Prostate cancer is generally slow growing and occurs in older men (over the age of 65). If the individual is not experiencing symptoms, healthcare professionals can use watchful waiting. Watchful waiting is the close monitoring an individual's condition without giving any treatment until symptoms appear or change. When a patient does need treatment, there are several conventional options available, which include surgeries, radiation, or hormone therapies. Patients with prostate cancer have a choice about their treatment.
Radical prostatectomy: Radical prostatectomy is a surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are two types of radical prostatectomy, including retropubic prostatectomy, during which the prostate and nearby lymph nodes are removed through an incision (cut) in the abdominal wall, and perineal prostatectomy, a surgical procedure to remove the prostate and nearby lymph nodes through an incision made in the perineum (area between the scrotum and anus).
Transurethral resection of the prostate (TURP): This is a surgical procedure to remove tissue from the prostate that may be blocking urine flow using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This surgery is sometimes performed to relieve symptoms caused by benign (non-cancerous) tumors. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.
Surgery complications: Surgery for prostate cancer can cause problems such as impotence (erectile dysfunction) and leakage of urine from the bladder or stool from the rectum. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. These surgeries are performed under general anesthesia, which may also cause complications.
Radiation therapy is a cancer treatment that uses high-energy radiation to kill cancer cells and shrink tumors. Radiation targets rapidly growing cancer cells and helps decrease metastasis, or the spreading to other areas of the body. There are two types of radiation therapy. External radiation therapy (XRT) uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy (or brachytherapy) involves surgically implanting tiny, radioactive capsules (called "seeds") into the cancerous prostate gland. The seeds emit radiation that kills the malignant tumor. The type of radiation therapy used depends on the type and stage of the cancer being treated. Side effects can include diarrhea, skin burns, sexual dysfunction, and urinary discomfort or urgency. Normal tissue can be damaged by radiation. However, new developments in radiation delivery may decrease the chances of damage.
Hormone therapy is utilized in cancer treatment to remove hormones or block their action, ultimately inhibiting the growth of cancer cells. Hormones are substances produced by glands in the body that circulate within the bloodstream and exert specific effects on the body. Some hormones can contribute to the growth of certain cancers. If laboratory tests show that the cancer cells have receptors (places of attachment) for hormones, then drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. Side effects may include nausea, vomiting, hot flashes, impaired sexual function, loss of desire for sex, and breast tenderness may occur in men treated with hormone therapies. Patients who begin hormone therapy may experience an increase in prostate cancer symptoms for approximately two weeks, due to a temporary increase in testosterone levels.
Luteinizing hormone-releasing hormone agonists: These drugs can prevent the testicles from producing testosterone (the male hormone). Examples are leuprolide (Eligard®, Lupron®, Lupron Depot®, Viadur®), goserelin (Zoladex®), and buserelin (Suprefact®).
Antiandrogens: Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide (Eulexin®) and nilutamide (Anadron®). Healthcare professionals recommend that patients who are taking antiandrogens get periodic liver function tests and should report symptoms such as nausea and vomiting, stomach pain, fatigue (extreme tiredness), appetite loss, dark urine, and yellowing of the eyes to their physician immediately.
Adrenal agents: Drugs that can prevent the adrenal glands from making androgens (male sex hormones) include aminoglutethimide (Cytadren®). Side effects include drowsiness, dizziness, headache, weakness, nausea, or loss of appetite during the first few weeks of treatment. As the body adjusts to the medication, the symptoms should disappear. If symptoms persist after two weeks, healthcare professionals recommend contacting a doctor.
Estrogens: Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone or the male hormone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects, including breast cancer development and an increase in stroke (neurological damage caused by lack of oxygen to the brain), or heart attack. Estrogens include conjugated estrogen (Premarin®) or estradiol (Ogen®).
Cryosurgery: Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. This type of treatment is also called cryotherapy. Cryotherapy alone rarely causes side effects. However, when used after the individual has undergone radiation therapy for the prostate cancer, it increases the risks of side effects. The rates of incontinence, or the involuntary excretion of urine from the body, in patients undergoing cryosurgery after radiation (either seeds or external beam) are 60-70%, compared to less than 1% of patients undergoing cryosurgery who have not had any prior radiation. Other risks of side effects, such as sexual dysfunction and pain, are increased when using cryosurgery after treatment with radiation. The severity of the side effects in the previously radiated group is directly related to the extent of freezing and the total amount of ice that is generated during the procedure.
Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology (cancer) specialist will usually recommend a single drug or a combination of drugs. Chemotherapy medications that may be used to treat prostate cancer include mitoxantrone (Novantrone®), paclitaxel (Taxol®), docetaxel (Taxotere®), estramustine (Emcyt®), and doxorubicin (Adriamycin®). Common side effects of chemotherapy depend on the type of drug used, dosage, and length of treatment. The most common side effects are fatigue, nausea and vomiting, diarrhea, hair loss, and increased susceptibility to infection.
Biologic therapy: Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Side effects include fever, chills, nausea, and vomiting.
High-intensity focused ultrasound: High-intensity focused ultrasound is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal (inside the rectum) probe is used to make the sound waves.
When the individual has not responded to treatment methods, the cancer has metastasized (spread to other areas of the body), and the prognosis is not good, palliative care (provides symptomatic relief but not a cure) may be chosen over aggressive therapies and the side effects associated with them.
Selenium: There is evidence that low selenium levels are associated with an increased risk of prostate cancer. In human studies, initial evidence has suggested that selenium supplementation reduces the risk of developing prostate cancer in men with normal baseline PSA (prostate specific antigen) levels, and low selenium blood levels. Selenium deficiency may be diagnosed by measuring the selenium in the blood where the normal level is 70 nanograms per milliliter or ng/ml in blood plasma (liquid component) or 90 ng/ml in red blood cells, where the normal values are indicated. Laboratory studies have reported several potential mechanisms for selenium's beneficial effects in prostate cancer, including a decrease in androgen receptors and PSA production, angiogenesis (growth of new blood vessels in tumors) inhibition, and increased antioxidant effects including cancer cell apoptosis (cell death).
Green tea: Green tea (Camelia sinensis) is reported to be an effective antioxidant, anticancer, and immune supplement. Drinking green tea daily may decrease cancer and cardiovascular disease risks. One clinical trial showed minimal benefit using green tea extract capsules for the treatment of hormone refractory prostate cancer. Further research is needed. Caution is advised when taking green tea, as adverse effects including an increase in bleeding and drug interactions are possible. Caffeine-free products are available.
Lycopene: Lycopene, an antioxidant found in tomatoes, is a cancer fighting phytochemical.Lycopene is a carotenoid (in the vitamin A family), and much research exists on the positive effects of carotenoids on the human body including antioxidant effects. Laboratory studies have reported lycopene inhibits the growth of prostate cancer cells.
Modified citrus pectin: Pectins are gel-forming polysaccharides from plant cell walls, especially apple and citrus fruits. Modified citrus pectin may reduce the metastasis (spread to other areas of the body) of certain types of cancers, including lung, prostate, and breast. More research is needed in this area, especially with other types of cancer and with other criteria for prostate cancer progression.
Vitamin D: There is preliminary evidence based on laboratory and limited human studies that high-dose vitamin D may be beneficial in the treatment of prostate cancer. This area is under active investigation, but clear evidence of benefits is not yet available.
In recommended dosages, vitamin D supplements are used without toxic effects.
Vitamin E: The role of vitamin E supplementation for prevention of prostate cancer is controversial. There are numerous laboratory studies that support possible anti-cancer properties. However, the results of population research and human research have been mixed, with some studies reporting benefits and others finding no effects. Vitamin E succinate (one specific form of vitamin E) has been reported in laboratory studies to inhibit the growth of human prostate cancer cells.
Milk thistle (Silybum marianum) is used to detoxify the liver and as an antioxidant. Recent studies have reported that milk thistle may effective against prostate cancer cells. Caution is advised when taking milk thistle, as adverse effects including drug interactions are possible. Milk thistle should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
Quercetin: There is some evidence that quercetin, a bioflavonoid and antioxidant, may be useful for the treatment of chronic prostatitis (inflammation of the prostate). Further research is needed to confirm these results. Quercetin is reported safe in recommended dosages.
Initial studies in patients with cancer (such as prostate cancer) report variable effects on disease progression or death rates when intercessory prayer is used. Better quality research is necessary before a firm conclusion can be drawn.
Compounds found in Panax ginseng
have been reported effective in increasing immunity, thereby causing cancer cell apoptosis (cell death) in laboratory studies. More research needs to be performed. Caution is advised when taking panax ginseng, as adverse effects including drug interactions are possible.
Pygeum: Pygeum (Pygeum africanum) is an African plant that is reported effective when used in men with prostate problems. Pygeum has been observed to moderately improve urinary symptoms associated with enlargement of the prostate gland or prostate inflammation. Numerous human studies report pygeum to significantly reduce the number of nighttime urinary episodes, urinary hesitancy, urinary frequency, and pain with urination in men who experience mild-to-moderate symptoms. However, pygeum does not appear to reduce the size of the prostate gland. It is unclear how pygeum compares to the effectiveness or safety of other medical therapies, such as prescription drugs (e.g. alpha-adrenergic blockers or 5-alpha reductase inhibitors), surgical approaches, or other herbs/supplements such as saw palmetto. Caution is advised when taking pygeum, as adverse effects including drug interactions are possible. Pygeum should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
Saw palmetto: Saw palmetto (Serenoa repens) is reported effective when used in men with prostate conditions. Numerous human trials report that saw palmetto improves symptoms of benign prostatic hypertrophy (BPH) such as nighttime urination, urinary flow, and overall quality of life, although it may not greatly reduce the size of the prostate. Although the quality of these studies has been variable, overall they suggest effectiveness.
Shiitake mushroom: Shiitake mushroom (Lentinus edodes) can help the body fight infections and protect against immune system conditions such as cancer. Caution is advised when taking shiitake, as adverse effects including an increase in bleeding and drug interactions are possible. Shiitake should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
Prostate screening: The American Urological Association (AUA) encourages men who are in good health to have annual PSA testing starting at age 50, or at age 40 if they're in high-risk groups, such as black men or those with a father, brother, or son with the disease.
Lifestyle changes: Diets should include less high-fat dairy products, such as cheese, sour cream, and ice cream. High fat dairy products and the calcium contained in dairy may increase the risks of developing prostate cancer. Cruciferous vegetables (such as broccoli, cabbage, and cauliflower) have been reported to contain cancer-fighting phytochemicals that may decrease the chances of developing prostate cancer. Antioxidant containing foods, including fruits (such as berries, grapes, and tomatoes) and vegetables (such as peppers and carrots) may help prevent the development of prostate cancer. Dietary consumption of red meat and/or processed meats may increase the risks of developing cancer of the colon, rectum, stomach, pancreas, bladder, ovaries, prostate, breast and lung, and other diseases such as heart disease, rheumatoid arthritis, type 2 diabetes, and Alzheimer's disease. Exercise (at least 30 minutes daily for five days a week), smoking cessation, and relaxation all may contribute to decreasing the risk factors associated with developing prostate cancer.