The prostate is a small gland located under the base of the urinary bladder which has many small glands that secrete a fluid which is a component of semen.  It is the cells of these glands which eventually become cancerous.  The incidence of cancerous changes in the prostate gland increases from about 30% in men in their fifties up to 80% in men in their seventies.  These incidence numbers come from autopsy exams in men that have died from other causes.  Prostate cancer is diagnosed in about 250,000 American men each year and kills about 30,000.  There are several different treatment options for prostate cancer which depend upon the extent of the disease when it is diagnosed, the age and other health conditions of the patient, and a consideration of the effects of treatment on other aspects of a man’s life.  This article will focus solely on the treatment options for prostate cancer.

Because prostate cancer is a slowly growing tumor, this approach can make sense for someone who is older and has other health problems that may make other treatments riskier.  The possibility certainly exists that the individual will die of something else prior to experiencing problems from the prostate cancer.  Younger men may also want to watch for a while to maintain their quality of life.  About one-third of men choose this approach.

Radiation can be used for both early, localized disease and for late disease that has spread. It can be used alone or in addition to other therapies. Brachytherapy is a special type of radiation therapy where about 100 radioactive pellets are placed with a needle through the skin directly into the tumor where they emit radiation for a very short distance in the tumor. The implant of the pellets can be done on an outpatient basis.

Radiation therapy can also take the form of external beam radiation where a linear accelerator is used to direct beams of radiation from outside the body into the tumor and kill the prostate cancer cells. Treatment is spaced over several weeks with daily visits to the radiation therapy center. Radiation therapy is often used when a patient may not be healthy enough for surgery.

Surgery is typically used for early, localized disease or disease that has failed to respond to other, less invasive treatments in reasonably healthy males.  In a radical prostatectomy, the entire prostate is removed.  This surgery can be done either with an incision across the abdomen, through an incision between the scrotum and the anus, or laparoscopically.  Currently, the robot assisted version (known as the da Vinci) is the first choice for treatment of localized prostate cancer.  The surgery often results in nerve damage that will affect the quality of life afterwards.

Cryosurgery involves exposing the prostate to extremely cold temperatures (as low as minus 302 degrees F) in order the freeze the cancerous cells and kill them.  Metal rods are inserted into the prostate using ultrasound as a guide.  The rods are then cooled by argon gas.  When used by an experienced surgeon, cryosurgery has a very good success rate, but the incidence of impotence following the procedure is close to 90%.

The purpose of hormonal therapy is to prevent the cancer cells from getting dihydrotestosterone which they require for growth.  This can be done surgically by removing the testicles or with various medications.  Unfortunately, the cancer cells can become resistant to this treatment after one to two years.  Hormonal therapy is usually used on cancers that have already spread beyond the prostate.

HIFU is another method that is used to physically destroy the cancer cells located in the prostate by heating them to 212 degrees F. The device is able to focus the ultrasound waves on the tumor and thus minimize side effects such as incontinence and impotence. Currently HIFU is not approved for use in the United States, but is available in Canada, Europe, Japan, and parts of Central and South America.

Chemotherapy is usually reserved for advanced prostate cancer that has spread.  Various chemotherapeutic agents have shown some promise in being able to slow progression of the disease and alleviate symptoms by reducing pain and prolonging life.

Prostate cancer, like any other cancer, can be very scary.  However, survival is improved with early detection.  There are many treatment options for prostate cancer which can offer the possibility of prolonged remission or cure.  You should consider the benefits and risks for the various treatment options and discuss these your his doctor.