Traditional Treatments
Active Surveillance
Because prostate cancer is often slow growing, some patients might never need to obtain treatment for it -- this is particularly true for men who are older or have other serious medical programs. Active surveillance is the approach where instead of undergoing surgery or radiation therapy, the cancer is monitored closely for signs of changes that make definitive treatment for patients advisable. This usually involves periodic visits to the urologist (typically every 6 months) for a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE). Repeat prostate biopsies are often done on a yearly basis.
Radical Prostatectomy
If the prostate cancer has not spread beyond the prostate gland, surgery is a common way to cure it. The traditional surgical approach is to perform a radical prostatectomy, which involves removing the entire prostate gland as well as some of the tissue around it. Although radical prostatectomy can completely cure localized cancer, there are significant long-term side effects which are predominantly obstructive, such as urinary dysfunction, incontinence, and erectile dysfunction.
External Beam Radiation Therapy
Radiotherapy is an alternative to surgery and uses ionizing radiation or photons to kill the cancer cells. The most common type of radiation therapy is External Beam Radiation Therapy (EBRT). It can be as effective as surgery, but it typically requires multiple daily treatment sessions and is still associated with significant urinary symptoms in the short-term and loss of erectile function in the long-term.
Brachytherapy (Internal) Radiation Therapy
Brachytherapy is an alternate radiation therapy that uses small radioactive pellets or “seeds” that are placed inside the prostate and the cancer is irradiated “internally”. The pellets are typically placed inside the prostate using small needles and left there permanently. The pellets typically give off radiation for several weeks or months. It is not uncommon to be advised to stay away from pregnant women and small children during this time. Brachytherapy can cause irritation of the rectum and urethra and is known to also be associated with erectile dysfunction.