Does Surgery Have to Be Part of Prostate Cancer Treatment?

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Does Surgery Have to Be Part of Prostate Cancer Treatment?

Fortunately, there are several treatment options available for men diagnosed with prostate cancer – one of which is surgery. If you received a prostate cancer diagnosis from a urologist, they might recommend surgery to remove the prostate as part of your treatment plan. For some men, surgery is necessary. However, it's a good idea to talk with an oncologist who specializes in prostate cancer to learn about other non-surgical prostate cancer treatment options.

Typically, prostate cancer grows slowly, giving men and their families time to evaluate various treatment options. 

Is Prostate Cancer Surgery Required for All Men? 

Unlike other types of cancer, where surgery is a standard part of the treatment plan for almost all patients, prostate cancer is unique. Many men are relieved to learn that there are other options for prostate cancer treatment since prostate removal surgery, called a prostatectomy, can create complications such as urine incontinence and erectile dysfunction.

In some cases, surgery is necessary, especially if the cancer is large and growing quickly. Men in this situation may need additional therapies administered following the prostatectomy to ensure that all cancer cells are destroyed.

How to Determine the Right Prostate Cancer Treatment For You

The samples of tissue removed during your prostate biopsy allow the pathologist to provide a Gleason score. This score tells the oncologist how quickly the cancer is growing. 

The score is created by assigning the two most predominant cell patterns a number between 1 and 5. A score of 1 means the cells are healthy. A score of 5 means the cells are cancerous. These two numbers are added together to create the Gleason score. The score of the most predominant cell pattern is put first in the equation. Anything less than a score of 6 is not considered cancer.

If you have a lower Gleason score, your oncologist is likely to recommend delaying treatment until the prostate cancer has progressed further. However, if your Gleason score is 4+3=7 or higher, you may need to start treatment sooner. 

Related read: A Gleason Score of 7: Why is it So Important?

When considering the best treatment plan for you, the oncologist will also evaluate your overall health, age, and stage of prostate cancer. 

How Soon Until I Have to Choose a Prostate Cancer Treatment Plan? 

If you have early-stage prostate cancer, your oncologist may recommend active surveillance as the first step for treating your prostate cancer. Active surveillance can be a safe option in cases where the cancer hasn't spread much or if you have difficulty tolerating therapies. The goal is to avoid “over-treating” the patient when treatment may not be necessary yet. 

Active surveillance means that you do not begin treatment right away. Instead, your oncologist will monitor you regularly, performing tests every 3-6 months to see whether the cancer is progressing. Be sure not to skip any follow-up tests! Talk to your oncologist if at any point you feel anxious about waiting to start treatment.

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Prostate Cancer Treatment Options Other than Surgery

If your oncologist has determined that treatment should begin soon, one of the following alternatives to surgery might be recommended. For some men, surgery is still necessary in combination with one or more of the following treatments.

Radiation Therapy for Prostate Cancer

Sometimes, radiation therapy is recommended as the primary treatment for prostate cancer. This is because it comes with fewer permanent side effects compared to surgery.

Two types of radiation therapy are used to treat prostate cancer. Some men receive both types:

  • External beam radiation therapy is delivered from a large machine outside the body. Many men receive intensity-modulated radiation therapy or 3-D conformal radiation therapy, which are types of EBRT. Treatments usually last a few weeks. Steps are taken to protect the bladder and rectum, as much as possible, from receiving radiation therapy.
  • Internal radiation therapy (brachytherapy) delivers low doses of radiation therapy via small implants called seeds. Once inserted into the prostate, the seeds give off radiation for months. There is no need to remove the seeds later. 

Hormone Therapy

Hormone therapy is used to keep prostate cancer cells from getting the male hormones (androgens) they need to grow. Standard prostate cancer hormone therapies include the following: 

  • Luteinizing hormone-releasing hormone (LH-RH) agonists which can help prevent the testicles from making testosterone
  • Antiandrogens which are drugs that block the action of male hormones

Typically, hormone therapy is used by doctors to treat prostate cancer that has spread (metastasized) to other areas of the body. For some men, the cancer can remain under control for two or three years, but others may have a much shorter response time to hormone therapy. When this happens, additional treatment is needed since the hormone therapy is no longer effective. 

Targeted Therapy for Prostate Cancer

Targeted therapy is its class of medications. Each targeted therapy focuses on a specific function that causes cancer cells to stop reproducing. PARP inhibitors are a type of targeted therapy for prostate cancer. PARP (poly(ADP)-ribose polymerase) enzymes are needed to repair damaged DNA within cells. By blocking the PARP pathway for cancer cells, enzymes can’t reach them, and the cells die. 

Related read: Cutting-Edge Therapy for Advanced Prostate Cancer 

Chemotherapy for Prostate Cancer

Chemotherapy is rarely used as a first-line therapy for prostate cancer. However, it can be effective in treating advanced prostate cancer that has spread to other areas of the body or when cancer no longer responds to other types of treatment. 

Clinical Research Trials for Prostate Cancer

Some patients can access new and improved prostate cancer treatments through clinical research trials. If you are a good fit, your oncologist will discuss a trial with you. You will have the final say in whether you participate or use a standard treatment process.

Which Prostate Cancer Treatment Is Best For You?

If you're newly diagnosed with prostate cancer, know that surgery might not be your only treatment option. The prostate cancer specialists at Rocky Mountain Cancer Centers are ready to help formulate a treatment plan, even if there's time to wait. We know that our patients are unique, which means their prostate cancer treatment plan should be, too. 

Prostate cancer specialists are available at RMCC locations throughout the Colorado Front Range, including Boulder, Colorado Springs, and Denver. Request an initial consultation or a second opinion to ensure complete confidence in the recommended treatment plan. 

Find a Prostate Cancer Specialist

J. Mark Barnett, MD

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Longmont, CO

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Alonso V. Pacheco, MD

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Patrick Eulitt, MD

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Lone Tree, CO

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Nauman Moazzam, MD

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Lakewood, CO

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Charles Leonard, MD

Radiation Oncologist

Littleton, CO

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