Prostate Cancer Treatments, Outcomes, and Prognosis

There are few things more frightening, stressful, or life-life changing than a cancer diagnosis. And for men, prostate cancer is a particularly invasive and upsetting illness. It’s also a particularly common condition, affecting 191,930 men in the US last year alone1. This is the second most common cause of cancer in men, following skin cancer. Fortunately, it is also one of the most treatable.

The 5-year survival rate for men with prostate cancer discovered in the local or regional state (which accounts for 90% of cases) has a 5-year survival rate of nearly 100%. Those are exceptionally good odds. For those cases where the cancer has begun to spread to neighboring regions, this number falls to 30%.

In other words, the single most important factor when dealing with prostate cancer, is how quickly it is discovered. As long as the cancer is found before it has a chance to spread, then it can be effectively treated. This article will examine the nature of prostate cancer, and the treatment options.

What Causes Prostate Cancer

To best understand the prostate cancer treatment options, it is pertinent to understand what causes cancer and how it affects the body.

Essentially, cancer is caused by mutations in DNA. The DNA is the genetic code housed in the nucleus of every single cell in your body. This code tells the cell how to behave and what to do, but it is also the “blueprint” that the body uses to create more cells like it. Over time, cells die and new ones form to take their place. This process occurs via something called mitosis: the division of one cell into two new identical ones.

During mitosis, it is the DNA that is referred to by the body to ensure that each cell is the exact same and functions as it should. Problems occur however when DNA becomes damaged due to free radicals, radiation, age, or unknown factors. With faulty DNA, the body begins to make faulty copies of the cell. This is what we call a cancerous cell.

In fact, all of us have cancerous cells throughout our body. Fortunately, they are too few in number to cause any negative effects. Most of them will die with time, and we will continue to function normally and healthily.

The problems occur when those unhealthy cells split and divide again. And again. Gradually, this causes the cancer to spread and to form a legion. That legion eventually grows to the point where it constitutes a large amount of tissue taking up the organ. Once the tumor becomes too large, the organ stops functioning properly. Depending on where the tumor is located, this can result in a number of unwanted symptoms.

In the case of prostate cancer, this will typically include urgency, blood in the urine, weak urine flow, pain and burning during urination, and similar effects2.

How Prostate Cancer is Treated

Treatments for prostate cancer then are centered around preventing the spread of cancerous cells. This can include removing the tumor, or targeting damaged cells with various procedures such as radiotherapy.

Therefore, the following treatments are the most commonly available:

Surgery: Surgery is a prostate cancer treatment that is used simply to remove the tumor. This will involve removal of the entire prostate in most cases (radical open prostatectomy), which can risk damaging sexual function. Nerve-sparing surgery can be used to increase the chances of a man maintaining sexual function post-surgery. Other potential side effects include urinary incontinence.

Other surgery options are robotic or laparoscopic prostatectomy which uses a camera and instruments inserted through a keyhole incision. This can then be used to remove the prostate.

Transurethral resection of the prostate involves surgery to relieve urinary blockage, though this won’t treat the cancer itself.

Radiation Therapy: External beam radiation therapy is the most common type used to treat prostate cancer. This involves the use of x-rays applied to the area, which can destroy the cells. The concern with these x-rays is that they also destroy healthy cells, which can lead to a number of unwanted symptoms and a general feeling of being unwell among patients. However, a particular type of treatment called Conformal Radiation Therapy (CRT) can be used to minimize this damage to the surrounding healthy tissue and organs.

Another form of external beam radiation therapy is something called hypofractionated radiation therapy. This form uses higher doses, but over a shorter term. This has been found to be effective for those with early-stage prostate cancer.

Brachytherapy is a more extensive treatment that involves the insertion of radioactive sources directly inside the damaged tissue (in this case the prostate). These sources are referred to as seeds and will release radiation in only that specific area. The amount of time they work for can depend on the precise nature of each seed however. They are left in the prostate indefinitely and may work for up to 1 year.

Chemotherapy: Chemotherapy is a treatment that works similarly to radiotherapy, except that it uses chemicals rather than radiation in order to destroy the cancer cells. This also helps to reduce the growth rate of cancerous cells.

Chemotherapy is mostly used for advanced or castration-resistant prostate cancer and is not considered a first option. That’s because chemotherapy does not only affect the damaged prostate, but will affect the entire body. Also found to be effective, is to add testosterone suppression therapies to the chemotherapy, which can significantly lengthen lifespan.

Immunotherapy: Immunotherapy is a form of treatment used specifically to boost the body’s own defenses against cancerous materials. This can be used in combination with other types of treatment.

Vaccine therapy uses sipuleucel-T, which is adapted to be unique for each patient. First, blood is removed from the patient via a process called leukapheresis. Special immune cells can then be removed from the blood and modified in the lab before being reinserted. The body will then have learned to recognize and destroy prostate cancer cells, if all goes to plan. Because this treatment does not lead to shrinking of the tumor, or lower PSA levels, it is difficult for physicians to monitor the progress and effectiveness of the treatment.

Other Treatments: There are many other treatments available for treating prostate cancer, as well as treatments used to manage the symptoms and to control the side-effects of other treatments. These include bone modifying drugs for example, which can be used to help combat the weakening of bone in response to testosterone suppression. Radiopharmaceuticals can be used to treat castration resistant patients.

Keep in mind that often the treatment recommended will be “watchful waiting.” As the term suggests, this simply involves watching the patient’s progress and waiting for the right time to act.

Alternative Remedies

As well as many medical treatments, there are also alternative remedies for prostate cancer. These include the use of strong vitamin supplements, herbal remedies, light therapies, and homeopathy.

While it is true that supporting a healthy immune system with nutrients and vitamins can help to improve outcomes, it’s also extremely important to not to ignore the value of medical treatments: even where they might be expensive.

The most important thing with any form of cancer is to identify the issue as early as possible, and then to speak with your GP about treatment options.

  1. Prostate Cancer: Statistics
  2. Prostate Cancer: Symptoms and Signs