Prostate cancer treatment

The Prostate is a small organ, in the size of a walnut located below the urinary bladder and at either side of the male urethra. It produces fluid for the semen and nourishes the sperm. Prostate enlargement and cancer are common in older men and is easy to treat when diagnosed at early stages. The following are the treatment options available for prostate cancer

Chemotherapy for prostate cancer

Chemotherapy is the method of injecting anti-cancer agents into the vein of the patient to destroy the cancer cells. It is also given as oral medicines where they travel the bloodstream and attack the cancer cells that are spread to other parts of the body as well. Recent research studies prove that chemotherapy is beneficial for those who suffer cancer of the prostate when given in combination with hormone therapy. The chemo drugs for prostate cancer are predominantly used one at a time and not in combination. Some common chemo drugs used to treat prostate cancer are,

  • Mitoxantrone
  • Cabazitaxel
  • Docetaxel
  • Estramustine

The first line of treatment is with docetaxel with prednisone, after the tumor cells get resistant to this drug, cabazitaxel is tried next. These drugs slow down the growth of the cancer cells and also reduce the severity of the symptoms, but they are least beneficial in curing cancer.

Chemotherapy is given in cycles with each treatment cycle followed by a rest cycle to get rid of the symptoms. The duration of the cycles is generally two or three weeks long. Possible side effects of chemo drugs are loss of hair, sores in the mouth, loss of appetite, nausea, and vomiting, etc.

Hormone Therapy

This is also known as the androgen suppression therapy as androgens stimulate the tumor cells to proliferate and grow. The goal of the treatment is to reduce the level of male sex hormones, the androgens in the body so that they don’t fuel the cancer cells in the prostate gland. Testosterone is the major androgen for males and is produced by the testis. Lowering the level of testosterone will shrink the size of the tumor to some extent. Hormone therapy is not a cure for cancer and is used when

  • Cancer has spread too far to other organs
  • Cancer keeps relapsing after treatment with radiation or surgery
  • It is also used along with radiation therapy or before it to shrink the size of the tumor.

Several types of hormone therapies are used to treat prostate cancer.

  1. Orchiectomy: The surgeon removes the testicles, where most of the androgens are made. This procedure causes cancer to shrink or to stop growing over time. It is the simplest and the least expensive form of hormone therapy.
  1. Luteinizing hormone-releasing hormone agonist: These drugs decrease the number of androgens produced by the testicles. The agonist is either injected or placed as small implants under the skin to release small and frequent doses of the drug. Commonly used LHRH agonists are Histrelin, Triptorelin or Goserelin.
  1. LHRH antagonist: These drugs work along with LHRH agonists and lower the level of testosterone much quickly. This method is used in advanced tumors of the prostate and is given as a monthly shot under the skin.
  2. Anti-androgens: For the prostate cancer cells to grow, the androgens have to attach with a protein in the cancer cell known as the androgen receptor. Anti-androgens are drugs that connect with these receptors, limiting the androgens from causing the growth of the tumor. The commonly used anti-androgens are, Nilutamide, Bicalutamide, and Flutamide.
Cryotherapy

Cryotherapy also is known as cryosurgery or cryoablation is a promising prostate cancer treatment where very cold temperatures are used to freeze and kill the prostate cancer cells. It is used for cancer relapse after radiation therapy. It is the best treatment option to treat tumors at their early stage and for those clients whose general health cannot tolerate surgery and radiation therapy.

This treatment is performed under spinal or epidural anesthesia or general anesthesia. The doctor makes use of transrectal ultrasound to guide the hollow needles through the skin between the anus and the scrotum to reach the prostate.  The prostate is destroyed under USG guidance and without causing damage to the surrounding healthy tissues. Warm salt water is sent through a catheter in the urethra during the procedure to keep it from freezing.

This is a minimally invasive treatment option with less pain and minimal blood loss. But its long term effect in curing cancer is not known and this is not prescribed for men with very large prostate glands.

Radiation Therapy

Radiation therapy makes use of high energy beams to focus and destroy the cancer cells. This is the treatment of choice for those men with low-grade prostate cancer. Radiation therapy is used for recurring cancers after surgery. Also, it helps to keep advanced cancer in control to relieve symptoms. The common types of radiation therapy are,

  • 3D- CRT: In the three-dimensional conformal radiation therapy, special devices are used to map the location of the prostate tumor precisely. The radiation beams are shaped and aimed at the tumor from different angles so as to enhance the exposure and to minimize damage to the healthy tissues.
  • SBRT: Large dose of radiation is targeted on the tumor to shrink it at the earliest
  • Proton beam radiation therapy: In this therapy proton beams are focused on the tumor instead of the high energy rays. Proton beams spare healthy tissues and is effective in attacking the tumor cells.
  • EBRT: External radiation beams are focused on the prostate gland from a device outside the body.
Surgical Management

Surgery is the treatment of choice for prostate cancer if it has not spread outside the prostate. Some of the surgical options available are,

  • Open prostatectomy: This is performed either as an open or laparoscopic procedure under GA or SA. A long skin incision is performed to remove the prostate and the nearby tissues.
  • Laparoscopic prostatectomy: This is performed using special laparoscopic surgical tools to remove the prostate. This is becoming a more common surgical approach in recent years as it is minimally invasive and has a short recovery period.
  • Radical retropubic prostatectomy: The surgeon makes an incision in the lower abdomen from the umbilicus to the pubic bone. Along with the tumor, the surgeon also removes the surrounding lymph nodes, to check for a possible invasion.
  • Radical perineal prostatectomy: The surgeon makes an incision between the anus and the scrotum to remove the prostate gland. But this can result in erection problems and also the lymph nodes cannot be removed though it helps with minimal pain and early recovery.
  • TURP: In transurethral resection of the prostate, the doctor sends a special instrument (rectoscope) through the penis and removes the inner part of the prostate that surrounds the urethra. Through the scope, heat or laser is passed to vaporize the tissues.