Prostate Cancer Treatments and Living with the Disease
A diagnosis of prostate cancer can be scary, but there are many effective treatments available, and most prostate cancers are very treatable – especially if caught early.
The treatment plan that’s best for you will depend on how aggressive the cancer is, whether it’s spread beyond the prostate, and your overall health and preferences. Here’s an overview of the main treatment options and some insight into living with the disease during and after treatment.
Treatment Options
Active Surveillance (Watchful Waiting): Not all prostate cancers need immediate treatment. If the cancer is small, appears low-grade (not aggressive), and is confined to the prostate, doctors may suggest active surveillance. This means closely monitoring the cancer with regular PSA tests, prostate exams, and occasional biopsies or MRIs, rather than treating it right away. The idea is to avoid overtreatment of a cancer that isn’t causing problems. If tests show the cancer is growing or becoming more active, then curative treatment (surgery or radiation) would be started at that time. Active surveillance is often recommended for older men or those with very low-risk cancer. It’s a way to preserve quality of life (by avoiding side effects of treatment) without significantly increasing risk.
Surgery (Radical Prostatectomy): Surgery involves removing the entire prostate gland (along with some surrounding tissue and usually the seminal vesicles). This is typically done for cancer that is believed to be confined to the prostate and offers a chance for a complete cure. Surgery can be performed via a traditional open approach or through minimally invasive methods (laparoscopic or robotic surgery). Many hospitals now use robotic-assisted techniques that allow precise surgery through small incisions. After a radical prostatectomy, the prostate is gone and, ideally, the cancer is gone with it (confirmed by testing the removed tissue and checking that margins are clear of cancer). Recovery from surgery takes a few weeks for the incisions to heal and for urinary control to improve. Common side effects in the aftermath:
Urinary incontinence: Right after the catheter is removed, almost all men have some leakage of urine. Over the weeks and months after surgery, the majority regain control, but some men may need to use a small pad for security, especially with exertion. Pelvic floor exercises (Kegels) can strengthen the muscles that control urination and speed up recovery. Only a small percentage of men have long-term severe incontinence, and there are additional treatments (like slings or artificial urinary sphincters) for those cases.
Erectile dysfunction: Surgery can affect the nerves that run alongside the prostate which are responsible for erections. Nerve-sparing techniques aim to preserve those nerves, but success depends on factors like the tumor’s location and a man’s pre-surgery erectile function. Younger men and those with good function beforehand have a better chance of recovering potency. It might take anywhere from several months to a couple of years to see the maximum improvement. During recovery, doctors can prescribe medications (e.g., sildenafil/Viagra or similar drugs) or other therapies to help with erections. Some men recover spontaneous function; others may need ongoing assistance to achieve erections adequate for intercourse.
Despite these side effects, many men choose surgery because it can remove the cancer completely, and knowing the post-surgery pathology helps guide further steps (some men might need follow-up radiation if there’s any indication some cancer cells were left behind).
Radiation Therapy: Radiation is a non-surgical option that can cure prostate cancer by killing cancer cells in the prostate.
External Beam Radiation Therapy (EBRT): This method directs radiation from a machine to the prostate and sometimes the surrounding areas. It’s usually done as an outpatient treatment, Monday through Friday, for several weeks (though newer protocols can shorten the number of sessions). Each session is quick (a few minutes) and painless. Over the course of treatment, men may experience side effects like fatigue, increased urinary frequency or urgency, mild burning with urination, or bowel changes such as loose stools. These side effects often peak towards the end of treatment and then improve. Long-term, the majority of men do well, though a small fraction might have persistent urinary or rectal irritation. Effects on erections tend to happen gradually – some men notice a decline in erectile function a year or more after radiation.
Brachytherapy: This is internal radiation. Tiny radioactive seeds (each about the size of a grain of rice) are implanted directly into the prostate. They emit radiation at close range over a period of weeks or months and then become inert. Brachytherapy can be done with permanent low-dose seeds or temporary high-dose sources. It’s generally a one-time procedure under anesthesia. Brachytherapy is often used for low to intermediate risk cancers. Side effects are similar to EBRT: urinary irritation (some men may need to use medication to ease urinary symptoms for a while) and occasional rectal discomfort. Because the radiation is very targeted, the risk of affecting other organs is low. Erectile dysfunction can occur in the longer term, as with external radiation.
Sometimes doctors combine radiation with hormone therapy for a period of time (for instance, 6 months to 3 years of hormonal treatment) if the cancer is higher-risk. The hormone therapy can shrink and weaken the cancer, making the radiation more effective, but this combined approach is typically for more aggressive cancers.
Hormone (Androgen Deprivation) Therapy: As mentioned, prostate cancer typically relies on testosterone to grow. Hormone therapy either lowers testosterone levels or blocks the cancer’s ability to use testosterone. It’s commonly used in advanced cancer (cancer that has spread beyond the prostate) or in cases of recurrence. It can also be used along with radiation for aggressive localized cancers. Hormone therapy alone usually isn’t curative; rather, it puts the cancer “on pause,” often for several years. It can significantly shrink tumors and alleviate symptoms. The main side effects are due to the low testosterone state: hot flashes, lowered sexual desire, erectile dysfunction, breast tenderness or slight enlargement, potential weight gain and muscle loss, and mood changes. Some men also feel more fatigued. Doctors will monitor bone health because long-term testosterone suppression can weaken bones (osteoporosis). They may recommend calcium, vitamin D, or other medications to protect bone density if you’re on long-term hormone therapy.
Chemotherapy and Advanced Treatments: For metastatic prostate cancer that doesn’t respond to hormone therapy (castration-resistant prostate cancer), chemotherapy can be used. Chemotherapy drugs (given intravenously) like docetaxel can help men live longer and ease cancer-related symptoms. Chemo is not a first-line treatment for early prostate cancer, but it becomes important in advanced disease. Other newer treatments for advanced cases include:
Immunotherapy: One example is sipuleucel-T (Provenge), a vaccine that stimulates the immune system to fight prostate cancer cells. It’s used in certain men with advanced cancer and can extend survival a bit with minimal side effects, though it’s a complex and expensive treatment.
Targeted therapy: If the cancer has specific genetic mutations, targeted drugs can be effective. For instance, PARP inhibitors (like olaparib) can be used in men whose tumors have mutations in DNA-repair genes (such as BRCA mutations).
Radioisotope therapy: For cancer that has spread to bones, treatments like radium-223 (Xofigo) act like a calcium mimic and deliver radiation directly to bone metastases, helping reduce pain and improving survival in some cases.
These advanced therapies are tailored to the individual’s disease characteristics and often used sequentially to keep the cancer under control for as long as possible.
Living with Prostate Cancer
During Treatment: Whether you undergo surgery, radiation, or other therapies, taking care of yourself during treatment is important. Eating a healthy diet and staying active as much as you can will help your body recover and cope. For example, during radiation therapy, regular light exercise can combat fatigue. After surgery, walking and gentle activity help regain strength (while heavy lifting should be avoided for a few weeks as advised by your surgeon).
Coping with Side Effects: Two of the most significant side effects that can affect daily life are urinary and sexual changes:
Urinary incontinence: If you experience leakage after surgery, know that it often improves. Continuing pelvic floor exercises as instructed can strengthen the muscles. There are also absorbent pads or guards that can be worn discreetly if needed. If incontinence persists beyond a year, see a urologist specializing in incontinence – there are treatments (like sling procedures or artificial sphincters) that can dramatically improve this issue.
Erectile dysfunction: It can take time (months or longer) for erections to recover after prostate surgery or radiation. Don’t hesitate to talk to your doctor about it – treatments are available. Oral medications (PDE5 inhibitors such as Viagra or Cialis) are often tried first and help many men. If those aren’t effective, other options include vacuum erection devices, injection therapy, or penile implants. It’s also important to communicate with your partner – intimacy can continue in other forms, and maintaining physical closeness and emotional support is key. Some couples seek counseling or sex therapy to navigate these changes together.
Emotional Well-being: A cancer diagnosis and treatment can cause emotional ups and downs. It’s normal to worry about the cancer itself, the treatment decisions, and potential impacts on lifestyle and relationships. Give yourself permission to seek support. That might be talking openly with family or friends, joining a support group where you can meet other men who have been through similar experiences, or speaking with a mental health professional. Many men find that connecting with others – for instance, at a local prostate cancer support meeting – reassures them that they’re not alone and provides practical tips for coping.
Follow-Up and Long-Term Outlook: After initial treatment (like surgery or radiation intended to cure), you’ll have regular follow-ups. Typically, PSA blood tests are done every few months at first, then semiannually or annually. A rising PSA could indicate a recurrence, in which case additional treatment (such as radiation after surgery, or hormone therapy) might be recommended. The majority of men treated for localized prostate cancer will not have a recurrence, and for those who do, subsequent treatments are often successful in controlling the disease.
For men living with advanced prostate cancer, the focus shifts to managing the cancer as a chronic condition. This means regular treatments (like periodic hormone therapy injections) and monitoring. Many men in this situation continue to enjoy life for years, managing the cancer with the help of their medical team. Quality of life becomes a big consideration – balancing treatment side effects with symptom control. Palliative care specialists (who focus on symptom management and quality of life) can be a part of the care team even while you’re getting treatments like chemo or hormone therapy; they help manage pain, fatigue, or other issues.
Staying Healthy After Cancer: Men who have been treated for prostate cancer should continue with healthy lifestyle practices. Exercise, for example, is shown to improve outcomes and quality of life in prostate cancer survivors. It helps with fatigue, mood, and even bone health (critical if you’re on hormone therapy). Eating a balanced diet is equally important for overall health and recovery. Some research suggests that a diet rich in vegetables and low in saturated fats might be beneficial for prostate cancer survivors, so the dietary tips in the prevention section apply here as well.
Conclusion
Life after a prostate cancer diagnosis can be fulfilling and active. Treatments like surgery and radiation have high success rates, and even when prostate cancer is advanced, there are therapies that can control it for a long time. The journey isn’t without challenges – you may face temporary or long-term changes in urinary or sexual function, and you’ll need to go to regular medical appointments. However, with time, most men adjust to these changes. It helps to stay informed about what side effects to expect and how to manage them, and to involve your partner or loved ones in discussions so they understand what you’re going through. Remember that you don’t have to go through it alone – there are resources and support networks dedicated to prostate cancer patients.
In summary, prostate cancer is a very treatable disease, especially when caught early. Surviving prostate cancer and thriving after it is the norm for many men. By working closely with your healthcare team, maintaining a healthy lifestyle, and seeking support when needed, you can navigate treatment and recovery successfully. Many men find that once treatment is over and side effects are managed, they can return to their usual activities and enjoy life, perhaps with a new appreciation for their health and loved ones.