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What Are My Treatment Options for Prostate Cancer?

No man ever wants to hear his doctor say, “You have prostate cancer.” But 1 in 7 men will hear that news during his lifetime.

In fact, more than 161,000 cases of prostate cancer are diagnosed in the U.S. each year, and it’s the third-leading cause of cancer death in men, according to American Cancer Society estimates.

But while those statistics may sound frightening, Matthew Milowsky, MD, says they don’t tell the whole story. He’s a urologic cancer specialist at UNC Lineberger Comprehensive Cancer Center in Chapel Hill.

“For the great majority of men diagnosed with prostate cancer, the prognosis is excellent,” Dr. Milowsky says. “We now know that many of these men can live normal lives and never suffer complications because of their prostate cancer.”

Patients have choices about the treatment they pursue, Dr. Milowsky says. These decisions are made based on conversations with doctors and a patient’s preferences.

If you’ve been diagnosed with prostate cancer, you have three main options for what to do next:

  • Active surveillance
  • Surgery
  • Radiation therapy

Active Surveillance

More than half of men who are newly diagnosed with prostate cancer are good candidates for active surveillance first, Dr. Milowsky says. This means the cancer is not immediately treated and instead is closely monitored to make sure it’s not growing. This is an appropriate option especially for men with an early diagnosis of low-risk prostate cancer. Because prostate cancer often grows slowly, many men may never need more than active surveillance.

Generally with active surveillance, a man will go to the doctor twice a year for a prostate-specific antigen blood test and a digital (finger) rectal exam to determine if his cancer has remained stable or gotten worse.

The doctor will also perform prostate biopsies, in which small samples of the prostate are removed and examined under a microscope for tumors. The doctor may also order an MRI if needed.

If the doctor finds the prostate cancer is getting worse, it’s time to consider taking further action.

Surgery

In some cases, the next step may be surgery. Some men with more aggressive prostate cancer may need a radical prostatectomy, in which a surgeon removes the prostate gland and some of the tissue around it, including the seminal vesicles.

Different types of surgical approaches can be used to perform a radical prostatectomy:

  • Traditional open surgery is still sometimes performed, but it may lead to a slower recovery.
  • Minimally invasive surgery, such as laparoscopic or robot-assisted surgery, has become more common and offers a quicker recovery.

Possible side effects from surgery include urinary incontinence and erectile dysfunction. Doctors have ways to help patients manage side effects.

Radiation Therapy

There are two main types of radiation therapy: external beam radiation therapy (EBRT) and brachytherapy (internal radiation, also called seed implantation). Doctors will choose the best type of radiation to use based on the aggressiveness of the prostate cancer and patient’s overall health.

With EBRT, beams of radiation target the cancer on the prostate gland using a machine outside the body. There are different types of EBRT:

  • Intensity-modulated radiation therapy delivers small amounts of radiation to the prostate daily, usually over several weeks.
  • CyberKnife radiation allows doctors to precisely target tumors while minimizing radiation to other parts of the body. UNC Lineberger Comprehensive Cancer Center is the only academic center in central North Carolina to offer this treatment. It’s typically offered to patients with an early diagnosis.

Brachytherapy is a form of internal radiation treatment. It uses small radioactive pellets, or “seeds,” each about the size of a grain of rice. These pellets are placed into the prostate in a one-time outpatient procedure.

In some cases, men receiving radiation therapy may also take medications to reduce testosterone and boost the effectiveness of radiation therapy; this is used for patients with more aggressive cancers.

Possible side effects of both EBRT and brachytherapy include urinary irritation, looser stools, erectile dysfunction and fatigue. As with surgery, your doctor can help you cope with these effects and feel better.

Newly Diagnosed—Now What?

If you’ve been diagnosed with prostate cancer, you can meet with a surgeon, a radiation oncologist and, in some cases, a medical oncologist to learn more about which treatment options are best for you.

All of these treatment options are available at the UNC Urologic Oncology Clinic in Chapel Hill. The clinic provides patients with the unique opportunity to be seen by providers from multiple specialties during one visit. The providers meet as a team to discuss each patient’s case and coordinate the best treatment plan for each person.

UNC Lineberger also offers access to several clinical trials for men with prostate cancer. In some cases, clinical trials may offer new hope for patients and lead to safer, more effective treatments for future patients.

If you’re facing prostate cancer, talk to your doctor about what’s best for you, and remember—you have options.


If you have been recently diagnosed with prostate cancer, you or your doctor can call (866) 869-1856 to make an appointment at UNC’s Urologic Oncology Clinic in Chapel Hill.