Tips for Managing Prostate Cancer Treatment

Prostate cancer is one of the most common types of cancer — and also one of the most curable, with more than 90% of patients living at least five years after their diagnosis.

But receiving the diagnosis can bring difficult choices. Depending on a patient’s stage and other health factors, treatment paths can look very different — from surveillance, also known as a “watch-and-wait” approach, to more aggressive treatments such as surgery or radiation.

What are the most common prostate cancer treatments?

The surveillance approach, also known as “watch and wait,” is most common among men who have a low-grade prostate cancer, says Jonathan Bloom, MD, a urologist and prostate cancer expert at the Wilmot Cancer Institute.

If your prostate cancer was found through screening, which typically starts around age 50 for men of average risk, it’s likely your cancer was caught in earlier stages. Most prostate cancers are detected through screening, with patients experiencing no symptoms of the disease. Only with advanced prostate cancer do symptoms — such as blood in the urine, bone pain, or weight loss — start to develop.

Not all men may be candidates for this strategy as they may have more aggressive localized prostate cancer. In this case, treatment is often recommended.

According to Bloom, these men may need treatment that could include surgery, hormonal therapy, radiation treatment, or specialized focal therapy such as high-intensity focused ultrasound (HIFU).

"Developing a treatment plan comes down to the stage and aggressiveness of the prostate cancer as well as the individual’s goals and preferences,” says Bloom.

Sometimes men know immediately what path they want to follow. For those who are unsure, the team at Wilmot Cancer Institute talks to each patient about goals and values as well as potential side effects of each option.

What are the side effects of prostate cancer surgery?

For men who have intermediate or advanced stage prostate cancer, surgery may be needed to remove the tumor. At Wilmot Cancer Institute, many prostatectomies are conducted using robotic surgery, but even this less-invasive option can have side effects, including incontinence and erectile dysfunction.

These side effects may be reduced for those who have high-intensity focused ultrasound (HIFU). With this procedure, instead of cutting into the body to remove the cancer, the surgeon uses focused ultrasound. While this treatment tends to have fewer side effects than more traditional surgery options, only some patients are eligible, based on the size and location of the tumor on the prostate.

What are the side effects of radiation therapy for prostate cancer?

Hong Zhang, MD, PhD, a radiation oncologist at Wilmot Cancer Institute who specializes in treating prostate cancer, explains that there are two main types of radiation treatment for prostate cancer: external beam radiation and brachytherapy.

External beam radiation is the most common type. It involves directing radiation into the body from a machine outside the body. Patients typically need to have daily treatment over several days or weeks. Side effects can include increased urinary urgency and frequency. It may also impact your bowel function, causing you to have more frequent bowel movements or diarrhea.

Brachytherapy, or internal radiation, involves placing radioactive material directly inside of the prostate. The material can stay in place either permanently or temporarily to kill the cancer.

“With brachytherapy, it eliminates a lot of the radiation exposure to the normal tissue, such as the bladder and the rectum,” Zhang says. “It can deliver very high dose radiation safely.”

In addition to sparing organs near the prostate, this option can be helpful for men who are unable to travel for daily radiation therapy.

“Potentially, this may improve access to our patients, especially those who live far away,” Zhang says.

However, brachytherapy is not without side effects, which can include more pronounced urinary frequency and urgency right after the procedure. These symptoms will subside over time.

Whether you have external beam radiation therapy or brachytherapy, there are medications that can reduce these side effects, so talk with your care team for guidance.

What are the side effects of chemotherapy and hormone therapy for prostate cancer?

Chemotherapy is less commonly used in prostate cancer, but it can help men who have cancer that has spread throughout the body. Side effects of chemotherapy can include nausea, loss of appetite, fatigue, weight loss, and hair loss.

“Patients receiving chemotherapy should work closely with their oncology team to monitor and address side effects from chemotherapy,” says Brendan Guercio, MD, a medical oncologist at Wilmot Cancer Institute who specializes in treating prostate cancer with medications like chemotherapy and hormone therapy. “Proven medications can safely treat chemotherapy-induced nausea, and physical activity can help patients combat fatigue.”

Hormone therapy is sometimes used for more advanced prostate cancer. The goal is to reduce the amount of testosterone in the body because testosterone can fuel prostate cancer. Side effects can include hot flashes, fatigue, and difficulty sleeping. There are medications and non-traditional ways to combat these side effects, so it is important to work with your oncology team if you experience these issues.

Why are clinical trials important when it comes to prostate cancer treatment?

Clinical trials look at many factors in prostate cancer. Sometimes they evaluate brand-new treatments for the cancer or cancer’s side effects. Since prostate cancer already has a high cure rate, many prostate cancer clinical trials focus on improving quality of life.

Wilmot currently has clinical trials open for prostate cancer patients and is working to open another clinical trial focused on a medication that could help lessen bladder irritation from radiation therapy.