Treatment of Prostate Cancer
If you are lucky, your cancer may grow at a prolonged rate and not need any treatment. However, most people have faster-growing prostate cancers which need treatment - sometimes immediate. This is especially true if they have one of the rare and fast-growing types of prostate cancer which are aggressive. Your doctor will keep in mind the following points before discussing and deciding upon a treatment plan with you:
● The stage, severity and extent of the cancer
● The risk of your cancer
● Your age and physical condition/health
● What your goals are and the types of treatments you would prefer
Depending upon the stage and extent of your cancer, you may be asked to undergo other diagnostic tests. These tests will influence your doctor’s treatment plan while it may seem tempting to opt for immediate and radical treatment which will bring immediate results and remission. Keep in mind that this generally involves heavy doses of chemotherapy which can adversely affect your life in both the short and long-term. Additionally, many of the medicines that are used to treat prostate cancer are powerful, and all have side effects which can make you very sick.
It is better to take a second or third opinion from a good urologist. This will help you plan out the best course of treatment with your doctor. You will heal faster and stay healthier longer if you make radical lifestyle adjustments with your therapy. This includes regular exercise, quitting smoking, limiting alcohol, eating right, and minimizing stress. If you feel angry or depressed because of your cancer and treatment, remember to see a psychologist, psychiatrist or both because good mental health will help you recover faster and stay in remission longer.
Surgery
If your Gleason and TNM scores are high enough, you may need to have surgery to remove part or all your prostate. The operation only removes the affected areas, which include the lymph nodes and a little bit of surrounding tissue (to remove any new cells which may have or be spreading!). This surgery is known as radical prostatectomy and can be done in two ways:
● With robots
● Through an incision in your abdomen
With robots
If your doctor chooses this option, he or she will put a robot which contains instruments needed for the surgery into your abdomen. The doctor will then use a remote control to have the robot operate. Because the surgery is entirely mechanical, it is the least invasive and most accurate one with the highest success and survival rates.
Through an incision in your abdomen
This is called retropubic surgery. If your doctor does this type of surgery, he or she will make an incision in your lower abdomen and remove your prostate.
Radiation
This is a powerful and toxic energy which is designed to kill prostate cancer cells. Doctors use two types of chemotherapy to fight prostate cancer:
● External beam radiation
● Brachytherapy
External beam radiation
You will lie down while a machine will send x-ray beams all over your body. These beams are designed to kill the cancer cells.
Hormone therapy
Sometimes, surgery and chemotherapy are not enough. You will need various treatments which will stop new cancer cells from being created. Hormone therapy can accomplish this. You get this because it shuts down testosterone production - testosterone is what gives the cells in your prostate (including cancer cells) the energy and nourishment they need to grow. Your cancer will go into remission for longer, and you will be healthier if your doctor includes therapies which don’t allow new cancer cells to thrive as part of your treatment plan.
Three main types of hormone therapy exist:
● Medicines that shut down testosterone production
● Medications which keep testosterone from nourishing cancer cells
● Orchiectomy - this surgery gets rid of your testicles
Medicines that shut down testosterone production
This suite of medications is known as Luteinizing Hormone-releasing hormone (LH-RH) agonists. They block the messages which your brain sends to your testicles to produce and release testosterone. All testosterone production shuts down as a result. Many drugs are on the market (all prescription) which are used to do this. Some of them are Leuprolide, Goserelin, and Triptorelin.
Medicines which keep testosterone from nourishing cancer cells
These are anti-androgens. They stop testosterone from providing the energy and nutrients cancer cells need to grow. Some of these medicines include Bicalutamide, Nilutamide, and flutamide. If these don’t work, your doctor may rely on the potent drug Xtandi as a last resort.
Orchiectomy
If your doctor takes your testicles out entirely, your overall testosterone production levels will immediately drop dramatically.
Note that these types of hormone therapy are used as a last resort therapy and only for men with prostate cancer that is in the advanced stages. If you have later-stage prostate cancer, your doctor may choose this because it is effective in reducing the size of the tumours, which makes them more likely to be killed off by chemotherapy.
Brachytherapy
Your doctor will load many nodules with radiation energy which he or she will place the buds inside your body. These nodules will gradually emit low doses of radiation energy which will kill the cancer cells. The buds are inserted with a laparoscopic needle which is guided with an ultrasound. You don’t need to worry about surgery to get rid of these nodules because they ‘die out’ and become harmless with time.
Freezing prostate tissue
This is referred to as cryoablation/cryosurgery, and it is beneficial because it kills cancer cells by freezing them. If your doctor performs this procure, he or she will insert tiny needles into your prostate. Ultrasound images will guide him or her for accuracy and effectiveness. The needles are full of cold gas which freezes the surrounding tissue. The doctor will immediately reheat the tissue using another gas. This process must be repeated multiple times to be effective.
Chemotherapy
You will be given a cocktail of potent, radioactive medicines. These are effective in killing cells that grow too fast. You can get them through an IV, or you can take them like a pill. Chemotherapy is enough if cancer has metastasized or if other treatment options aren’t viable or successful.
Biological therapy
Doctors refer to this as immunotherapy because it uses your immune system to kill cancer cells. It’s a brand-new therapy with very high success rates and the least amount of side effects. You will likely be given Provenge (a powerful biological therapy medicine) which is very effective at sending prostate cancer into remission should relapses occur.
Your doctor will use a blood draw to obtain some of your immune cells. He or she will then genetically engineer them to kill prostate cancer cells. The new immune system cells work wonders when reintroduced into your body!
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