Prostate Cancer

Active surveillance or watchful waiting

Active surveillance means that you will be watched closely by your doctor. If you are a younger or active man who is at low risk, this will mean regular checkups. If the cancer starts to grow more quickly, you will need to have other treatment, such as surgery. Your regular checkups may include Reference digital rectal exams Opens New Window, Reference PSA tests Opens New Window, and Reference biopsies.

Active surveillance is a good treatment choice for younger or active men who have low-risk cancer that hasn't spread.^{Reference 5}

• The main reason to choose active surveillance is to avoid or delay the side effects of treatments.
• The main reason to choose other treatment (and not active surveillance) is to not miss the chance to cure the cancer. If the cancer grows and spreads, it may be harder to treat.

Watchful waiting also means that you will be closely watched by your doctor. But the goal of watchful waiting is to treat symptoms that cause problems rather than to cure the cancer. For some older men or those who aren't expected to live more than 10 years, the main reason to choose watchful waiting is to have the best possible quality of life.

Radiation therapy

Reference Radiation therapy may be used alone or combined with Reference hormone treatment or surgery to treat prostate cancer. Like surgery, it is most effective in treating cancer that hasn't spread outside the prostate. When combined with surgery, radiation is used to destroy any cancer cells that might be left behind and to relieve pain when the cancer has spread.

Radiation treatment for prostate cancer includes:

• External radiation. Also called external beam radiotherapy, or EBRT, radiation therapy uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may make your symptoms worse. The most common forms of external radiation are:
  • Conformal radiotherapy (3D-CRT). It uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
  • Intensity-modulated radiation therapy (IMRT). It uses newer 3D-CRT technology to target the cancer.
  • Proton beam therapy. This is radiation therapy that uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which protects nearby healthy tissues (especially the rectum). Sometimes proton beam therapy is combined with X-ray therapy. (It is available only at big medical centers.)
• Internal radiation (brachytherapy). Brachytherapy is a one-time radiation treatment that uses tiny radioactive seeds. After you are given anesthesia, the doctor uses a needle to inject the seeds into your prostate, where they slowly release radiation directly into the cancer. Sometimes external radiation or hormone therapy is added to brachytherapy. If you already have urinary problems, brachytherapy may make your symptoms worse.
  • High-dose-rate (HDR) brachytherapy. For this form of brachytherapy, radioactive material is placed into the prostate for a very brief period of time (seconds to minutes) and then removed. The radiation is delivered this way several times.

Opens New Window Prostate Cancer: Should I Have Radiation or Surgery for Localized Prostate Cancer? Opens New Window

Cryosurgery

Reference Cryosurgery, also called cryoablation, freezes the prostate gland to kill the cancer. This is often done when surgery isn't an option and when the cancer is advanced but still inside the prostate gland. And the results, including side effects such as Reference incontinence Opens New Window or an injury to the rectum, depend very much on the doctor's skill and experience. With cryosurgery, the prostate gland isn't removed.

Clinical trials

Your doctor may talk to you about joining a research study called a Reference clinical trial if one is available in your area. Clinical trials are research studies to look for ways to improve treatments for prostate cancer.

One treatment being studied in clinical trials in the U.S. is high-intensity focused ultrasound (HIFU). This uses an intense heat from focused sound waves to kill cancer cells. HIFU is also used for men who have cancer inside the prostate but who cannot have surgery. HIFU is a treatment that is used in Canada, Europe, and the United States. In the U.S., HIFU is being used in clinical trials. It is not yet FDA-approved.

Complementary therapy

People sometimes use Reference complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

• Reference Acupuncture Opens New Window to relieve pain. Acupuncture may also help reduce hot flashes from taking hormone therapy.
• Reference Meditation Opens New Window or Reference yoga to relieve stress.
• Reference Massage and Reference biofeedback Opens New Window to reduce pain and ease tension.
• Reference Reference Breathing exercises for relaxation.

Mind-body treatments like those mentioned above may help you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies aren't meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

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