Prostate cancer treatments: What you need to know

Men diagnosed with low-risk prostate cancer often follow active surveillance. This wait-and-see approach involves monitoring the cancer for changes with routine PSA testing and biopsies.

If at some point those findings suggest the cancer has grown and is likely to spread, treatment is recommended. There are three main options: surgical removal of the prostate, radiation to destroy the cancer cells, and hormone therapy to slow the cancer's growth. Your chosen path will depend on factors like your age, health, cancer stage, and personal preference.

Another aspect of treatment to consider is what side effects are possible. "Understanding how common these side effects are and their potential consequences can help men with their decision making, especially in terms of how treatment may affect their quality of life," says Dr. Adam Kibel, a urologist with Harvard-affiliated Brigham and Women's Hospital.

Surgery

Surgery can damage nearby nerves and surrounding structures, which can lead to the usual complications of surgery like infection and bleeding. "But erectile dysfunction [ED] and urinary incontinence are by far the side effects that concern men the most," says Dr. Kibel.

Studies suggest that 40% or more of men lose some erectile function after surgery. "It depends a lot on their prior ability and how much reserve they have," says Dr. Kibel. "It can take up to two years after treatment for patients to reach a steady state of erectile function. If you suffered from ED before or have other issues like diabetes or vascular problems that impair the ability to maintain an erection, you may have trouble returning to your previous level of sexual function.

Nearly all men will have some form of leakage immediately after the surgery, but this tends to improve over time and with pelvic floor muscle exercises. "About 60% of men regain urinary control within six months and 90% within a year," says Dr. Kibel. "The rest may have mild leakage, like after coughing, sneezing, or twisting their body, requiring the use of pads long-term."

Radiation

There are two primary radiation therapies: external beam radiation and brachytherapy. Which one is best for you depends on your cancer's risk group (low, intermediate, or high) and whether the tumor is confined to the prostate or has spread.

External beam radiation. There are several types, but they basically work the same way: rays of high-energy radiation are targeted to the site of the cancer in the prostate and sometimes nearby lymph nodes. External beam radiation effectively destroys cancer cells, but it can also damage healthy tissue in the rectum and bladder.

Brachytherapy. Brachytherapy involves placing radioactive pellets, or "seeds" — each about the size of a grain of rice — in or near the prostate tumor. The number of seeds ranges from 50 to 150, depending on the prostate gland size.

The most common short-term side effects of both radiation therapies are urination and bowel problems. Urinary issues include waking up in the night to urinate, needing to urinate more often during the day, and the sudden need to urinate. You also may have more bowel movements than usual and experience loose stools.

"Most of these problems go away after treatment is completed. Meanwhile, the symptoms can be managed with lifestyle modifications and medication," says Dr. Kibel. For example, your doctor may suggest dietary changes to help with bowel issues.

As with surgery, radiation can damage blood vessels and nerves and cause ED. However, research suggests that about 60% to 85% of men who had satisfactory erections before radiation treatment will have them after treatment.

Hormone therapy

For men whose cancer has spread to other organs, or for high-risk localized prostate cancer in men getting radiation, doctors usually prescribe treatment with a male hormone blocker, known as androgen deprivation therapy (ADT). Common side effects include decreased sexual drive, ED, hot flashes, and low energy. Long-term treatment also can lead to muscle and bone loss.

Men may reduce their risks for these side effects by making sure they regularly exercise as much as tolerated during and after treatment. One study found that men who did two hour-long workouts per week that included both aerobic and resistance exercises had fewer side effects after three months than men who did not exercise. Adopting a heart-healthy diet like the Mediterranean or DASH diet also can help. Men need to be sure they get enough dietary calcium and vitamin D to help maintain bone density.

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