Prostate Cancer Treatments and Medications

What is prostate cancer?

Cancer is uncontrolled cell growth in the body. Prostate cancer is the diagnosis of that uncontrolled growth that’s primarily in the prostate—a male sex gland located above the penis that produces seminal fluids—and/or the healthy tissue around it. Although some forms of prostate cancer can be asymptomatic, the most common symptoms of prostate cancer are difficult or unproductive urination; frequent urination, especially at night; blood in the urine or semen; pain, frequent infections, and erectile dysfunction.

How is prostate cancer diagnosed?

Many cases of prostate cancer, especially ones in the very early stages or that are asymptomatic, are diagnosed by routine screenings during an annual physical with a primary care physician or urologist. Men under 40 years old are considered extremely low risk for prostate cancer. Prostate cancer screening is common for men over the age of 65 or men who are at high-risk for developing prostate cancer. These tests may include:

• Digital rectal exam (DRE): A digital rectal exam is a physical exam where the doctor inserts a finger in the rectum to examine the prostate gland directly to check for growths or irregularities
• PSA test: A PSA test is a blood test that can measure the levels of prostate-specific antigens (PSAs). Higher levels of PSAs can be indicative of cancerous growth inside the prostate gland. However, PSA levels can’t predict whether or not the abnormality is cancerous. This can lead to false positives and unnecessary prostate biopsies and screening. The benefits are often outweighed by the negatives and so PSA testing is not recommended for most men. It’s important to speak to your doctor about whether he or she would recommend PSA level testing and what the potential drawbacks may be.
• Biomarker test: If you are experiencing symptoms of prostate cancer, your doctor may order a biomarker test. This test checks for markers in the blood, urine, or tissue that could indicate the presence of cancerous growth or tissues.
• Luteinizing hormone test (LH test): Prostate cancer is associated with a decrease in testosterone levels. Therefore, your doctor may order blood tests to check LH and levels of testosterone.

If any of these tests show positive results for the possibility of prostate cancer, your doctor’s next step will be to confirm a diagnosis. This can be achieved with one or more of the following tests:

• Biopsy: A biopsy is a procedure in which your doctor will remove small samples of prostate tissue that can be closely examined by a pathologist for the presence of prostate cancer cells.
• Transrectal ultrasound (TRUS): A TRUS is often administered congruously with a biopsy. An ultrasound probe is inserted into the rectum and used to produce images of the prostate to detect the presence of growths, tumors, or irregular tissues.
• PCA3 test: If PSA levels are found to be higher than normal, your doctor may do a urine test known as a PCA3 test in order to detect the presence of the PCA3 gene, which is generally only detected when prostate cancer is present.
• MRI fusion biopsy: This test is a newer hybrid test that combines MRI scans with the transrectal ultrasound to identify potentially problematic areas for a more targeted and precise biopsy of possible prostate cancer cells or tissue.

Prostate cancer treatment

The treatment of prostate cancer, like most cancer treatments, is an ever-evolving field that is constantly changing and adapting to new ideas being tested in clinical trials and with new technologies. Prostate cancer, especially the 90% found in the early stages, is highly treatable and outcomes of remission can be very positive.

Stage I

Stage I prostate cancer is cancer that’s found very early in growth, has a low Gleason score, hasn’t spread beyond the prostate to other parts of the body, and may not continue growing or produce further difficulties for the patient.

Stage II

Stage II prostate cancer is a cancer that is measurably larger than stage I, but that has still not spread beyond the prostate. Again, treatment options vary and are dependent upon whether you are experiencing symptoms, your age, the rate of cancer growth, etc.

Stage III

Stage III prostate cancer is cancer that has spread past the prostate to nearby organs such as the seminal vesicles but that has not yet spread beyond or into the lymph nodes. Stage III cancers can present a bigger risk for recurrence.

Stage IV

Stage IV prostate cancer is cancer that has progressed further and spread beyond the localized area to other organs and areas of the body. Stage IV cancers are difficult to treat. Options for treatment during this stage of cancer are often more aggressive.

• Continued active surveillance: This option is particularly viable for cancers that are growing very slowly, for men of advanced age who may have quality-of-life concerns or other illnesses, and often younger men as well to avoid unnecessary treatments.
• Watchful waiting: Watchful waiting is much like active surveillance. However, with watchful waiting, there may be a more hands-off approach to testing because the patient may have more pressing medical concerns that need to be taken care of and waiting on treatment can help preserve the quality of life.
• Radiation therapy: Radiation therapy involves a radiation oncologist utilizing targeted beams of radiation to eradicate diseased tissue. This can be in the form of an external beam (where radiation is laser targeted at the affected tissue), brachytherapy (where radioactive seed isotopes are inserted directly into the tissue), or a combination of both. It is often used to help alleviate urinary incontinence. It’s usually administered with or followed up by hormone therapy.
• Radical prostatectomy: This is the surgical removal of part or all of the prostate. The removal of the prostate and neighboring lymph nodes could be followed by hormone or radiation therapy if it’s suspected during surgery that the cancer may have spread or if PSA levels remain elevated.
• Hormone therapy: Oftentimes radiation treatment or a prostatectomy may be followed by hormone treatments also known as androgen suppression therapy. Hormone therapy is intended to stop the production of male hormone cells, known as androgens, to inhibit the growth of cancer cells.
• Chemotherapy: For cancers that are further progressed or that are not responding to hormone therapies, your doctor may recommend undergoing chemotherapy to shrink cancer growth. It is often not indicated until other treatments haven’t proven successful and will often be administered with or followed up by a course of hormone therapy. The usual chemotherapy used is docetaxel anhydrous, although new regimens are being tested in clinical trials. The most common side effects of this form of chemotherapy are nausea, hair loss, and the suppression of red blood cell production. be administered with or followed up by a course of hormone therapy.
• Transurethral resection of the prostate (TURP): This surgery is less invasive than a radical prostatectomy and is meant to relieve symptoms caused by tumor or cancer growth in advanced prostate cancer. Part of the inner prostate is resected utilizing heat.

Prostate cancer treatment options by stage

Treatment options vary depending on what stage your cancer has progressed to when you're diagnosed. Prostate cancer is rated using a Gleason score with a higher score indicating more progressed cancer. Let’s take a closer look at treatment options by stage.

Other prostate cancer therapies

Depending on your type of cancer, your progression in the disease, and whether or not you have metastatic prostate cancer, your doctor may recommend other treatments including:

• Cryotherapy: Cryotherapy uses extremely cold temperatures targeted directly at affected cancer tissue to kill cancer cells and impede growth. Cryotherapy is still a new technology being used in clinical trials and there are few studies yet that give statistical data on the effectiveness of the procedure.
• Immunotherapy: A burgeoning field in cancer treatment is immunotherapy. Immunotherapy harnesses the power of a person's immune system to help kill off cancer cells and prevent regrowth. Immunotherapies work by “hacking” the immune system and enabling the body’s immune response to more directly impact cancer cells. It is generally administered intravenously.Currently, there are two FDA-approved therapy options for advanced prostate cancers that have either spread or are proving hormone therapy-resistant. These are Provenge, a vaccine derived from the patient’s immune cells that attacks proteins inside the cancer cell and Pembrolizumab. Immunotherapies may be added to the treatment regimen of men utilizing radiation therapy, pre-chemotherapy, or for men who have metastatic prostate cancer. These new medications are associated with thyroid disorders, adrenal dysfunction, and rarely, diabetes insidious, a disorder with excessive urination and thirst due to the loss of ADH, the water hormone.

• Androgen deprivation therapy (ADT): Androgen deprivation drugs are drugs intended to lower the level of androgens in the body to help stop the body from fueling the production of cancer cells. Side effects of androgen deprivation drugs can include erectile dysfunction, hot flashes, reduced sexual function or desire, and shrinkage of the penis and/or testicles.

Prostate cancer medications

Prescription medication may be used to treat prostate cancer. Decisions regarding prescription medications can only be made in consultation with your doctor and may be dependent on your diagnosis, age, risk factors, specific needs, and other treatments or therapies being used.

Antiandrogens

Antiandrogens are testosterone level lowering drugs that work to block the uptake of androgens and suppress male hormones. These include:

• Eulexin (flutamide)
• Vantas (histrelin acetate)
• Casodex (bicalutamide)
• Xtandi (enzalutamide)
• Erleada (apalutamide)

Androgen synthesis inhibitors

Androgen synthesis inhibitors are medications that work to suppress the creation or synthesis of male hormones in the body, which can help inhibit the growth of cancer cells. Where antiandrogens work to replace male hormones with female, androgen inhibitors work to stop the male hormone production outright. Zytiga (abiraterone acetate) is an example of an androgen synthesis inhibitor. Side effects may include joint swelling or pain, diarrhea, cough, sweating, and hot flashes.

Estrogen

More recently, estrogen hormone treatments for prostate cancer have fallen out of favor with the uptick in antiandrogen therapies available. However, estrogen may still occasionally be prescribed in cases that prove resistant to other hormone therapies. Estrogen therapy helps block the production of androgens in the body by replacing them with higher doses of female sex hormones instead. Side effects could include growth of breast tissue, hot flashes, and loss of bone density.

Radiopharmaceuticals

Radiopharmaceuticals are used in cases of prostate cancer that has metastasized in or near the bones and is causing bone pain. They work by targeting pain receptors and include the following drugs:

• MetastronTM (strontium-89)
• Quadramet® (samarium-153)
• Xofigo® (radium-223)

What is the best medication for prostate cancer?

The best prostate medication for you depends on the severity of your case, your stage of cancer, medical history, and any medications you may already be taking that may cause negative interactions. Consult your doctor or pharmacist for medication recommendations. The following are commonly used prostate cancer drugs.

What are the common side effects of prostate cancer medication?

All medications have the potential for side effects, and prostate cancer medications may as well. The most common side effects for hormone therapy treatments are hot flashes, osteoporosis, loss of bone density, a decrease of sexual desire, and erectile dysfunction. As with all side effects, you should contact your medical oncologist, doctor, or pharmacist should they continue or worsen.

How to treat prostate cancer naturally

While there are no proven non-medical cures or preventions for prostate cancer, it may be possible to lower your overall risk for prostate cancer, alleviate symptoms, and improve overall health by utilizing natural remedies and making changes in your lifestyle, diet, and daily routines.

Less fried and grilled meat

This includes lowering your consumption of fried or grilled meats. Cooking meat at a sustained high temperature could form and release compounds in the meat that may increase the risk of cancer.

Eliminating sugar

There have also been some studies and scientific thought around sugars and other carbohydrates that deliver a quick glycemic load to the bloodstream as risk factors for certain kinds of cancers including prostate cancer. Eliminating sugars and focusing your diet on whole foods and grains instead of processed carbohydrates could help ward off cancer if you’re at risk.

Coffee consumption

Coffee contains many antioxidant properties that can help the body fight disease and heal. A 2016 analysis of previous studies and research found that drinking moderate amounts of coffee in your diet could help your body fight against prostate cancer.

Tomatoes and lycopene

Tomatoes that have been processed—generally those found in cans or sauces—have an antioxidant known as lycopene. Study after study of lycopene and its effects on the body have found that men who eat diets high in lycopene have a lower risk for cancers, including prostate cancer.

Saw palmetto

Saw palmetto contains antioxidants and other nutrients that can have positive anti-inflammatory effects on the body and may help with prostate cancer symptoms such as an enlarged prostate.

Pomegranate

Researchers are still studying the impact of pomegranate on chemotherapy patients and some studies have shown it to shrink existing cancer cells in lab animals.

African plum tree bark extract

African plum tree bark extract has long been used in other cultures as a way to treat symptoms such as an enlarged prostate, frequent need to urinate, and inflammation. Some studies have even shown that it could help reduce cancer cell growth, but so far findings are preliminary.

Soy-based foods

Soybeans and soy-based foods like soy milk, tofu, miso, and certain meat substitutes are high in a chemical compound known as isoflavones that have been found to contain high anti-inflammatory properties that have been shown to aid the body in many ways. They’ve also been found to possibly impact the way that the androgen receptors pathway remains open during treatment.

Omega-3 fatty acids

Other studies have found some connections between diets high in Omega-3 fatty acids and a reduced risk for prostate cancer. Omega-3s are most commonly found in seafood and fish but are also present in some legumes, flax seeds, and some nuts like walnuts. It also has positive benefits that can help keep your heart healthy.

Can you ever be cured of prostate cancer?

Prostate cancer is one of the most survivable cancers. The five-year survival rate for localized prostate cancer is nearly 100%. With proper cancer care, a prostate cancer diagnosis is not a death sentence.

How long do you live after being diagnosed with prostate cancer?

With early diagnosis, proper treatment, and adequate follow-up care, men with prostate cancer can live full and healthy lives and the vast majority are able to live cancer-free after treatment. Over 96% of men are still prostate cancer-free over a decade after treatment.

What is the most effective treatment for prostate cancer?

The good news is that there are many effective treatments that can result in positive outcomes for prostate cancer patients. For example, for localized prostate cancer, external beam radiation therapy can have an up to 95% efficacy. Radical prostatectomy has also been found to achieve an over 90% efficacy against prostate cancer. The decision of which treatment plan or plans to follow is ultimately a personal decision that should be based on the recommendations of your doctor.

Which is better for prostate cancer: surgery or radiation?

The question of which is better for your specific prostate cancer can only be answered by you in consultation with your doctor and it’s dependent on the type and stage of cancer you have as well as personal factors such as health and age. Both options can achieve optimal outcomes and both have their own potentials for risk and side effects.

Can you treat prostate cancer with tablets?

Yes, in fact, many doctors and patients choose to utilize hormone therapies to combat the growth and spread of prostate cancer. These pill therapies include Casodex (bicalutamide), Xtandi (enzalutamide), Erleada (apalutamide), Eulexin (flutamide), Vantas (histrelin acetate), and Zytiga (abiraterone acetate)

What foods can kill prostate cancer? Can prostate cancer be reversed by diet?

The question of whether certain foods can kill or reverse prostate cancer is a complicated one that is still being researched by scientists. What we do know, however, is that there seems to be some correlation between diet and health and that in some regions where diets are more plant-based are more prevalent than here in Western countries, aggressive prostate cancers occur less frequently. For sustained health, many doctors recommend adopting a diet that is high in fruits and vegetables and whole grains and low in animal-based and processed foods.

Resources

• Prostate Cancer: Statistics
• Immunotherapy for Prostate Cancer
• Can Diet Help Fight Prostate Cancer?
• Chemicals in Meat Cooked at High Temperatures and Cancer Risk
• Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo
• Coffee and cancer risk: A meta-analysis of prospective observational studies