Prostate cancer is one of the most common types of cancer in men. Fast-growing tumors can spread to other parts of your body. This form of cancer can be hard to treat if it is not caught early. Slow-growing tumors may not require treatment at first, or at all.

Path to improved health

Below are the most common prostate cancer treatments. Each treatment type has different benefits, risks, and outlooks. Talk to your doctor about what option is best for you.

Watchful waiting

If you have slow-growing cancer, your doctor may recommend observation as the first phase of treatment. This also might apply to men who are older or have severe health issues. Watchful waiting involves monitoring changes in your symptoms and tumors. It can consist of regular rectal exams, blood or imaging tests, and/or biopsies. If your doctor detects changes, they likely will suggest a type of active treatment.

Surgery

Radical prostatectomy is a surgery to remove your entire prostate. This includes lymph nodes and seminal vesicles. Surgery typically is an option if your cancer is contained to your prostate and has not spread. The surgeon can remove your prostate through one large incision or laparoscopically. Laparoscopic surgeries are also known as minimally invasive surgeries. They are performed using a laparoscope (a small, thin tube with a camera on the tip that is used to see the inside of your body) through a small number of incisions. These types of surgeries lead to less pain and a quicker recovery time than more invasive surgeries.

Surgery does require a stay in the hospital. Recovery time varies from several weeks to months. Usually, you can return to work in about 1 month. During recovery, you will have a catheter to help you urinate until the cut heals. Most men regain bladder control within a few weeks after surgery.

The success rate for surgery is very high if all the cancer gets removed. Surgery also provides your doctor with information. They will know the exact size and state of your tumor. However, as with all surgeries, there can be complications. These include blood clots, internal damage, or a reaction to the medicine. After surgery, you could have bleeding or an infection. There is a chance of erectile dysfunction (impotence) or loss of bladder control.

Men who have surgery to treat prostate cancer are no longer able to have children naturally. Your body still creates sperm but does not release it. If you want to have a baby, talk to your doctor about storing sperm before surgery. Treatment also can alter your orgasms and increase your risk of getting a hernia in your groin.

Radiation therapy

Radiation kills cancer cells using high-energy rays. This treatment is an option for both low- and high-grade forms of prostate cancer. It can be done on its own or with surgery. It also is an option if not all cancer gets removed or if your cancer comes back.

There are two types of radiation therapy. External radiation is known as beam therapy. It uses a machine that is similar to an X-ray. You get it 5 days a week for 6 to 8 weeks. Each radiation session lasts about 10 minutes. Internal radiation is known as seed therapy, or brachytherapy. It is more intense and only is given 1 time. Seed therapy requires a hospital stay since it involves anesthesia (medicine that puts you to sleep). The increased dose of radiation can cause discomfort.

The success rate for radiation therapy is about the same as surgery. Since the prostate gland and lymph nodes are not removed, your doctor won’t know the exact size and state of the tumor. Beam therapy has milder side effects than seed therapy. These can include frequent urination or urinary burning or bleeding. Rectal pain, rectal bleeding, and diarrhea are possible during or following treatment. Over time, you might become infertile or have erectile dysfunction.

Chemotherapy

Chemotherapy kills cancer cells using powerful drugs. It is given through an IV (intravenous) drip. A course of treatment lasts several weeks or months. Chemotherapy often has intense side effects. Most common are nausea, fatigue, and hair loss. It mostly is used by men who have fast-growing or advanced prostate cancer. It can help prolong your life.

Cryotherapy

Cryotherapy kills cancer cells using cold gases to freeze them. It is an option for men who have early or recurring cancer. It can be used in combination with other treatment types. The goal of cryotherapy is to eliminate your prostate gland. This is like surgery but is less invasive. It destroys your prostate with cold temperatures instead of an incision and removal.

Your doctor will perform a transrectal ultrasound (TRUS) to monitor the process. It does require a stay in the hospital because anesthesia is used. Cryotherapy often is less painful than surgery and has a shorter recovery time. You will have a catheter to help you urinate while you heal. Most men regain control of their bladder and bowels within a few weeks.

The long-term success rate of this treatment is unknown. A wide range of side effects is possible. Mild ones include urinary or rectal bleeding or burning. A swollen scrotum or penis and erectile dysfunction is common.

Hormone therapy

Your doctor might prescribe medicine to lower your level of male hormones, or androgens. Your hormones, including testosterone, can cause prostate tumors to grow or spread. Hormone therapy often is used in combination with other treatments. It can be done for several months in the form of pills or injections.

Hormone therapy does not cure prostate cancer. It can help shrink your tumor or prevent future growth. It also can control symptoms of prostate cancer. Side effects include fatigue, decreased sex drive, and erectile dysfunction. Osteoporosis (weakened bones) can be a more severe side effect.

Things to consider

It is up to you and your doctor to decide what treatment options are best. It may be good to get a second opinion. You should take several factors into consideration, including:

• Grade and stage of cancer
• Age and lifespan
• Overall state of health
• Any medicines you take or other conditions you have
• Size of your prostate gland (enlarged glands are more sensitive to treatment)
• Lifestyle changes
• Recovery time

Your outlook for prostate cancer depends on these factors, as well. Ask your doctor what you can do to prolong and improve your quality of life.

Questions to ask your doctor

• Is my grade and stage of cancer treatable or curable?
• How do I know if I need treatment?
• How do I decide what treatment is best for me, or what treatment to start with?
• Are there any clinical trials available to me?
• How long does treatment last?
• How will treatment affect my daily life? Will I still be able to do my normal activities?
• Can treatment affect my sex life or ability to have children?
• What are the long-term effects of prostate cancer treatment?
• What is my chance of cancer returning after treatment?
• What happens if I choose not to get treatment?

Resources

American Family Physician: Prostate Cancer: Making Decisions About Treatment

American Society of Clinical Oncology: Prostate Cancer: Treatment Options

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Hormone replacement therapy (HRT) is a type of treatment that involves taking hormones to prevent or treat certain medical conditions. Common uses for HRT include treating menopause in women and preventing osteoporosis.

The hormones used in HRT are synthetic hormones. This means they are created in a laboratory (rather than by the body). Once these hormones are inside the body, they act like natural hormones.

In the past, doctors routinely prescribed HRT. They hoped it could help guard against certain diseases and treat the symptoms of menopause. The diseases doctors hoped HRT could help prevent included osteoporosis, heart disease, and cancer. Information from research studies suggests HRT may not be safe for most women. This means the risks of using HRT outweigh the benefits. For a few women, benefits may outweigh the risks. This is why it is important to talk to your doctor about HRT.

Path to improved health

To study HRT, a health initiative was organized. This initiative used several studies to gather information on the effects of HRT. The goal of the initiative was to determine if HRT is safe.

What is the Women’s Health Initiative?

The Women’s Health Initiative (WHI) was a set of studies conducted by the National Institutes of Health, a division of the U.S. Department of Health and Human Services. Through these studies, researchers gathered information about the health of women who have gone through menopause. In the HRT trial, researchers were studying the effects of HRT on the health of postmenopausal women. Researchers were trying to determine whether using HRT affects a woman’s chances of developing:

• Breast cancer
• Colorectal cancer
• Heart disease
• Osteoporosis

Who was involved in the HRT trial?

Two groups of women were involved in the HRT trial:

• Women who had undergone hysterectomy (surgical removal of the uterus). This group took either estrogen or a placebo (sugar pill).
• Women who were also postmenopausal but had not undergone hysterectomy. These women took either combination HRT (both estrogen and progestin) or a placebo. The specific brand medicine used in this group was Prempro. There are other brands of combination-therapy HRT available. Only Prempro was used in this study.

I heard this study was stopped. What happened?

The HRT trial was scheduled to end in 2005. However, researchers decided to stop the combination-therapy part of the study in 2002. This is because they could see that the risks of combination HRT outweighed the benefits. They found that long-term use (5 years or more) increased a woman’s risk of breast cancer, blood clots, heart attacks, and strokes.

What should I do if I am taking HRT?

If you’re taking HRT, do not panic. Visit your doctor before making any changes to your therapy. They will consider your menopausal symptoms and your risk for developing certain diseases. Your doctor will give you advice about the pros and cons of continuing HRT. Some of your options may include stopping treatment altogether, taking a lower dose of medicine, or switching to another type of treatment.

Are other kinds of drugs used in HRT safe?

Researchers aren’t sure, but it is possible that other HRT drugs aren’t safe to use, either. Women who use them could be at higher risk for breast cancer (specifically hormone-receptive breast cancer), blood clots, heart attacks, and strokes. Even so, many doctors believe that short-term use of HRT to control menopausal symptoms is still safe for most women. Women who have a history of heart disease or blood clots are at the highest risk and should most likely not receive HRT.

Is long-term use of HRT ever a good idea?

HRT still offers protection against osteoporosis and decreases the risk of colorectal cancer. If your risk for these diseases is high and your risk for diseases like breast cancer or heart disease is low, long-term use of HRT may be an option for you. For women who have severe menopausal symptoms, benefits of HRT may also outweigh risks. You and your doctor will need to talk about your personal risks and benefits before deciding whether long-term use of HRT is a good choice for you.

Are there other options besides HRT for treating menopausal symptoms and for lowering my risk of other diseases?

Yes. For some women, vaginal estrogen creams, antidepressants, soy products, and certain herbal supplements offer relief from menopausal symptoms. Other medications are available to help prevent and treat osteoporosis. Your doctor can help you decide which of these treatments might be most helpful for you.

Finally, remember that following a healthy lifestyle can also help protect against heart disease, osteoporosis, and some types of cancer. A healthy lifestyle includes:

• Eating a healthy diet
• Maintaining a healthy weight
• Exercising regularly
• Quitting smoking

Things to consider

The American Academy of Family Physicians (AAFP) recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. The AAFP also recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

According to the AAFP, “This recommendation applies to postmenopausal women who are considering hormone replacement therapy for the primary prevention of chronic medical conditions. This recommendation does not apply to women younger than age 50 years who have undergone surgical menopause. This recommendation does not consider the use of hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness.”

When to see a doctor

If you are having symptoms of menopause, you should see your doctor. Your doctor can evaluate your symptoms. Together, you can work out a plan to manage symptoms. This plan could involve using HRTs for a short time.

If you are currently taking HRTs, you should already be under the close care of your doctor. Be sure to keep following up with your doctor. Report any unusual symptoms.

Questions for your doctor

• Can HRT help me manage menopause symptoms?
• What will be my risks if I use HRT?
• How long can I safety use HRT?
• Is there a safer type of HRT for me?
• How do I know if I’m at risk for blood clots?
• How will you determine my dose of HRT?
• What tests will I need to take before beginning HRT?

Resources

National Institutes of Health: Menopausal Hormone Therapy Information

National Institutes of Health, MedlinePlus: Hormone Replacement Therapy

WomensHealth.gov: Menopause Hormone Therapy

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