loss, less pain, and quicker recovery. Side effects are comparable to other surgical methods.
Transurethral Resection of the Prostate (TURP)
Used primarily for benign prostatic hyperplasia (BPH), not cancer. A resectoscope is inserted through the urethra to cut and remove excess tissue, which is flushed into the bladder.
No external incision is required.
Radiation Therapy
Uses high-energy X-rays to kill cancer cells. Recommended based on cancer stage and patient health.
Used for:
- Localized low-grade cancers (cure rates similar to surgery).
- Advanced cancers, combined with hormone therapy.
External Beam Radiation Therapy (EBRT)
Radiation is directed at the prostate from an external machine. Used to cure early-stage cancer or relieve symptoms (e.g., bone pain) in advanced cases.
Newer techniques allow higher doses with less damage to surrounding tissues.
Brachytherapy
Radioactive sources are placed directly into the prostate near the tumor.
- Temporary: Wires (Palladium-103 or Iodine-125) are inserted for minutes and then removed.
- Permanent: Small radioactive seeds are implanted and release radiation slowly over time.
Cryotherapy
Also called cryosurgery, this uses extreme cold to freeze and destroy cancer cells and most of the prostate. Used as an alternative to surgery or primary treatment for early-stage cancer.
Chemotherapy
Used when cancer has spread beyond the prostate and hormone therapy fails. Common drugs include:
- Docetaxel (Taxotere)
- Estramustine (Emcyt)
- Cabazitaxel (Jevtana)
- Mitoxantrone (Novantrone)
Hormone Therapy
Also known as androgen suppression therapy, it reduces male hormones (androgens like testosterone and DHT) that fuel cancer growth.
Approaches include:
- Orchidectomy: Surgical removal of testicles to stop androgen production.
- LHRH Agonists: Injections that reduce testosterone (e.g., Leuprolide, Goserelin, Triptorelin).
- LHRH Antagonists: Like Degarelix (Firmagon), which lower testosterone quickly without initial tumor flare.
Immunotherapy
Stimulates the immune system to attack cancer cells. For prostate cancer, a vaccine called Sipuleucel-T is used to enhance immune response against cancer cells.
Many symptoms of prostate cancer—difficulty urinating, frequent urination, burning sensation—are often mistaken for aging. Consult a specialist for screening and risk assessment. If you or someone you know has been diagnosed, explore all treatment options with a qualified oncology team.