Prostate Cancer Treatment - One Size Doesn't Fit All

Prostate cancer treatments offer individualized solutions

/ Author:  / Reviewed by: Joseph V. Madia, MD

You hear the doctor say, "You have prostate cancer." Before the shock of that news wears off, you might be overwhelmed by all your options for treating the most common, non-skin cancer in men.

The good news is that when caught and treated early, the five-year survival rate for prostate cancer is 99 percent.

Plan on spending time asking questions, researching and talking because determining the best prostate cancer treatment option is a complicated process.

Shannon Cox, M.D., a board-certified cancer specialist at Austin Cancer Centers in Austin, Texas, tells dailyRx, "I usually spend at least an hour and sometimes two hours with patients going over all the treatment options. There's a lot to talk about."

Treatment decisions are based on the stage and grade of your cancer (how advanced the disease is), if the cancer is growing, your age and general health. Then you'll want to know and weigh the risks, benefits and side effects of each treatment and how they will impact your quality of life.

Treatment overview

Most cancer treatment involves some combination of surgery, chemotherapy and radiation. Prostate cancer has a number of other alternatives, ranging from watchful waiting to advanced individualized therapies. Here's an overview of the most common treatments:

No immediate treatment

If you're diagnosed with a low-risk prostate cancer, you may not need to be treated immediately. Instead, your condition may be closely monitored with what's known as "watchful waiting." Or you may have regular testing with "active surveillance" during which your healthcare provider is looking to see if the cancer gets worse. Should the cancer grow, then you can decide about treatment.


You and your physician may decide the best alternative is surgical removal of the prostate. The procedure is known as a radical prostatectomy, and there are several ways this surgery is performed.

Radiation therapy

Three different types of radiation are used to treat prostate cancers. External beam is focused on the area where the tumor is. With brachytherapy, radioactive beads are placed inside the prostate. Proton therapy is the newest technology used to zero in on the cancer itself, while sparing healthy nearby tissue.

Hormone therapy

Most prostate cancers are driven by the male hormone, testosterone.  Drugs are used to lower the levels of testosterone your body produces or blocks the hormone from reaching the cancer cells.

Freezing and heating tissue

Cryotherapy is a method used to freeze prostate tissue, thereby killing cancer cells. And high-intensity focused ultrasound does just the opposite - heating the tissue to kill the cancer.


This method involves using cancer-killing drugs.

Gene, vaccine, targeted therapies

Some treatment centers offer individualized cancer therapy that's based on the specific genetic mutations of your cancer.

Where to start

After diagnosis, the tissue is examined under a microscope to determine what's called the Gleason Score. This is a system of grading prostate cancer tissue to predict how likely the tumor will spread.  Gleason scores range from 2 to 10.The lower the score, the less likely the cancer will spread and the higher the score, the more serious the disease.

Additionally, the cancer will be staged. These classifications range from Stage I that indicates a small, low-risk tumor to the most advanced Stage IV, which means the cancer has spread beyond the prostate gland.

This information will be used by your physician to guide the discussion. The lower the Gleason score and Stage, the less intervention likely will be needed.

Different types of surgery

There are two main types of surgeries to remove the prostate.

With the first, an incision is made and the prostate is removed, along with surrounding tissue, nearby lymph nodes and seminal vesicles, if necessary. Surgical techniques vary primarily by where the incision is placed.

Laparoscopic surgery uses cameras attached to tiny tubes. Small incisions are made in the abdomen through which the tubes are inserted. The physician views what the camera sees on a monitor to guide the instruments. Robots can be used to assist in this surgery, which offers easier recovery and fewer complications.

Proton therapy 

The latest advancement in radiation for prostate cancer is proton therapy. This technology uses more powerful beams of high-dose radiation that can be delivered precisely to treat even difficult to reach tumors.

Perhaps the greatest benefit of proton therapy is its accuracy. Surrounding tissues aren't bothered. It's a painless method that requires very little down time.

Hormone therapies

Many prostate cancers are fueled by male hormones known as androgens. Testosterone is one such hormone.

Roughly one- third of prostate cancers require hormone therapy that's called androgen deprivation therapy (ADT) to reduce the tumor size or slow the cancer growth. While hormone therapy controls prostate cancer, it doesn't cure it.  

There are a number of different drugs used in this therapy. Sometimes the testicles (where testosterone is produced) are removed in a surgery known as an orchiectomy. This procedure causes permanent infertility and erectile dysfunction in 90% of men.

Side effects

All prostate cancer treatments have some side effects. Surgery can cause sexual dysfunction, urinary and bowel problems that can last months or years. Surgery and radiation can also cause permanent infertility.

Hormone therapy may also cause a number side effects, most of which can be effectively treated.

"One of the most important parts of our discussion has to do with quality of life issues," Dr. Cox said. "Each of the treatments has benefits that have to be carefully weighed with the risks and side effect profiles to arrive at the solution that works best for each man."

Helping you understand you options

The Baylor College of Medicine and The University of Texas MD Anderson Cancer Center collaborated to develop a tool to help men with localized prostate cancer understand their options. This multi-media was created for the John M. Eisenberg Clinical Decisions and Communications Science Center, with funding from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.

It's an excellent resource you can access below and may want to review as part of your research and discussions with your doctor in developing the best treatment plan for you.