Virginia Commonwealth University

VCU Massey Cancer Center

Treatment options

What are the different types of surgery for prostate cancer?

The following are some of the different surgical options used to treat prostate cancer:

  • Radical prostatectomy – an open-surgery procedure in which the entire prostate gland and some tissue around it are removed. This surgery involves an incision in either the abdomen or the scrotum area.
  • Transurethral resection of the prostate (TURP) – surgery to remove part of the prostate gland that surrounds the urethra by using a small tool that is placed inside the prostate through the urethra. There is no incision with this method.
  • Cryosurgery – a procedure that involves killing the cancer by freezing the cells with a small, metal tool placed in the tumor.

Possible complications or side effects of prostate cancer surgery

Long-term, serious side effects are somewhat less common now than in the past, as new surgical methods continue to be introduced. New, nerve-sparing surgical procedures may prevent permanent injury to the nerves that control erection and damage to the opening of the bladder. However, possible complications and side effects of prostate cancer surgery still exist. Be sure to discuss the following with your physician before a surgical procedure:

  • Incontinence – the inability to control urine, which may result in leakage or dribbling of urine, especially just after surgery. Normal control returns for many patients within several weeks or months after surgery, although some patients become permanently incontinent.
  • Impotence – the inability to have an erection of the penis. For a month or so after surgery, most men are not able to get an erection. Eventually, approximately 40 percent to 60 percent of men will be able to get an erection sufficient for sexual intercourse, but without ejaculation of semen, since removal of the prostate gland prevents that process.

    This effect on a man’s ability to achieve an erection is related to the stage of the cancer and the patient's age. However, most men who have surgery should expect some decrease in their ability to have an erection. For men who are completely impotent after surgery, several solutions are available.

What is radiation therapy?

Radiation therapy uses high-energy rays to kill cancer cells and to decrease their ability to divide. Radiation is often used to treat prostate cancer that is still confined to the prostate gland or has spread only to nearby tissue. If the cancer is more advanced, radiation may be used to shrink the size of the tumor and to provide relief from symptoms.

What are the types of radiation therapy?

There are generally two types of radiation therapy:

  • External radiation (external beam therapy) – a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. This type of radiation therapy may be given daily for several weeks.
  • Internal radiation (implant therapy) – a procedure that uses small, radioactive seeds (each about the size of a grain of rice) that are implanted directly into the cancerous prostate tumor. The implanted seeds may be left in permanently or may be only temporary. The seeds emit small amounts of radiation for a period of weeks or months.

What are side effects of radiation therapy?

As each person’s individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.

Possible side effects of external beam radiation therapy for prostate cancer may include:

  • Diarrhea (with or without blood in the stool) and colitis.
  • Problems associated with urination. 
  • A degree of impotence (inability to achieve or maintain an erection), which may occur within two years of radiation therapy. 
  • Fatigue, especially during the later weeks of treatment.

Possible side effects of internal radiation therapy for prostate cancer may include:

  • Slight bleeding soon after the seeds are placed.
  • Occasional loss of the seeds when urinating. 
  • Irritation of the rectum.

Where can I learn more about radiation therapy?

For more information about radiation as a treatment for prostate cancer, please visit the VCU Department of Radiation Oncology.

What is hormone therapy?

Produced mainly in the testicles, the male hormone testosterone causes prostate cancer cells to grow. Reducing testosterone levels can make the prostate cancer shrink and become less active.

The goal of hormone therapy is to lower the level of male hormones in the body, particularly testosterone. Hormone therapy does not cure the cancer and is often used to treat persons whose cancer has spread or recurred after treatment. Most studies show that hormone therapy works better if it is started early.

What are the different types of hormone therapy?

There are several types of hormone therapy, including the following:

  • Orchiectomy – the surgical removal of the testicles to prevent male hormones, ones that stimulate growth of the prostate cancer, from being produced.
  • LHRH (luteinizing hormone-releasing hormone) -analogs – drugs that decrease the amount of testosterone produced in a man’s body by interfering with the normal chemical signals sent from the pituitary gland in the brain to the testicles.
  • Anti-androgens – substances that block the body’s ability to use testosterone, because even after orchiectomy or LHRH-analog treatment, a small amount of testosterone may still be produced in the body. Other hormonal drugs may be used for periods of time during treatment.

What are side effects of hormone therapy?

As each person’s individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.

Possible side effects of hormone therapy for prostate cancer may include:

  • Hot flashes.
  • A degree of impotence (inability to achieve or maintain an erection). 
  • Diminished libido (desire for sex). 
  • Enlargement of the breasts.

What is the duration of hormone therapy?

The duration of hormone therapy varies, but usually lasts a period of a few months, depending on the individual situation. Research presented at the 2000 American Society of Clinical Oncology meeting suggests that long-term hormone therapy (an additional two years) for those men who have locally advanced prostate cancer may control the disease better than short-term hormone therapy. Always consult your physician for more information regarding hormone therapy treatment.

What is chemotherapy?

Chemotherapy is the use of drugs to treat cancerous cells. Specific treatment for prostate cancer will be determined by your physician based on:

  • Your age, overall health and medical history.
  • Stage of the cancer. 
  • Your tolerance for specific medications and procedures.
  • Expectations for the course of the disease. 
  • Your opinion or preference.

Often chemotherapy is not the primary therapy for men with prostate cancer, but may be used when prostate cancer has spread outside of the prostate gland or in combination with other therapies.

According to the American Cancer Society, chemotherapy is not effective against early prostate cancer. And although it may slow tumor growth and reduce pain, it also has had limited success for the treatment of advanced prostate disease.

How is chemotherapy administered?

Your oncologist will determine how long and how often chemotherapy treatments are necessary, if at all. Chemotherapy can be administered intravenously (in the vein) or by pill, and usually involves a combination of drugs. Chemotherapy treatments are often given in cycles: a treatment period, followed by a recovery period, followed by another treatment period.

Chemotherapy may be given in a variety of settings including your home, a hospital outpatient facility, a physician’s office or clinic, or in a hospital. Hospitalization may be necessary to monitor treatment and to control chemotherapy’s side effects.

What are the most common side effects of chemotherapy?

As each person’s individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.

Most side effects of chemotherapy disappear once treatment is completed. Common side effects of chemotherapy depend on the drug used, the dosage and the length of treatment, and may include:

  • Nausea and vomiting
  • Hair loss 
  • Anemia 
  • Reduced ability of blood to clot
  • Mouth sores 
  • Increased likelihood of infection 
  • Fatigue

What is angiogenesis?

Angiogenesis, the formation of new blood vessels, is a process controlled by certain chemicals produced in the body. Although this may help in normal wound healing, cancer can grow when these new blood vessels are created. Angiogenesis provides cancer cells with oxygen and nutrients, allowing the cancer cells to multiply, invade nearby tissue and spread to other areas of the body (metastasize).

What are angiogenesis inhibitors and how do they work?

A chemical that interferes with the signals to form new blood vessels is referred to as an angiogenesis inhibitor.

Sometimes called antiangiogenic therapy, this experimental treatment may prevent the growth of cancer by blocking the formation of new blood vessels. In some animal case studies, angiogenesis inhibitors have caused cancer to shrink and resolve completely.

In humans, angiogenesis inhibitors are only used in clinical trials at this time. These drugs are still considered investigational. Research studies are now underway to help scientists learn whether the approach will apply to human cancers. Patients with cancers of the breast, prostate, pancreas, lung, stomach, ovary, cervix and others are being studied. If the research studies demonstrate that angiogenesis inhibitors are both safe and effective for cancer treatment in humans, these drugs will need approval by the U.S. Food and Drug Administration to become available for widespread use.

What are herbal remedies for prostate cancer?

Over the centuries, man has gone from a simple diet consisting of meats, fruits, vegetables and grains to a diet that often consists of foods rich in fats, oils and complex carbohydrates. Nutritional excess and nutritional deficiency have become problems in today’s society, both contributing to several chronic diseases. Many dietary and herbal approaches attempt to balance the body’s nutritional well-being. Dietary and herbal approaches may include dietary supplements and herbal medicine.

Herbal medicine or “herbal remedies” for treatment of prostate cancer have not been studied scientifically (in a randomized clinical trial, a highly regarded approach). In particular, combination herbal remedies currently on the market should be approached with caution, as reported side effects have included venous thrombosis (blood clots in veins), breast tenderness and loss of libido (desire for sex.) For example, a popular supplement sometimes used by men with prostate cancer, called PC-SPES, was taken off the market after a warning by the U.S. Food and Drug Administration in 2002. PC-SPES was found to contain other prescription drugs that could cause serious health problems, according to the American Cancer Society. In addition, many herbal preparations have not been studied in men with prostate cancer.

Consult with your physician prior to utilizing any type of dietary or herbal supplements in the treatment or prevention of prostate cancer.