Table of Contents
In this article, you will learn all the prostate cancer treatment options available as well as benefits and side effects and complications of each option. In addition, you will discover 12 simple tips you can use to prevent or manage the cancer and the side effects of the treatment in case you are already diagnosed with it. You will also discover a simple remedy that a man used to become healthy after being diagnosed with stage 4 prostate cancer that metastasized to his bones.
Treatment for prostate cancer may involve active surveillance, surgery, radiation therapy – including brachytherapy (prostate brachytherapy) and external-beam radiation therapy, proton therapy, high-intensity focused ultrasound (HIFU), cryosurgery, hormonal therapy, chemotherapy, or some combination.
Prostate cancer treatment options also extend to survivorship-based interventions. These interventions are focused on five domains including: physical symptoms, psychological symptoms, surveillance, health promotion and care coordination.
The favored treatment option depends on the stage of the cancer, the PSA level and the Gleason score, a grading system is used to help evaluate the prognosis of men with prostate cancer using samples from a prostate biopsy. Other important factors include your age, general health, and feelings about potential treatments and their possible side-effects. Because all treatments can have significant side-effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.
Here are 11 prostate cancer treatment options
Active Surveillance
Active surveillance is observation and regular monitoring without invasive treatment. In the context of prostate disease, this usually comprises regular PSA blood tests and prostate biopsies. Active surveillance is often used when an early stage, slow-growing prostate cancer is suspected. However, watchful waiting may also be suggested when the risks of surgery, radiation therapy, or hormonal therapy outweigh the possible benefits. Other treatments can be started if symptoms develop, or if there are signs that the cancer growth is accelerating.
Approximately one-third of men who choose active surveillance for early stage cancer eventually have signs of tumor progression, and they may need to begin treatment within three years.
Prostate Cancer Surgery
Prostate cancer treatment options also include many surgical procedures. Surgical removal of the prostate, or prostatectomy, is a common treatment either for early stage prostate cancer or cancers that have failed to respond to radiation therapy.
Most common prostate cancer surgical procedures include:
Radical Retropubic Prostatectomy
The most common type is radical retropubic prostatectomy, when the surgeon removes the prostate through an abdominal incision. Another type is radical perineal prostatectomy, the removal of the prostate through an incision in the perineum, the skin between the scrotum and anus. Radical prostatectomy can also be performed laparoscopically, through a series of small (1 cm) incisions in the abdomen, with or without the assistance of a surgical robot.
Radical Prostatectomy Side Effects
Radical prostatectomy is effective for tumors that have not spread beyond the prostate; cure rates depend on many factors such as PSA level and Gleason grade. However, it may cause nerve damage that may significantly alter the quality of life of the prostate cancer survivor. Radical prostatectomy has been associated with a greater decrease in sexual function and increased urinary incontinence (mainly stress incontinence) than external beam radiotherapy.
Radical prostatectomy has traditionally been used alone when the cancer is localized to the prostate. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has higher risks of complications.
Laparoscopic Approach
Laparoscopic radical prostatectomy (LRP) is a new way to treat the prostate surgically with intent to cure. Contrasted with the open surgical form of prostate cancer surgery, laparoscopic radical prostatectomy requires a smaller incision. Relying on modern technology, such as miniaturization, fiber optics, and the like, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment but is technically demanding and seldom done in the USA.
Laparoscopic radical prostatectomy side effects
Laparoscopic radical prostatectomy may cause temporary or long-term erectile dysfunction (impotence). There may be no ejaculation at orgasm (dry orgasm) after the surgery. The surgery will result in infertility, increased risk of temporary or long-term urinary incontinence and Penile shortening.
Robotic Assistance
In the hands of an experienced surgeon, robotic-assisted laparoscopic prostatectomy (RALP) may reduce positive surgical margins when compared to radical retropubic prostatectomy (RRP) among patients with prostate cancer according to a retrospective study. The relative risk reduction was 57.7%. For patients at similar risk to those in this study (35.5% of patients had positive surgical margins following RRP), this leads to an absolute risk reduction of 20.5%. 4.9 patients must be treated for one to benefit (number needed to treat = 4.9).
Transurethral Resection
Transurethral resection of the prostate, commonly called a “TURP,” is a surgical procedure performed when the tube from the bladder to the penis (urethra) is blocked due to the prostate enlargement. In general, TURP is done for benign prostatic hyperplasia and is not meant as definitive treatment for prostate cancer. During a TURP, a small instrument (cystoscope) is placed into the penis and the blocking prostate is cut away by cautery.
Cryosurgery
Cryosurgery is another method of treating prostate cancer in which the prostate gland is exposed to freezing temperatures. Cryosurgery is less invasive than radical prostatectomy, and general anesthesia is less commonly used. Under ultrasound guidance, a method invented by Dr. Gary Onik, metal rods are inserted through the skin of the perineum into the prostate. Highly purified argon gas is used to cool the rods, freezing the surrounding tissue at −186 °C (−302 °F). As the water within the prostate cells freezes, the cells die. The urethra is protected from freezing by a catheter filled with warm liquid. But among other Cryosurgery side effects, Impotence occurs up to 90% of the time.
Surgical Removal of the Testicles
In metastatic disease, where cancer has spread beyond the prostate, removal of the testicles (called orchiectomy) may be done to decrease testosterone levels and control cancer growth.
Prostate Cancer Surgery Complications
The most common serious complications of surgery are loss of urinary control and impotence.
Erectile Dysfunction
Although penile sensation and the ability to achieve orgasm usually remain intact, erection and ejaculation are often impaired. Medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may restore some degree of potency. For most men with organ-confined disease, a more limited “nerve-sparing” technique may help reduce urinary incontinence and impotence.
Urinary Incontinence
Radical prostatectomy, transurethral resection of the prostate (TURP), and radiation therapy are the main causes of stress incontinence in men, with radical prostatectomy being the top cause. In most cases, the incontinence 
resolves within 12 months with conservative treatment. Multiple factors, such as injury of the urethral sphincter or nervous bundles can play a role, causing mostly stress incontinence. Stress urinary incontinence happens when the urethral sphincter (the muscular sphincter that closes the bladder) fails to properly close, leading to leakage of urine in situations where the abdominal pressure is higher than usual, such as when laughing, sneezing, or coughing.
Conservative treatment, such as pelvic floor muscle training (Kegel exercise) has been prescribed to improve urinary continence. Other therapies include the use of penile clamps, transurethral bulking agents, and catheters, however, the most commonly used surgical therapies performed are the placement of a urethral sling or artificial urinary sphincter. In patients with moderate to severe stress urinary incontinence after prostate surgery, artificial urinary sphincter is the treatment of choice, after all the other conservative measures fail.
Prostate Cancer Radiation Therapy
Radiation therapy, also known as radiotherapy, is one of the most common prostate cancer treatment options. It is often used to treat all stages of prostate cancer. It is also often used after surgery if the surgical procedure was not successful at curing the cancer.
Radiotherapy uses ionizing radiation to kill prostate cancer cells. When absorbed in tissue, ionizing radiation such as gamma and x-rays damage the DNA in cancer cells, which increases the probability of apoptosis (cell death). Normal cells are able to repair radiation damage, while cancer cells are not. Radiation therapy exploits this fact to treat cancer.
Types of Prostate Cancer Radiation Therapy
Two different kinds of radiation therapy are used in prostate cancer treatment: external beam radiation therapy and brachytherapy (specifically prostate brachytherapy).
External Beam Radiation Therapy
External beam radiation therapy (EBRT) uses a linear accelerator to produce high-energy x-rays that are directed in a beam towards the prostate. A technique called Intensity Modulated Radiation Therapy (IMRT) may be used to adjust the radiation beam to conform with the shape of the tumor, allowing higher doses to be given to the prostate and seminal vesicles with less damage to the bladder and rectum.
External beam radiation therapy is generally given over several weeks, with daily visits to a radiation therapy center. New types of radiation therapy such as IMRT have fewer side effects than traditional treatment. However, in the short term, EBRT has been associated with acute worsening of urinary obstructive and bowel symptoms.
Internal Radiation Therapy (Brachytherapy)
Permanent implant brachytherapy is a popular treatment choice for patients with low to intermediate risk features, can be performed on an outpatient basis, and is associated with good 10-year outcomes with relatively low morbidity.
The therapy involves the placement of about 100 small “seeds” containing radioactive material (such as iodine-125 or palladium-103) with a needle through the skin of the perineum directly into the tumor while under spinal or general anesthetic. These seeds emit lower-energy X-rays which are only able to travel a short distance. Although the seeds eventually become inert, they remain in the prostate permanently. The risk of exposure to others from men with implanted seeds is generally accepted to be insignificant. However, men are encouraged to talk to their doctors about any special temporary precautions around small children and pregnant women.
Prostate Cancer Radiation Therapy Side effects
Radiation therapy Side effects might occur after a few weeks into treatment. Both types of radiation therapy may cause diarrhea and mild rectal bleeding due to radiation proctitis, as well as potential urinary incontinence and impotence. Symptoms tend to improve over time except erections which typically worsen as time progresses.
A new method to reduce rectal radiation injury in prostate cancer patients involves the use of an absorbable spacer placed between the prostate and rectum. MRI showing hydrogel spacer pushing the rectum away from the prostate during radiotherapy. Prostate Rectum Spacers should be compatible with all prostate cancer radiotherapy treatments including 3D conformal, IMRT and stereotactic radiation and brachytherapy.
High Intensity Focused Ultrasound
High intensity focused ultrasound (HIFU) was first used in the 1940s and 1950s in efforts to destroy tumors in the central nervous system. Since then, HIFU has been shown to be effective at destroying malignant tissue in the brain, prostate, spleen, liver, kidney, breast, and bone.
HIFU for prostate cancer utilizes ultrasound to ablate/destroy the tissue of the prostate. During the HIFU procedure, sound waves are used to heat the prostate tissue, thus destroying the cancerous cells.
Contraindications to HIFU for prostate cancer include a prostate volume larger than 40 grams, which can prevent targeted HIFU waves from reaching the anterior and anterobasal regions of the prostate, anatomic or pathologic conditions that may interfere with the introduction or displacement of the HIFU probe into the rectum, and high-volume calcification within the prostate, which can lead to HIFU scattering and transmission impairment.
Hormonal Therapy
Hormonal therapy involves manipulation of the endocrine system through exogenous or external administration of specific medications which inhibit the production or activity of the hormone antagonists.
Androgen deprivation therapy
Hormone therapy blocks prostate cancer cells from getting dihydrotestosterone (DHT), a hormone produced in the prostate and required for the growth and spread of most prostate cancer cells. Blocking DHT often causes prostate cancer to stop growing and even shrink.
However, hormonal therapy rarely cures prostate cancer because cancers that initially respond to hormonal therapy typically become resistant after one to two years.
There are several forms of hormonal therapy:
- Antiandrogens – these are medications such as flutamide, nilutamide, bicalutamide, enzalutamide, apalutamide, and cyproterone acetate that directly block the actions of testosterone and DHT within prostate cancer cells.
- DHEAs – Medications that block the production of adrenal androgens such as DHEA include ketoconazole and aminoglutethimide.
- GnRH antagonists – GnRH action can be interrupted in one of two ways. GnRH antagonists such as abarelix and degarelix suppress the production of LH directly by acting on the anterior pituitary. GnRH agonists such as leuprorelin and goserelin suppress LH through the process of downregulation after an initial stimulation effect which can cause initial tumor flare. In order to prevent stimulation of tumor growth during the initial LH surge, an antiandrogen such as cyproterone acetate is prescribed a week before and three weeks after GnRH agonists are given.
- Abiraterone acetate was FDA approved in April 2011 for treatment of castration-resistant prostate cancer for patients who have failed docetaxel therapy. Abiraterone acetate inhibits an enzyme known as CYP17, which is used in the body to produce testosterone.
The most successful hormonal treatments are orchiectomy and GnRH agonists. Despite their higher cost, GnRH agonists are often chosen over orchiectomy for cosmetic and emotional reasons. Eventually, total androgen blockade may prove to be better than orchiectomy or GnRH agonists used alone.
Estrogen Therapy
High-dose estrogen therapy is used in the treatment of prostate cancer. Estrogens that have been used include 
diethylstilbestrol, fosfestrol, ethinylestradiol, ethinylestradiol sulfonate, polyestradiol phosphate, and estradiol undecylate, as well as the dual estrogenic and cytostatic agent estramustine phosphate. Newer estrogens with improved tolerability and safety like GTx-758 have also been studied. Estrogens are effective in prostate cancer because they are functional antiandrogens. They both suppress testosterone levels into the castrate range via their antigonadotropic effects and they reduce the fraction of free and bioavailable testosterone by increasing sex hormone-binding globulin levels. Estrogens may also have direct cytotoxic effects in the prostate gland.
Prostate Cancer Chemotherapy
Chemotherapy is sometimes recommended in prostate cancer treatment. It is used when the tumor has spread outside the prostate gland and hormone therapy isn’t working. Recent research has also shown that chemo might be helpful if given along with hormone therapy. Chemotherapy is not, however, a standard treatment for early prostate cancer.
Prostate Cancer Alternative Therapies
Do not neglect to include baking soda and maple sirup in your prostate cancer treatment options. The baking soda and maple syrup solution has been used for decades for different purposes, ranging from boosting energy and PH levels to prostate cancer therapy. Some men claim to get their health back thanks to the solution after they were diagnosed with state 4 prostate cancer.
Here Is a simple baking soda and maple syrup recipe
1) Mix 3 parts organic maple syrup with 1-part aluminum free baking soda
2) Stir with low heat (not over 120 degrees) for 5-10 minutes
3) Take 3 tablespoons per day for one to two months.
Note: It does not taste good at all.
Here Are 12 Survival Tips for Staying Healthy
- Get a Second Opinion (maybe a 3rd or a 4th) after the diagnosis.
- Do the Baking Soda and Maple Syrup remedy
- First and foremost, create a survivorship plan
- Get good sleep, 7-8 hours per night.
- Eliminate alcohol, milk and sugar in your diet
- Drink organic fruit and fruit juice daily
- Achieve and maintain a healthy weight.
- Practice regular exercise and remain active.
- Be socially active and emotionally strong.
- Do research and learn all you can about the cancer and use resources available.
- Seek Support from friends, family, and cancer support communities.
- Increase your intake of Vitamin D3, organic cruciferous vegetables (Broccoli, watercress, red cabbage…).
