What Are the Treatment Options for Prostate Cancer?

(Read time: 9 minutes)

This article is not intended to replace professional medical care or advice. If you have any questions or need additional information, please talk with your doctor.

If you or a loved one has been diagnosed with prostate cancer, it’s important to talk to your doctor about which treatment option is right for you. Discussing your options with other physicians and specialists, including radiation oncologists and urologists, may help you assess all available treatment options and potential outcomes.¹

What are the common treatment options for prostate cancer?

For most men diagnosed with prostate cancer, the common treatment options are:^2–5

• Active surveillance
• Surgery (a prostatectomy)
• Radiation therapy

Additional prostate cancer treatment options may include cryotherapy, hormone therapy, chemotherapy, and immunotherapy.²

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Treatment decisions are based on a combination of clinical factors, such as the stage and grade of cancer, your age, overall health, and the risks and benefits associated with each treatment option.²

Other factors to consider in your treatment decision may depend on the medical equipment available at different facilities. For example, some facilities may have proton centers, while others may be equipped with stereotactic body radiation therapy (SBRT), which can impact the type of treatments available to you.

With that in mind, let’s look at three common treatment options for prostate cancer, along with their potential side effects.

What is active surveillance for prostate cancer?

Active surveillance for prostate cancer involves regular checkups and monitoring of low-grade prostate cancers that have Gleason scores of 6 or less.^2,3 Active surveillance may be discussed alongside other treatment options for prostate cancer and may be used to help determine if or when additional intervention may be needed. Active surveillance may be an option if you:^2,3

• Are risk averse: Active surveillance is used to avoid treatment side effects when the risk of the prostate cancer progressing is very low
• Are older or have other serious health problems: In such cases, an invasive procedure such as surgery may not be a treatment option, especially with slow-growing cancer

Active surveillance is not for everybody. It is important to talk to your doctor to see if it’s the right fit.

What is surgery for prostate cancer (a prostatectomy)?

A prostatectomy, or the surgical removal of the prostate, is a common treatment plan for low-grade prostate cancer that has not spread beyond the prostate.^2,4

There are three major types of surgery for prostate cancer:

1. Radical retropubic prostatectomy

In this type of prostatectomy, the surgeon makes an incision in the abdomen and removes the prostate gland directly. This is the more common option because the surgeon can remove nearby lymph nodes as well if there’s concern the cancer could spread.^2,4

After surgery, you may need to stay in the hospital for a few days and limit your activity for a few weeks during recovery.⁴

2. Radical perineal prostatectomy

Radical perineal prostatectomy involves the surgeon making an incision between the scrotum and anus and removing the prostate gland. This operation is used less often because the potential for erectile dysfunction is higher and lymph nodes cannot be removed in this manner.⁴

For this type of procedure, a hospital stay of a few days followed by limited activity for several weeks during recovery is standard.⁴

3. [Robot-assisted] Laparoscopic radical prostatectomy

A more advanced prostatectomy involves manually guiding telescopic surgical instruments and a camera through ports in the stomach to the surgical site. The surgeon can perform the prostatectomy without major incisions, compared to the other methods.⁴

It’s important to note that any of these surgeries, like other treatment options, can lead to side effects, including erectile dysfunction and urinary dysfunction.⁴

Other problems that can occur during or after of a prostatectomy include, but are not limited to:⁴

• Reaction to anesthesia
• Bleeding
• Blood clots
• Nearby organs damaged
• Surgery site infections
   

What is radiation therapy treatment for prostate cancer?

Radiation therapy is often used to treat stage 1 and stage 2 prostate cancer and can often complement other treatment options (like hormone therapy or surgery) if the cancer has spread beyond the prostate and is stage 3 or above.^2,5

There are two main types of radiation therapy:

1. External beam radiation 

When undergoing external beam radiation, high-energy beams of radiation are focused on the prostate gland from a machine outside the body. Some potential benefits of external beam radiation may be:^5,6

• It’s non-invasive and the procedure itself is painless^5,6
• The treatment lasts only a few minutes and is an outpatient procedure^5,6
• Newer techniques and technologies allow higher doses of radiation to target the cancer, while limiting exposure to healthy tissues nearby^5,6
• Treatment success rates can be as high as 95% for intermediate-risk prostate cancer and 91% for high-risk prostate cancer⁷

External beam radiation can lead to various side effects, including but not limited to:^5,6

• Bowel problems
• Urinary problems
• Erection problems, including impotence
• Feeling tired
• Lymphedema

2. Brachytherapy (internal radiation)

There are two types of brachytherapy: low-dose rate (LDR) and high-dose rate (HDR).^2,5,6 Which type of brachytherapy you may receive depends on your specific situation.

With LDR brachytherapy, small seeds of radioactive pellets are placed into your prostate. Sometimes, the radioactive pellets are left in position permanently.^2,5,6,8

With HDR brachytherapy, multiple catheters attached to a single radioactive source are placed temporarily into the tumor for a few minutes and then removed. Tumors can be treated with very precise doses of localized radiation, which reduces the risk to surrounding healthy tissues.^2,5,6

The advantage of brachytherapy is that it has relatively high precision because the pellets can be placed in a very targeted manner.^2,5,6

The side effects from brachytherapy are similar to those from external beam radiation.^2,5,6

Newer technologies may reduce the risk of radiation therapy side effects

Although radiation therapy can be a very effective treatment option for many types of prostate cancer, the potential side effects may affect a patient’s quality of life.⁵

As an example, due to its proximity to the prostate, the rectum may be exposed to radiation that is targeting the prostate during external beam and brachytherapy radiation treatments. This exposure can lead to several side effects, including bowel problems.^9–11

Fortunately, advanced techniques and innovative products are helping mitigate the side effects of prostate cancer treatments like radiation therapy.^9–11

SpaceOAR™ Hydrogel is an absorbable polyethylene glycol (PEG) based hydrogel that works by creating a temporary space between the rectum and prostate and is designed to reduce the radiation dose delivered to the rectum during prostate cancer radiation therapy. The gel is made primarily of water and PEG. SpaceOAR Hydrogel is a pre-treatment option placed by a doctor that stays in place for about three months during radiation treatment. It is naturally absorbed by the body about six months after placement.^9–11

In a clinical study, 149 patients received SpaceOAR Hydrogel, and 73 patients did not.⁹ Three years after treatment:

• Bowel function (inability to control bowel movements, causing stool to leak unexpectedly from the rectum): SpaceOAR Hydrogel reduced declines in bowel quality of life by 70%¹⁰
• Urinary function (difficult or painful urination or leakage): fewer men with SpaceOAR Hydrogel had a decline in urinary issues compared to the patients who did not receive SpaceOAR Hydrogel¹⁰
• Sexual function: SpaceOAR Hydrogel patients who were potent at baseline (in other words, able to get an erection before their treatment) were 67% more likely to retain erectile function¹²

It is important to talk with your doctor about the benefits and risks associated with SpaceOAR Hydrogel. If you’d like to find a doctor or a specialist to discuss SpaceOAR Hydrogel, click on the link below and enter your ZIP code: