Prostate cancer treatments and drug therapy options
Different types of treatments are available for men with prostate cancer. While some treatments are standard, other treatments may be available through clinical trials to extend or improve upon currently available standard treatments.
Treatment choices often depend on the stage, type, and location of the cancer, the person’s age and overall health, and expected side effects.
drug options
Your cancer treatment team prescribes prostate cancer drugs to block hormones, kill cancer cells, and strengthen your immune system.
Hormone therapy This treatment, also called androgen deprivation therapy (ADT), removes or blocks the effects of male hormones called androgens that cause prostate cancer to grow.
Medicines include:
- Luteinizing hormone-releasing hormone agonists such as leuprolide (Lupron, Lupron Depot, Eligard, Prostap, Viadur), goserelin (Zoladex), degarelix (Firmagon), and relugolix (Orgovix), which stop the production of testosterone by the testicles
- Anti-androgens, such as apalutamide (Erleada), darolutamide (Nubeqa), flutamide (Euflex, Euflexin), and enzalutamide, which block the effects of androgens
- Abiraterone acetate (Zytiga) prevents androgen production by cancer cells
chemotherapy This treatment uses drugs to stop cancer cells from growing by killing them or stopping them from dividing. Chemotherapy drugs may be given orally or by infusion or injection into a vein or muscle.
For prostate cancer patients, the most common chemotherapy drug is docetaxel (Taxotere). Doctors often give this along with steroids. If this doesn’t work, cabazitaxel (Jevtana) may be prescribed.
targeted therapy These drugs identify and attack specific targets on cancer cells. PARP inhibitors, such as olaparib (Lynparza), block enzymes involved in DNA repair associated with prostate cancer. Doctors recommend them for some men with mutations in genes such as BRCA1 or BRCA2.
immunotherapy This therapy uses a person’s own immune system to fight cancer. Sipuleucel-T (Provenge) is a type of immunotherapy that oncologists use to treat prostate cancer that has spread.
bone health therapy Your doctor will prescribe a drug such as zoledronate (Lecrast, Zometa).
surgery
Doctors may recommend surgery to treat prostate cancer in men who are otherwise healthy and whose tumor has not spread from the prostate. Surgical methods include:
- radical prostatectomy The surgeon removes the prostate, surrounding tissue, and seminal vesicles. This surgery can be performed through an incision in the abdomen or perineum, or using keyhole surgery (laparoscopic surgery) or robot-assisted surgery.
- Pelvic lymphadenectomy In this procedure, lymph nodes in the pelvis are removed and the tissue is tested to see if there are cancer cells.
- Transurethral resection of the prostate (TURP) The surgeon removes tissue from the prostate using an instrument inserted through the urethra. This may be done to relieve symptoms such as blocked urine flow before trying other treatments.
- Cryosurgery or cryotherapy This treatment is currently only available in clinical trials and uses a device that freezes and destroys prostate cancer cells.
radiation therapy
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells.
- External radiation therapy A machine outside the body sends radiation toward the cancer. Approaches include conformal radiation (shaping the beam to the tumor) and hypofractionated radiation (delivering a higher dose in fewer days). Proton therapy is a type of external radiation therapy that is more precise than other forms and may reduce the side effects of radiation.
- internal radiation therapy Also known as brachytherapy, this treatment uses radioactive seeds, needles, and wires placed directly in or near the cancer.
- Radiopharmaceutical treatment Radioactive substances are used to treat cancer. For example, radium-223 (an alpha emitter) is injected into the bloodstream to treat prostate cancer that has spread to the bones.
Stay alert and actively monitor
Both of these approaches involve deferring immediate treatment but differ in the intensity of monitoring. It may be helpful for older men without symptoms or for men with other medical conditions.
Watchful waiting means carefully monitoring the condition without treating it until signs and symptoms appear. Doctors usually use it in men whose life expectancy is limited due to aging or other health problems, usually in advanced prostate cancer.
During active surveillance, cancer treatment teams may track early-stage cancer in healthy men who want to avoid the side effects of treatment but are aiming to cure the disease. Active surveillance essentially involves postponing radiation therapy or surgery until the first sign that the cancer is progressing.
Management of erectile dysfunction
Almost all men treated for prostate cancer have some kind of problem getting or maintaining an erection, known as erectile dysfunction. After 2 years, 3 to 6 out of 10 men return to their pre-treatment sexual function, depending on the type of treatment the man receives.
To achieve an erection, the following options are available:
- oral medicine
- Topically applied therapies such as prostaglandins, sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra)
- A device known as a penis pump that uses a vacuum seal to draw blood into the penis
- Inserting the implant under general anesthesia allows the man to press the release button and achieve an erection.
Which criteria you use depends on your preferences, other health conditions, and your doctor’s advice. Many people treated for prostate cancer go on to have active and fulfilling sex lives.
