Tumors that have metastasized are incurable and require drug based therapies to treat the whole body. The goal of advanced prostate cancer treatment is to shrink or control tumor growth and control symptoms. There are many treatment choices for advanced prostate cancer. Which treatment to use, and when, will depend on discussions with your doctor.
It is best to talk to your doctor about how to handle side effects before you choose a plan. Hormone therapy is a treatment that lowers a man's testosterone, or hormone, levels.
This therapy is also called ADT. Testosterone, an important male sex hormone, is the main fuel for prostate cancer cells, so reducing its levels may slow the growth of those cells. Hormone therapy may help slow prostate cancer growth in men when prostate cancer has metastasized spread away from the prostate or returned after other treatments.
Some treatments may be used to shrink or control a local tumor that has not spread. There are several types of hormone therapy for prostate cancer treatment, including medications and surgery. Your doctor may prescribe a variety of therapies over time. Surgery to remove the testicles for hormone therapy is called orchiectomy or castration. When the testicles are removed, it stops the body from making the hormones that fuel prostate cancer. It is rarely used as a treatment choice in the United States.
Men who choose this therapy want a one-time surgical treatment. They must be willing to have their testicles permanently removed and must be healthy enough to have surgery.
This surgery allows the patient to go home the same day. The surgeon makes a small cut in the scrotum sac that holds the testicles. The testicles are detached from blood vessels and removed. The vas deferens tube that carries sperm to the prostate before ejaculation is detached.
Then the sac is sewn up. There are multiple benefits to undergoing orchiectomy to treat advanced prostate cancer. It is not expensive. It is simple and has few risks. It only needs to be performed once. It is effective right away. Testosterone levels drop dramatically. Side effects to your body include infection and bleeding.
Removing the testicles means the body stops making testosterone, so there is also a chance of the side effects listed below for hormone therapy. Other side effects of this surgery may be about body image due to the look of the genital area after surgery. Some men choose to have artificial testicles or saline implants placed in the scrotum to help the scrotum look the same as before surgery.
Some men choose another surgery called subcapsular orchiectomy. This removes the glands inside the testicles, but it leaves the testicles themselves, so the scrotum looks normal. There are different types of hormone therapy available as injections or as pills that can be taken by mouth. Some of these therapies stop the body from producing luteinizing-hormone-releasing-hormone LHRH, also called gonadotrophin releasing hormone, or GnRH.
LHRH triggers the body to make testosterone. Other therapies stop prostate cells from being affected by testosterone by blocking hormone receptors. Sometimes, after the first shot, a blood test is done. This is done to check testosterone levels. You may also have tests to monitor your bone density during treatment. With LHRH treatment there is no need for surgery. Candidates for this treatment include men who cannot or do not wish to have surgery to remove their testicles.
There are different types of medical hormone therapy your doctor could prescribe to lower your body's production of testosterone. After your testosterone levels drop to a very low level, you are at "castration level. They may be used for cancer that has come back, whether or not it has spread.
When first given, agonists cause the body to produce a burst of testosterone called a "flare". Agonists are longer acting than natural LHRH. As a result, the testicles are not stimulated to produce testosterone. Based on the drug used, they could be given from once every one, three or six months. These drugs also lower testosterone. Antagonists may be taken by mouth or injected shot under the skin, in the buttocks or abdomen. The shot is given in the health care provider's office.
You will likely stay in the office awhile after the shot to ensure there is no allergic reaction. After the first shot, a blood test makes sure testosterone levels have dropped. You may also have tests to monitor bone density. Antiandrogen drugs are taken as a pill by mouth.
This therapy depends partly on where the cancer has spread and its effects. This treatment lowers testosterone by inhibiting the androgen receptors in the prostate cancer cells. Normally, testosterone would bind with these receptors to fuel growth of prostate cancer cells.
With the receptors blocked, testosterone cannot "feed" the prostate. Using anti-androgens a few weeks before, or during, LHRH therapy may reduce "flare ups. This method blends castration by surgery or with the drugs described above and antiandrogen drugs. The treatment reduces production of testosterone and can help stop it from binding to cancer cells.
Surgery or taking oral drugs may be ways to lower the testosterone made by your testicles. The rest of the testosterone is made by the adrenal glands. Antiandrogen therapy blocks testosterone made by the adrenal glands. These drugs help stop other parts of your body and the cancer itself from making more testosterone and its metabolites. Men newly diagnosed with metastatic hormone sensitive prostate cancer mHSPC or men with metastatic castration-resistant prostate cancer mCRPC may be good candidates for this therapy.
Androgen synthesis inhibitors may be taken by mouth as a pill. This drug helps stop your body from releasing the enzyme needed to make androgens in the adrenal glands, testicles and prostate tissue, resulting in reduced levels of testosterone and other androgens.
Because of the way it works, this drug must be taken with an oral steroid. Unfortunately, hormone therapy may not work forever, and it does not cure the cancer. Over time, the cancer may grow in spite of the low hormone level. Other treatments are also needed to manage the cancer. Hormone therapies have many possible side effects. Learn what they are. Intermittent not constant hormone therapy may also be a treatment option. Before starting any type of hormone therapy, talk with your health care provider.
There are many benefits and risks to each type of hormone therapy, so ask questions of your doctor so you understand what is best for you.
Chemotherapy drugs can slow the growth of cancer. These drugs may reduce symptoms and extend life. Treatments like surgery, radiation, and hormone therapy remove or destroy the cancer. However, all of these treatments can have sexual side effects. This can include trouble getting an erection, having an orgasm, and fathering children. Prostate cancer may dampen your sex drive. Knowing that you have cancer and going through treatment can both cause you to feel too anxious to have sex.
Hormone therapy used to treat prostate cancer can also affect your libido. This treatment slows prostate cancer growth by lowering testosterone levels in your body. You need testosterone to have a healthy sex drive.
Hormone therapy can also affect your self-esteem and sex drive by making you gain weight or causing your breast tissue to enlarge.
If your hormone levels are low, your doctor may be able to prescribe testosterone replacement therapy to bring them back up to normal.
This depends on your overall cancer treatment plan. Some men notice that their penis is slightly smaller after prostate cancer treatment. In a study , about 3 percent of participants reported that they had a reduced penis size after radical prostatectomy or radiation plus hormone therapy.
The men said their smaller penis affected their relationships and their satisfaction with life. Talk to your doctor about increased risk of prostate cancer. If you have a very high risk of prostate cancer, you and your doctor may consider medications or other treatments to reduce the risk. Some studies suggest that taking 5-alpha reductase inhibitors, including finasteride Propecia, Proscar and dutasteride Avodart , may reduce the overall risk of developing prostate cancer.
These drugs are used to control prostate gland enlargement and hair loss. However, some evidence indicates that people taking these medications may have an increased risk of getting a more serious form of prostate cancer high-grade prostate cancer.
If you're concerned about your risk of developing prostate cancer, talk with your doctor. Prostate cancer care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
This content does not have an English version. This content does not have an Arabic version. Overview Prostate cancer Open pop-up dialog box Close. Prostate cancer Prostate cancer occurs in the prostate gland, which is located just below the bladder in males and surrounds the top portion of the tube that drains urine from the bladder urethra.
Request an Appointment at Mayo Clinic. Prostate gland Open pop-up dialog box Close. Prostate gland The prostate gland is located just below the bladder in men and surrounds the top portion of the tube that drains urine from the bladder urethra. Share on: Facebook Twitter.
Show references AskMayoExpert. Prostate cancer adult. Mayo Clinic; Niederhuber JE, et al. They can also be affected by radiation treatment. These nerve bundles help control blood flow to the penis. The length of time ED lasts after treatment depends on many things, including how firm your erections are before treatment.
Sometimes, it may take one year or longer to recover erectile function. In the meantime, your doctor may have ED treatment options for you. If it's possible, nerve-sparing surgery may help prevent long-term damage. Older men have a higher chance of permanent ED after this surgery. For more information on how prostate cancer surgery can affect your erections, read our After Treatment: Erectile Dysfunction Issues After Prostate Cancer Treatment section.
It may surprise you to know that men are still able to have an orgasm climax , even after a radical prostatectomy. An erection is not needed to climax. There will be very little, if any, fluid with an orgasm. In addition, you can no longer cause a pregnancy after surgery.
This is because the prostate, seminal vesicles, and connections to the testicle were removed and the vas deferens was divided during surgery. Planning for fertility preservation in advance of surgery is an option for men who want to have children. Read our Fertility Preservation fact sheet to learn more on this. It is important to know that sexual desire is not lost with this surgery or radiation treatment. The exception to this is if hormones are also given as part of treatment, usually given temporarily with radiation therapy.
Incontinence is the inability to control your urine. After prostate cancer surgery, you may experience one or more type of Incontinence. Stress Incontinence - is urine leakage when coughing, laughing, sneezing or exercising. It is the most common type of urine control problem after radical prostatectomy. Overactive Bladder Urge Incontinence - is the sudden need to go to the bathroom even when the bladder is not full because the bladder is overly sensitive.
This type of incontinence is the most common form after radiation treatment. Mixed Incontinence - is a combination of stress and urge incontinence with symptoms from both types. Because incontinence may affect your physical and emotional recovery, it is important to understand your treatment options. For more information on how prostate cancer surgery can affect incontinence, read our After Treatment: Incontinence Issues After Prostate Cancer Treatment article.
Updated January Radiation therapy uses high-energy rays to kill or slow the growth of cancer cells. Radiation can be used as the primary treatment for prostate cancer in place of surgery. It can also be used after surgery if the cancer is not fully removed or if it returns.
Radiation therapy mostly involves photon beams or proton beams. Photon beams make up traditional x-rays. They carry a very low radiation charge and mass, and can scatter to nearby health tissue. On the other hand, proton beams have more charge and heavy mass and can target deep tissue.
A physician can direct proton radiation treatment to the specific site of cancer, minimizing damage to nearby healthy tissue. Before you begin, it helps to ask your doctor s why they recommend one type of radiation therapy over another.
Photon-based external-beam x-rays may damage nearby healthy tissue. That damage can cause side effects. Some newer 3DCTR machines have imaging scanners built into them.
It allows higher doses of radiation to be delivered to cancer cells while protecting surrounding healthy tissue. It uses a machine called a synchrotron or cyclotron to speed up and control the protons.
High-energy protons can travel deeper into body tissue than low-energy photons. With proton therapy, radiation does not go beyond the tumor, so nearby tissue is not affected. There are fewer side effects. Intensity-modulated proton beam therapy IMPT is a new way to deliver targeted PBT, but these machines are expensive and are not offered everywhere.
Stereotactic Body Radiation Therapy SBRT delivers large doses of radiation to exact areas, such as the prostate, with advanced imaging. The entire course of treatment is given over a shorter period, for just a few days. With any radiation treatment, the side effects should be discussed with you before you begin. With brachytherapy, radioactive material is placed directly into the prostate using a hollow needle. LDR brachytherapy is when your doctor uses a thin needle to insert radioactive "seeds" the size of a rice grain into the prostate.
These seeds send out radiation, killing the prostate cancer cells nearby. In LDR, the seeds are left in the prostate even after treatment is finished. HDR brachytherapy is when your doctor puts radiation into your prostate using a slightly larger hollow needle to insert a thin catheter. This catheter stays in your body until treatment is done. The radiation source stays in your prostate for a short period of time. Once your treatment is done, all radioactive material is removed. You may need to stay in the hospital overnight.
Sometimes radiation therapy is combined with hormone therapy to shrink the prostate before starting. Or, hormone therapy may be combined with external beam therapy to treat high-risk cancers. The benefit of radiation therapy is that it is less invasive than surgery. Whether the radiation is given externally or internally, this treatment is effective for early stage prostate cancer. Some need both types of radiation combined to treat their cancer. The main side effects of radiotherapy are incontinence and bowel problems.
Urinary problems usually improve over time, but in some men they never go away. Erectile dysfunction, including impotence, is also possible. Many men feel tired for a few weeks to months after treatment. If hormone therapy is used with radiation, sexual side effects are common.
These can include loss of sex drive, hot flashes, weight gain, fatigue, decreased bone density and depression. Fortunately, these side effects can be managed and usually go away when hormone therapy is stopped. It helps to work with your radiologist before you begin treatment to prepare for any known side effects in advance.
Follow-up visits with your healthcare team will help you address any new problems. Download our fact sheet on Radiation for Prostate Cancer [pdf] to learn more.
Cryotherapy , or cryoblation, for prostate cancer is the controlled freezing of the prostate gland. The freezing destroys cancer cells. Cryotherapy is done under anesthesia.
This treatment is for men who are not good candidates for surgery or radiotherapy because of other health issues. For this procedure, the prostate is imaged and measured. Special needles called "cryoprobes" are placed in the prostate under the skin. The needles are guided by ultrasound, to direct the freezing process. A catheter will be used in the hospital until you can urinate on your own. After cryotherapy, a patient is monitored with regular PSA tests and in some cases a biopsy.
Cryotherapy has been found to have some side effects. You may experience incontinence and other urinary or bowel problems at first.
Erectile dysfunction is likely. Worth noting is the risk of a fistula. A fistula is a channel that forms after surgery between the urethra and the rectum. This may cause diarrhea or bladder infections. It can be used for the whole gland.
This uses a needle-thin probe to circle the tumor with a special solution that kills the tumor by freezing it. This uses a "NanoKnife" to pass an electrical current through the tumor. The electricity creates very tiny openings called pores in the tumor's cells, leading to cell death. For men with small, localized prostate tumors , focal therapy may be an option.
Focal therapy is a general term for a few methods. They kill small tumors inside the prostate, without destroying the whole gland or healthy tissue nearby. There are a few types of focal therapy in clinical trials. Ideally, focal therapy would lead to fewer side effects including changes in urinary function.
The long-term benefits of focal therapy are not yet known. Research is being done to study this further. Right now, the FDA has approved this method to destroy prostate tissue, but not clearly to treat prostate cancer. Because many of these treatments are so new, insurance coverage is not often available. Prostate cancer cells use the hormone testosterone to grow, similar to our need for food.
Hormonal therapy is also known as androgen deprivation therapy ADT. It uses drugs to block or lower testosterone and other male sex hormones that fuel cancer.
ADT essentially starves prostate cancer cells of testosterone. ADT is used to slow cancer growth in cancers that are advanced or have come back after initial local aggressive therapy. It is also used for a short time during and after radiation therapy. Surgery: Removes the testicles and glands that produce testosterone with a procedure called an orchiectomy.
Medication: There are a variety of medications used for ADT. There are two types that are used at first. One is the injection of luteinizing hormone releasing hormone LH-RHs inhibitors.
These are also called either agonists or antagonists. They suppress the body's natural ability to turn on testosterone production. A second type which is often given with the first type are called non-steroidal anti-androgens.
These pills block testosterone from working. These therapies have been used for many years and are often offered as the first option for men who can't have or don't want other treatments. Hormone therapy usually works for a while maybe for years until the cancer "learns" how to bypass this treatment.
There are new medications available in recent years that may be used after other hormone therapy fails. This condition is called "castration-resistant prostate cancer" CRPC. For more information on this, review our Advanced Prostate Cancer website article. To block the production of androgens in CRPC patients, there are a few options. The drug Abiraterone Zytiga , given with prednisone, is one option that blocks an enzyme called CYP17, to stop these cells from making androgens.
This medication blocks signals in cells that tell it to grow and divide. Like other hormone therapies, these options also only work for a while. When they stop working, chemotherapy may be an option.
Hormone therapy has been linked to heart disease, diabetes and the loss of bone. You should discuss these risks with your doctor before you begin this treatment for prostate cancer. Hot flashes and fatigue are also short-term side effects of hormone treatment. The same is true for the loss of sexual drive. Chemotherapy uses drugs to destroy cancer cells anywhere in the body. It is used for advanced stages of prostate cancer. It is also used when cancer has metastasized spread into other organs or tissue.
The drugs circulate in the bloodstream. Because they kill any rapidly growing cell, they attack both cancerous cells and non-cancerous ones. Dose and frequency are carefully controlled to reduce the side effects this may cause.
Often, chemotherapy is used with other treatments. It is not the main treatment for prostate cancer patients. Many chemotherapy drugs are given intravenously with a needle in a vein.
Others are taken by mouth. They are given in the healthcare provider's office or at home. You generally do not need to stay in the hospital for chemotherapy. They are often given once per month for several months.
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