The treatment options for prostate cancer can vary depending on a number of factors. These factors also affect the prognosis of the disease. The most important factor when determining which treatment option is best is the stage of the prostate cancer. The stage of the cancer is determined by multiple factors including the Gleason score, the PSA level, the grade of the tumor, how much the prostate is affected by the cancer, and whether the cancer has spread beyond the prostate and to other areas in the body.

The prognosis and treatment options also depend on the patient’s age, whether the cancer has just been diagnosed or has recurred, whether the patient has other health conditions, the side effects of the treatment, and if the patient has previously been treated for prostate cancer. The following are the stages of prostate cancer and the types of treatment options that are available at each of those stages:

Stage I prostate cancer:

Radical robotic prostatectomy
External-beam radiation therapy (EBRT)
Watchful waiting or active surveillance
Interstitial implantation of radioisotopes

Stage II prostate cancer:

Radical robotic prostatectomy
External-beam radiation therapy (EBRT) with or without hormonal therapy
Watchful waiting or active surveillance
Interstitial implantation of radioisotopes

Stage III prostate cancer:

Radical robotic prostatectomy with or without EBRT
External-beam radiation therapy (EBRT) with or without hormonal therapy
Hormonal manipulations (orchiectomy or luteinizing hormone-releasing hormone agonist)
Watchful waiting or active surveillance

Stage IV prostate cancer:

Hormonal manipulations
Bisphosphonates
External-beam radiation therapy (EBRT) with or without hormonal therapy
Palliative radiation therapy
Palliative surgery with transurethral resection of the prostate (TURP)
Watchful waiting or active surveillance

Recurrent prostate cancer:

Chemotherapy for hormonal management of prostate cancer
Immunotherapy

Radical robotic prostatectomy (aka Da Vinci Robotic Prostatectomy/Robotic-Assisted Laparoscopic Radical Prostatectomy):

Minimally-invasive surgical procedure to remove the prostate gland. This surgery is performed by a trained and skilled surgeon who uses a computer-enhanced robotic surgical system that is located next the operating table. The surgical system is composed of three main parts: a vision system with high magnification and resolution, robotic arms and instruments, and a console that the surgeon uses to view the operative field and control the instruments.

External-beam radiation therapy (EBRT):

External-beam radiation therapy targets the prostate gland with beams of radiation from a machine that sits outside the body. It is a three-dimensional conformal radiation therapy that creates a map of where your prostate is located using specialized computer systems. Radiation beams then target the prostate from several directions. The radiation oncologist will fit your body for a plastic mold to ensure you are in the same position for each treatment session. Intensity modulated radiation therapy (IMRT) uses a machine that moves around the patient while it targets and delivers radiation. The intensity of radiation can also be adjusted with this machine. There is also new technique called image-guided radiation therapy (IGRT) which is a computer-driven radiation machine that has imaging scanners to deliver treatment.

Watchful waiting or active surveillance:

This is not a type of treatment, but involves a continued monitoring of the prostate cancer through PSA blood tests, DREs, and ultrasound scans. Prostate biopsies may be done as well to monitor the aggressiveness and advancement of the tumor.

Hormonal manipulations:

An orchiectomy is the surgical removal of the testicles and luteinizing hormone-releasing hormone agonist is an injection like Lupron depot. Both are used to stop the production of testosterone because this hormone drives prostate cancer cell growth.

Bisphosphonates:

A group of drugs that can help relieve pain and high calcium levels caused by cancer that has spread to the bones.

Palliative radiation therapy:

Palliative therapy means "comfort care". Used to control the symptoms associated with tumors that cannot be treated by other treatment options. This is intended to maintain quality of life for patient’s whose cancer has spread beyond the prostate in which long-term control of the cancer is not possible.

Palliative surgery with transurethral resection of the prostate (TURP):

A TURP may help relieve urinary obstruction caused by advanced prostate cancer. Also intended to maintain quality of life for patient’s whose cancer has spread beyond the prostate in which long-term control of the cancer is not possible.

Chemotherapy:

Anti-cancer drugs are taken either orally or are injected to stop the growth of prostate cancer cells by killing them or restricting their division to other parts of the body.

Immunotherapy:

Biological substances are created in a lab or by the body and are used to boost the immune system to enhance the body’s ability to repair itself and prevent the growth and spread of prostate cancer cells. A new type of immunotherapy that has recently been released to the market is Provenge. Provenge is the first FDA approved Immunotherapy treatment and vaccine.

Prostate Health

PROSTATE HEALTH

Prostate cancer treatment options by stage