“It is absolutely possible in patients with prostate cancer to cure it.”
Even though prostate cancer is common—1 in 9 men will be diagnosed with prostate cancer during their lifetime—most men do not die from it. That’s because prostate cancer grows very slowly and prostate cancer treatments are better than ever.
“Almost always [prostate cancer] treatments are very effective if the cancer is confined to the prostate,” says William K. Oh, MD, chief of hematology and medical oncology at Mount Sinai Health System.
The prostate is a gland that makes fluid that’s part of semen. It’s below the bladder and forms a ring around the urethra (where urine comes out). Prostate cancer happens when normal cells in the prostate gland become abnormal and then grow out of control.
If the cancer is confined within the primary organ, which in this case is the prostate, it’s considered localized prostate cancer. If the cancer has spread (metastasized) beyond the prostate, this is called advanced, or metastatic, prostate cancer. Localized prostate cancer and advanced prostate cancer are treated differently.
Treating Localized Prostate Cancer
If a patient has localized prostate cancer, he and his doctor may discuss these three options:
Surgery for prostate cancer can be done in different ways. The most common approach is to remove the entire prostate gland and some surrounding tissue.
“Nowadays most of the surgeries are done using a robot-assisted approach,” says Dr. Oh. During a robot-assisted approach, a surgeon sits at a control panel in the operating room and moves robotic arms to operate. With robot-assisted surgery, “patients are in the hospital for shorter periods of time with less pain and less bleeding,” says Dr. Oh.
Radiation kills cancer cells. Radiation can be given from a machine that moves around your body, or a doctor might target the radiation directly into the prostate gland.
Because prostate cancer grows so slowly, some patients don’t need to be treated right away. “For some prostate cancers, you can monitor it,” says Dr. Oh.
Men who choose this method will likely have routine tests, such as a prostate-specific antigen test, to check if the cancer is growing more quickly. If that’s the case, the patient can then discuss treatment options with their doctor.
Treating Advanced Prostate Cancer
“If you present with advanced or metastatic prostate cancer, sometimes that means that the cancer has already escaped the prostate before you were diagnosed,” says Dr. Oh. “Unfortunately in this setting, the treatments are not curative. In other words, removing the prostate or radiating the prostate will not be enough to get rid of the cancer.”
Still, there are many treatments available that can control the cancer—sometimes for many, many years.
Male hormones in the body help the prostate cancer grow. Hormone therapies help reduce the number of these hormones, which in turn can shrink the cancer.
Chemotherapy is a term for medicines that kill rapidly dividing cells, which include cancer cells. Patients with advanced prostate cancer might get chemotherapy if hormone therapy stops working. Chemotherapy and hormone therapy may also be given at the same time.
Choosing the Right Prostate Cancer Treatment
Before deciding on a treatment, it’s important for patients to know all their options and work with their doctor to determine the right treatment for them. “I think the most important thing for any man dealing with prostate cancer is to balance the pros and cons of treatment—the effects of treatment versus the effects of cancer,” says Dr. Oh.
The right treatment will depend on:
- Whether the cancer is localized or advanced
- Age of the patient
- Other health problems the patient may have
- And how the patient feels about their treatment options.
“In most situations, the goal, as with all cancers, is to cure the cancer, to eradicate it,” says Dr. Oh. “It is absolutely possible in patients with [localized] prostate cancer to cure it.”
Dr. Oh is the chief of hematology and oncology at Mount Sinai Hospital, specializing in the management of prostate, renal, bladder, and testicular cancers. He is also the deputy director of The Tisch Cancer Institute of the Icahn School of Medicine at Mount Sinai.
00:00:00,000 --> 00:00:02,369
00:00:02,369 --> 00:00:04,192
I think the most important thing for
00:00:04,192 --> 00:00:07,656
any man dealing with prostate cancer
is to kinda balance the pros and
00:00:07,656 --> 00:00:11,565
cons of treatment, the effects of
treatment versus the effects of cancer.
00:00:11,565 --> 00:00:15,349
Almost always the treatments are very
effective if the cancer's confined
00:00:15,349 --> 00:00:16,255
to the prostate.
00:00:16,255 --> 00:00:23,256
00:00:23,256 --> 00:00:28,210
There's basically localized prostate
cancer and also advanced prostate cancer.
00:00:28,210 --> 00:00:30,360
If it's localized that
means it was caught early,
00:00:30,360 --> 00:00:33,290
while the cancer's still in
the primary organ, the prostate.
00:00:33,290 --> 00:00:37,170
And in that situation there are basically
three major options for how to treat it.
00:00:37,170 --> 00:00:38,820
You could remove it surgically, and
00:00:38,820 --> 00:00:44,030
nowadays most of the surgeries are done
using a robot assisted approach.
00:00:44,030 --> 00:00:45,255
You can do radiation, and
00:00:45,255 --> 00:00:48,664
there are many different ways of
delivering radiation to the prostate.
00:00:48,664 --> 00:00:51,950
And then the third option for some
patients is to do something called active
00:00:51,950 --> 00:00:55,410
surveillance, meaning that you don't
actually have to treat it right away.
00:00:55,410 --> 00:00:58,630
some prostate cancers you can monitor it,
00:00:58,630 --> 00:01:01,860
usually with the PSA tests and
additional biopsies, but
00:01:01,860 --> 00:01:05,280
you can follow the person without
having to treat it immediately.
00:01:05,280 --> 00:01:08,310
Surgical treatments have really
advanced over the past few years,
00:01:08,310 --> 00:01:13,230
the robot has really taken over
the surgical removal of prostate cancer.
00:01:13,230 --> 00:01:16,740
And patients are in the hospital for
shorter periods of time with less pain and
00:01:16,740 --> 00:01:17,950
00:01:17,950 --> 00:01:22,001
Radiation is also advanced, and
there are more accurate ways of targeting
00:01:22,001 --> 00:01:26,197
the prostate with better machines,
better targeted radiation therapies.
00:01:26,197 --> 00:01:28,504
There are also new drugs,
and many new drugs.
00:01:28,504 --> 00:01:32,650
In fact, there have been at least
eight new drugs approved in the last
00:01:32,650 --> 00:01:36,610
five years in prostate cancer, so
it's a very active area of research.
00:01:36,610 --> 00:01:39,260
And what it really means is that there
are more choices for our patients.
00:01:40,630 --> 00:01:44,978
If you present with advanced or metastatic
prostate cancer, sometimes that means that
00:01:44,978 --> 00:01:48,517
the cancer's already escaped
the prostate before you are diagnosed.
00:01:48,517 --> 00:01:52,590
Unfortunately in this setting usually
the treatments are not curative.
00:01:52,590 --> 00:01:54,160
In other words, removing the prostate or
00:01:54,160 --> 00:01:57,430
radiating the prostate will not be
enough to get rid of the cancer.
00:01:57,430 --> 00:02:01,580
But we do have treatments that can control
the cancer, sometimes for many years.
00:02:01,580 --> 00:02:02,960
These include hormonal treatments,
00:02:02,960 --> 00:02:06,240
chemotherapy, next generation
00:02:06,240 --> 00:02:10,390
So there are things that we can do for
patients who even present with advanced or
00:02:10,390 --> 00:02:11,710
metastatic prostate cancer.
00:02:11,710 --> 00:02:14,339
And many of these patients
can thankfully live for
00:02:14,339 --> 00:02:16,473
many years with effective treatments.
00:02:16,473 --> 00:02:21,835
Prostate Cancer (The Basics). UpToDate. (Assessed on September 12, 2019 at https://www.uptodate.com/contents/prostate-cancer-the-basics#H457221549)
Treating Prostate Cancer. American Cancer Society. (Assessed on September 12, 2019 at https://www.cancer.org/cancer/prostate-cancer/treating.html)
Surgery for Prostate Cancer. American Cancer Society. (Assessed on September 12, 2019 at https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html)