The prostate is a gland situated just underneath the bladder surrounding the urethra, and produces semen - the fluid that carries and protects sperm. It is about the size of a walnut, but if it becomes enlarged it can cause urinary problems. Cancerous tumours can sometimes grow within the prostate and spread to other parts of the body through the bloodstream or lymphatic system.
The exact causes of prostate cancer are not yet known, however studies show that there are several factors likely to increase your risk:
- Age – if you’re over 50
- Hormones – high levels of male hormones (androgens) including testosterone
- Heredity – if a close relative has had prostate cancer you are at increased risk
- Breast cancer – if a close female relative has had breast cancer it could mean that you’ve inherited a faulty gene and are at increased risk of getting prostate cancer
- African-American and Afro-Caribbean men are at greater risk
- Diet – eating lots of animal fat can increase your risk, whereas a diet high in fruit and vegetables (especially tomatoes) can decrease your risk
- Weight – being very overweight increases your risk of developing prostate cancer
This article on prostate cancer treatment options is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.
There are several different methods of treating prostate cancer, and the one you choose will depend on various factors such as your age, the stage and grade of the cancer, any other serious health problems you might have, and how you feel about the side effects of treatment. The best thing to do is to talk to your consultant in detail and discuss all possible prostate cancer treatment options. Often it is recommended that you do not have any prostate cancer treatment at all (if the cancer is particularly slow-growing).
1. Active monitoring of prostate cancer
Sometimes called ‘watchful waiting, ‘active surveillance’ or ‘expectant management,’ this approach is applicable to men who have a very slow-growing type of prostate cancer, or to those who are older, or have other major health problems. Some cancers are present but do not grow or develop for many years, so the most appropriate prostate cancer treatment often involves simply close monitoring with routine check-ups. When and if it begins to develop your doctor may recommend active treatment.
2. Surgery for prostate cancer
For men whose prostate cancer is developing, surgery to remove the growth is a common treatment. Most suitable for men who are otherwise healthy, usually under 70 years old, and whose cancer has not spread to other areas it is called a radical prostatectomy. This procedure involves removing the entire prostate gland and some of the healthy tissue surrounding it. This can be done via standard open surgery through a cut in the abdomen (retropubic) or between the testicles and the back passage (perineal), or via keyhole surgery (a laparoscopic prostatectomy) through smaller abdominal incisions.
There can be some permanent side effects of having a radical prostatectomy. A type of operation called nerve-sparing surgery was developed to combat erection difficulties after the operation. During this operation, the nerves next to the prostate are kept intact and not removed, leaving you more likely to be able to have erections naturally. It is not suitable for everyone and can increase the risk of the cancer returning if any cancer cells are already established inside the nerves. Nerve-sparing surgery is mostly performed on men with very early stage prostate cancer or cancer that is not growing close to the nerve bundles.
A radical prostatectomy causes impotence (erectile dysfunction) in up to 70% of men and is more likely the older you are. 20% of men will also experience minor urinary incontinence and in about 5% this will be severe.
3. Radiotherapy treatment for prostate cancer
If the cancer has not spread, it’s possible to use radiotherapy treatment. This involves directing high-energy waves into the prostate gland to destroy the cancer cells. There are two ways of giving radiotherapy to combat prostate cancer: external beam radiotherapy (although this is used less often than in the past) and internal radiotherapy (brachytherapy) which tends to be more accurate. Again, there are some serious side-effects to these cancer treatments, but your doctor will be able to discuss the benefits and drawbacks to each with you in detail.
4. Hormone therapy treatment for prostate cancer
This is a method for controlling the growth of prostate cancer. The male sex hormone testosterone is known to encourage cancer cells to develop so lowering the levels in the body slows down the growth rate, although cancer cells are not actually destroyed. Hormone therapy is used for men who cannot have surgery, or if the cancer has returned and spread to other parts of the body, or as a complement to other cancer treatment, such as before surgery in order to shrink the size of the tumour.
5. Chemotherapy treatment for prostate cancer
Although chemotherapy was not widely used in the past in prostate cancer treatment, recent studies with some well-known drugs (mitoxantrone (mitozantrone) and docetaxel (Taxotere)) have shown positive results. This type of cancer treatment is used if hormone therapy is no longer working or if the cancer has spread to other parts of the body. Although unlikely to result in a complete cure, it can slow the growth of the cancer, reducing symptoms and resulting in a better quality of life.
6. Cryotherapy treatment for prostate cancer
This is a technique to insert probes into the prostate through which cold gasses are introduced creating ice balls that destroy the prostate gland. Only suitable for prostate cancer that has not spread, cryotherapy has a similar effect to the surgical removal of the prostate.
7. Ultrasound treatment for prostate cancer
Using a machine that gives off high-intensity, focused ultrasound, cancer cells within the prostate are targeted and destroyed by heat (caused by the ultrasound waves). Suitable for cancer that has not spread outside the prostate or for cancer that has come back into the prostate after earlier treatment, this technique is still in the early stages of being used so may not be widely available. It has a 90% success rate and other areas of the prostate are not destroyed, although there are some side-effects similar to the side effects of surgery.