Choosing your treatment

Homme secouru par un autre homme représentatif du besoin de soutien liée au cancer de la prostate

Overview

Depending on your stage, grade, age, state of health, medical history, and family history—you may be able to choose your treatment from among several treatment options. In order to make an informed decision it is important to have all the information for each of the proposed options.

There are a number of treatments for prostate cancer available. Some treatments are standard (the currently used treatment), and some are still being tested in clinical trials.

Primary standard treatments

  • Active surveillance: Involves closely monitoring small, slow-growing prostate cancer with relatively normal-looking cells (as determined by biopsy results).
  • Radical prostatectomy (open, laparoscopic, robotic): Surgery that completely removes the prostate gland, as well as part of the urethra within the prostate and the seminal vesicles.
  • Radiation therapy (external beam, brachytherapy): Radiation therapy uses high-energy radiation to shrink tumours and kill cancer cells.
  • Hormone therapy: Hormone therapy deprives cells of the male hormones (androgens) that they need to grow.
  • Chemotherapy: Drugs that treat cancer. These drugs affect both cancer cells and healthy cells. Healthy cells tend to regenerate whereas cancer cells struggle to do so.
  • Biological Therapy: Biological therapy may be an option for a recurrence of prostate cancer. It can help prevent bone fractures in men whose cancer has spread to the bones or help prevent the spread of cancer to the bones.
  • Bone pain: There are medications, palliative treatments or hormonal treatment for bone pain caused by bone metastases.

Clinical trials

One way to access new treatments before they become widely available is to participate in clinical trials. A clinical trial is a research study that uses volunteers, called participants, to test new ways of preventing, detecting, treating, or managing prostate cancer or other illnesses. Some clinical trials help determine whether or not a new drug or device is effective and safe.

Participating in a clinical trial is a valuable contribution to research as clinical trials answer important questions that can lead to better health outcomes. Participation can be a good way for participants to access free treatments and to be closely monitored by health care workers. To learn more about clinical trials, speak with your healthcare team.

For more information on clinical trials, visit:

Alternative medicine

Complementary and alternative treatments include a wide range of approaches and therapies. It is important to understand the differences between conventional medicine, complementary therapies, and alternative therapies.

Traditional medicine – Medical or surgical treatments that are accepted and practiced within the Canadian healthcare system. The best available research has shown these treatments to be effective and safe. Radiation therapy is an example of conventional medicine.

Complementary therapies – Therapies used with or alongside conventional medicine, often to help people cope with cancer, treatment, or side effects. More research is needed to find out if they are safe and effective. An example of complementary therapy is using meditation to help with stress or anxiety during treatment.

Alternative therapies – Therapies used instead of conventional medicine. Alternative therapies have not been scientifically proven to be safe and effective. Following a special diet to treat prostate cancer instead of conventional treatments is an example of an alternative therapy. Delaying or refusing conventional therapies in preference of using alternative therapies can have serious health consequences.

Discuss all treatment decisions with your healthcare team.

 

Your type of cancer

Localized prostate cancer

stade 1 cancer prostate

Stage 1 – A tumor is localized only within the prostate

Low risk of progression (Stage 1)

Localized prostate cancer is contained within the prostate and has not spread outside of it. A minimum life expectancy of 10 years is necessary for you to undergo a radical curative treatment.

The tumour has spread to half of one of the two prostate lobes or less. It cannot be detected with a digital rectal exam, but can be detected by chance while undergoing a biopsy for elevated PSA levels. Many localized cancers are often not very aggressive and tend to grow slowly.

Localized prostate cancer

stade 2 cancer prostate

Stage 2 – The size of the tumour is larger than tumours seen at stage 1, but is still confined to the prostate

Intermediate risk of progression (T2a and T2b)

The tumour can be felt during a digital rectal exam and takes up half or more of one of the two prostate lobes.

High risk of progression (T2c)

The tumor is more aggressive and has spread to the other lobe and can occupy your entire prostate without spreading outside of the capsule. The cancer has not spread to the lymph nodes or other parts of your body.

Many treatment options for localized prostate cancer are available to you. Each treatment has their pros and cons. Discuss possible treatments with your urologist.

Locally advanced prostate cancer

stade 3 cancer prostate

Stage 3 – The tumour has spread beyond the prostate, but has not spread to the neighbouring organs or lymph nodes

High risk of progression (T3a and T3b)

The cancer has begun to spread beyond the prostate without spreading to far. It may have surpassed the limits of your prostate (the capsule) or has spread to your seminal vesicles—a large gland that secretes the liquid component of sperm.

The best treatment will also depend on how far your cancer has spread.

Advanced prostate cancer

stade 4 cancer prostate

Stage 4 – The tumour has spread to neighbouring organs, lymph nodes, or other parts of your body far from your prostate

At very high risk of progression

Non-metastatic

The tumour has spread beyond your seminal vesicles to other neighbouring regions such as your pelvic nodes, bladder, rectum, or pelvic wall.

Metastatic

The cancer is very aggressive and has spread to other parts of your body—far from your prostate. Metastases originating from the prostate most often develop in the bones and lymph nodes. Bone pain, fatigue, and urinary problems are all symptoms associated with advanced cancer.

Advanced prostate cancer cannot be cured. There are, however, many treatments that can help to reduce symptoms, manage your pain, and keep your cancer under control for several years.

Recurrent prostate cancer

metastase cancer prostate

A recurrence is cancer that comes back after a radical prostatectomy or radiation therapy—whether or not these treatments were associated with hormone therapy. A relapse is considered to be an advanced cancer case.

Localized

Your cancer can reappear in the same location where it was found before your first treatment.

Metastatic

Your cancer can show up in another part of your body. This is known as a metastatic recurrence.

Hormone therapy is the main treatment for a prostate cancer relapse. Hormone therapy can be suggested even if you have already undergone surgery or radiation therapy. Palliative treatments may also be added to reduce your bone pain and other symptoms.

Hormone-resistant prostate cancer

cancer prostate hormono resistant

Hormone therapy can keep the spread of your cancer under control for a number of years. However, with time, the cancer may become hormone-resistant* and start to grow again: hormone therapy will become ineffective.

Without metastases

In this type of cancer, metastasis is not yet perceptible through diagnostic examinations, although it has already taken place on a microscopic level and will eventually cause the patient pain. Only an increase in PSA levels can conclusively prove a recurrence.

At the moment, no standard treatment exists for this type of cancer. The doctor performs a regular follow-up every two or three months and confirms the presence of metastasis through diagnostic exams and PSA measurements once it becomes detectable.

One particularly promising avenue is the use of new hormonal agents now administered to CRPC patients with detectable metastasis. Chemotherapy also offers hope as a potential treatment for this stage of cancer.

*The following terms are also used in reference to hormone-resistant prostate cancer: castrate resistant prostate cancer (CRPC), androgen independent prostate cancer, and hormone refractory prostate cancer

With metastases

In this type of cancer, diagnostic exams such as bone or CAT scans can detect metastasis. Sadly, since curing the disease is no longer possible at this stage, prolonging life and preserving the patient’s quality of life become the number-one priorities.

The doctor attempts to delay complications due to metastasis— generalized cancer, weight loss, pain and bone fractures—for as long as possible. As soon as the cancer reaches the castration-resistant stage and metastasis is detectable, hormone therapy, which until then was very useful to ease symptoms and control the cancer, is no longer enough on its own.

Chemotherapy may be administered when hormone therapy stops being effective. Additional palliative treatments may be added to reduce bone pain and other symptoms.

Who will care of you?

Once prostate cancer has been diagnosed, it is usually urologists and radiation oncologists who treat your cancer.

If metastases are present, especially when using chemotherapy, a medical oncologist will often consult other health professionals.

Your healthcare team—consisting of your family doctor, radiation oncologist technicians, and volunteers—is there for support and comfort.

 

Factors to consider

groupe-homme avec cancer prostate

If you are diagnosed with prostate cancer, there are many different types of treatment available to you. Some treatments are standard (treatments that are currently in use) while others are still being tested in clinical trials.

The type of treatment administered depends on your individual needs. Treatment decisions are based on:

Your type of prostate cancer

  • 95% of prostate cancer cases are generally slow-growing tumours.

Your prostate-specific antigen rate (PSA)

  • A rapid increase of your PSA levels over pre-determined time may mean that your cancer is progressing and that a more aggressive treatment is necessary.

Your cancer stage and grade (Gleason score)

  • A low-risk, slow-growing localized cancer (contained within your prostate) often requires no treatment. You may be closely monitored for evidence of any progression.
  • A localized, intermediate- or high-risk cancer is usually treated more aggressively with surgery or radiation therapy. Hormone therapy can be added at any time during your treatment.

Presence of metastases

  • Advanced cancer that has spread beyond the prostate gland is treated primarily with hormone therapy. Radiation therapy is sometimes given to treat metastatic sites in the bone. Chemotherapy can be given when hormone therapy has stopped working.
  • The goal is to slow the growth and reduce cancer symptoms (palliative therapy)
  • Surgery may sometimes be used to relieve symptoms like urine blockage.

Your age and general health 

  • Your age and general health can influence your choice of treatment.
  • A radical prostatectomy for an elderly man in poor health involves a higher surgical risk compared to a middle-aged man in good health.
  • Active surveillance may be an option for elderly men with coexisting illnesses.
  • Treatment is often given to slow the growth of cancer or to relieve distressing symptoms such as urinary obstructions or severe back pain.

Your personal treatment preference

  • You may want to think about treatment side effects like incontinence or erectile dysfunction. Your choice of treatment may affect your quality of life and sexual function.

 

Your treatment options

cellule cancer prostate

Choosing a treatment can be difficult

Be sure to take the time to think about what is good for you and to get all the information you need. You will have an informed discussion with your doctor and choose the treatment option that is right for you.

Active surveillance

  • Regular checkups are scheduled every 3 to 6 months.
  • Checkups usually include a digital rectal exam (DRE), prostate‑specific antigen (PSA) test, and repeat prostate biopsies.

Surgery

  • radical prostatectomy – The most common surgery for the removal of localized prostate cancer. It completely removes the prostate cancer.
  • pelvic lymph node dissection – Done during a radical prostatectomy, this procedure removes the lymph nodes in the pelvis. It is done for intermediate- or high-risk prostate cancers.
  • transurethral resection of the prostate (TURP) – TURP relieves urinary obstruction symptoms caused by an enlarged prostate pressing on the urethra. This surgery is used for men with advanced prostate cancer or for men who are not healthy enough to undergo a radical prostatectomy. This surgery does not cure cancer.

Radiation therapy

  • Types of radiation therapy used to treat prostate cancer:
    • external beam radiation
    • permanent brachytherapy (low-dose internal radiation therapy)
    • temporary brachytherapy (high-dose internal radiation therapy)
  • Radiation therapy is usually combined with hormone therapy for cases of high-risk prostate cancer.
  • Hormone therapy can be given for a period of time before and after radiation therapy.

Hormone therapy

  • Hormone therapy for prostate cancer may include:
    • luteinizing hormone-releasing hormone (LH-RH) agonists
    • luteinizing hormone-releasing hormone (LH-RH) antagonists
    • anti-androgens (block effects of androgens in the tissue)
    • removal of the testicles (orchiectomy)
  • Hormone therapy can be combined with radiation therapy in high-risk prostate cancer cases.
  • Hormone therapy can be given for a period of time before and after radiation therapy.
  • Hormone therapy is sometimes given to men who have found lymph node metastases during a radical prostatectomy. It is also given in cases where prostate cancer recurs after surgery or radiation therapy.

Chemotherapy

  • Chemotherapy is used to treat castrate resistant prostate cancer (also called androgen-independent prostate cancer or hormone-refractory prostate cancer).

Biological therapy

  • Helps prevent bone fractures
  • Helps prevent cancer from spreading to your bones

Bisphosphonates

  • Helps relieve bone fractures from hormone-resistant cancers
  • Helps prevent broken bones

Clinical trials

  • There are clinical trials open to men with prostate cancer. For more information, go to the “Clinical trials” section of this chapter.

Follow-up after treatment

It is important to have regular follow-up visits, especially during the first 5 years after treatment.

 

Understanding your choices

Talk to your doctor

specialiste cancer prostate

Men recently diagnosed with prostate cancer experience heightened levels of stress and anxiety, which can make it difficult to process information. This makes it very difficult to make an informed decision, especially when it could be one of the most important decisions of your life. This is why your doctor-patient relationship is crucial.

Your doctor-patient relationship should be based on open communication and trust. Your doctor should see you as a human being with psychological, psychosocial, emotional, and cultural needs. You need to work as a team with your doctor to treat your prostate cancer most effectively.

Suggestions

Here are a few points to make your doctor’s visit as efficient as possible:

  • Don’t be afraid to ask questions about your disease, treatments, and side effects.
  • Keep a running list of your questions as they come to mind.
  • Take a relative or friend with you.

If your doctor is giving you too much information at one time, let him or her know. There is nothing wrong with letting your doctor know how much information you can absorb in a single visit.

 

The right doctor for me

cellule cancer prostate

It is very likely that you will meet many people who are good resources and can help you. However, once you have been diagnosed with prostate cancer, your primary doctor will be your urologist. Your family doctor will also be informed of your diagnosis in order to monitor your overall health. Your urologist is probably the one you will speak to most. If necessary, you may be referred to a radiation oncologist, medical oncologist, or doctor specializing in palliative care.

How to know?

Once you have picked an urologist, there are a number of questions you can ask if you are waiting for your diagnosis or if you have received a prostate cancer diagnosis.

General

  • What percentage of your practice treats prostate cancer?

Radical prostatectomy

  • How many radical prostatectomies do you do a year?
  • Do you do laparoscopic prostatectomies? Am I a good candidate?
  • What is the likelihood that I will have problems with bladder control after I undergo a radical prostatectomy?
  • What is the likelihood that I will experience problems obtaining or maintaining an erection if I undergo a radical prostatectomy?

Radiation therapy / Brachytherapy

  • Do you do external radiation therapy or brachytherapy?
  • What are the requirements to be a good candidate for brachytherapy? Am I a good candidate?
  • What is the likelihood that I will experience problems with bladder control after I undergo radiation therapy or brachytherapy?
  • What is the likelihood that I will experience problems obtaining or maintaining an erection after I undergo radiation therapy or brachytherapy?

Hormone therapy

  • What is hormone therapy?
  • What are the side effects?

Chemotherapy

  • What kind of chemotherapy is used to treat prostate cancer?
  • What are the side effects?
  • Is chemotherapy very toxic?

Palliative care

  • If I am no longer responding to any of the available prostate cancer treatments, can you help me?

Please also see our Your team and questions section

Help manage your treatment

It is important that you have enough information to really understand your situation. This will help you will feel more in control of your life and help you make decisions.

If, for whatever reason, you are not comfortable with your doctor, ask for a second opinion. Doing so does not mean you are questioning your doctor’s competency. Certain elements of the doctor/patient relationship may encourage you to consult another specialist.

Ask yourself the following questions:

  • Does my doctor spend enough time with me?
  • Are all my questions being answered?
  • Is the language my doctor is using clear, or is it too technical or medical?
  • Is there a language barrier?
  • Is my doctor’s office too far away from my home?

Perhaps you and your family need more reassurances about the possible treatment options and what would be the best approach to treat your cancer.

Seeking a second opinion is perfectly acceptable if you feel the need. Just let your urologist know—they may be able to suggest someone or give you information on how to get a copy of your chart.

We are here for you

Our urology healthcare professionals are there to listen, support and answer questions from patients, their families, the general public and healthcare professionals. Feel free to contact them.

Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, with our expert lectures, our section on available resources, the support that is offered to you, our events and ways to get involve to advance the cause.

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