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Treatment of Prostate Cancer
Because prostate cancers usually progress slowly, a physician may recommend a “watchful waiting” approach rather than immediate treatment. This is especially true for patients who are elderly or in otherwise poor health. If treatment is required, the physician may use surgery, radiation, hormone therapy, chemotherapy, or a combination of two or more of these approaches. Surgery is usually done only if the cancer has not spread from the prostate. The removal of the entire prostate plus some surrounding tissues (radical prostectomy) may be considered if examination of the pelvic lymph nodes reveals that they are not cancerous. Surgical risks include impotence and urinary incontinence. A second surgical procedure, transurethral resection of the prostate (TURP), is used to relieve symptoms but does not remove all of the cancer. TURP is often used in men who cannot have a radical prostectomy because of advanced age or illness or in men who have a noncancerous enlargement of the prostate. In men who are unable to have traditional surgery, cryosurgery may also be used. In this procedure, a metal probe is inserted into the cancerous regions of the prostate; liquid nitrogen is then used to freeze the probe, killing the surrounding cells.
If the cancer has spread from the prostate, radiation therapy may be used. Hormone therapy attacks the male hormones (androgens) that often stimulate the growth of prostate cancer. Orchiectomy, or removal of the testes, cuts off the tumour's supply of testosterone. Drugs called LHRH analogs, or LHRH agonists, chemically block the production of androgens without the need for surgery. Other drugs, called antiandrogens, block the activity of androgens and are sometimes used in combination with other forms of hormone therapy. Hormone therapy can slow the progression of prostate cancer, but it often causes reduced libido, abnormal growth or sensitivity of the breasts, and hot flashes. If surgery or hormone therapy fails, chemotherapy may be used. Chemotherapy uses drugs that kill dividing cells, such as cancer cells, but is not highly effective in treating prostate cancer. It can, however, slow the growth of the tumour.
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