Below is a partial list of possible treatments for prostate cancer. Not all of them are covered by provincial health insurance, or are even available in Canada. Some of them are only available as clinical trials, here or abroad. Discuss with your doctor which treatments may be appropriate for you. The earlier prostate cancer is detected, the more possible treatments are available to you (and the more complex your treatment decision becomes). Articles on some of these treatments can be found under Treatments in the light blue toolbar above.
Primary Treatments: These are possible first treatments:
– Active surveillance (A form of watchful waiting. For low volume, non-agressive ‘cancer’. This option delays possible treatment and the attendant side effects until, and if, other options are necessary.)
– Surgery (radical prostatectomy)
- Open
- Laparoscopic
- DaVinci robotic assisted
- Robotic CO2 laser
– Radiation therapy
- External beam (EBRT, variations are IMRT(Intensity-Modulated-RT), SBRT (Stereotactic Body RT), VMAT (Volumetric Arc T), Tomotherapy (a variation of CT guided IMRT), IGRT (Image Guided RT)
- Brachytherapy (permanent seed implants)
- High dose rate (HDR) Brachytherapy (temporary seed implants, usually followed by some EBRT)
- Proton beam therapy (France, Germany, USA, Japan, Switzerland)
- Cyberknife (robotic radiosurgery – Hamilton, Ottawa, Montreal)
– Prostate ablation (without radical surgery or ionizing radiation)
- HIFU (high intensity focused ultrasound)
– Focal therapy (partial prostate ablation, essentially a lumpectomy)
- MRI guided laser ablation lumpectomy
- targeted HDR lumpectormy (clinical trial)
– Hyperthermia (Germany. Heating the entire prostate kills cancer cells while leaving healthy cells.)
- Transurethral
- Whole body version
Secondary Treatments: All treatments occasionally fail to eliminate the cancer as manifested by a rising PSA post-primary treatment and a second treatment is necessary.
– Radiation therapy (EBRT) after surgery
– Hormone therapy (Androgen Deprivation Therapy, ADT, sometimes in combination with other treatments)
– Cryotherapy (Cryoablation)
Advanced Treatments: These are not generally first treatments. Unfortunately, sometimes the above treatments aren’t effective and sometimes, prostate cancer is detected too late for most of the above treatments. Many men have survived many years using the following treatments after most of the above treatments have failed. New treatments/drugs are constantly being developed. (This is what the Warriors group is about.) Here are some of the advanced treatments:
– Hormone therapy
– Chemotherapy
– Cabazitaxel is a form of chemotherapy
– Abiraterone (Zytiga) deprives tumors of testosterone so it is quite different from the usual hormone deprivation therapy
– Enzalutamide (Xtandia) blocks the ability of testosterone to promote prostate cancer growth so it too is not the usual hormone deprivation therapy
– Immunotherapy uses either a vaccine such as Provenge or some other drug to stimulate the body’s immune system to attack the cancer (Clinical Trial)
– Photodynamic Therapy injects a drug which seeks out the cancer and when irradiated with a laser or some form of light the drug then becomes activated to attack the cancer (Clinical Trial)
– Radium 223 is a new therapy for prostate cancer bone metastases but quite different from the other forms of radiation therapy. (Similar to an older Strontium 89 therapy.)