Specific treatment for prostate cancer will be determined by your physician based on:

• Your age, overall health, and medical history
• Stage of the cancer
• Your tolerance for specific medications and procedures
• Expectations for the course of the disease
• Your opinion or preference

Surgery: The following are some of the different surgical options used to treat prostate cancer:

• Radical prostatectomy – an open-surgery procedure in which the entire prostate gland and some tissue around it are removed. This surgery involves an incision in either the abdomen or the area behind the scrotum. Physicians at Stanford perform nerve-sparing prostatectomies, which maintains sexual function.
• Laparoscopic radical prostatectomy – a less-invasive type of radical prostatectomy in which the prostate gland is removed through small incisions using a laparoscope (a long, flexible lighted tube with a video camera attached) and special long, thin surgical tools. This type of procedure is commonly performed by a surgeon using a robot to precisely maneuver surgical tools (robotic laparoscopic radical prostatectomy).
• Transurethral resection of the prostate (TURP) – surgery to remove part of the prostate gland that surrounds the urethra by using a small tool that is placed inside the prostate through the urethra at the tip of the penis. There is no incision with this method. TURP is used as a palliative procedure (to relieve symptoms), not as a procedure to cure the cancer.
• Cryosurgery – a procedure that involves killing the cancer by freezing the cells with a small metal tool placed in the tumor.

Radiation therapy uses high-energy rays to kill cancer cells and to decrease their ability to divide. Radiation is often used to treat prostate cancer that is still confined to the prostate gland, or has spread only to nearby tissue. If the cancer is more advanced, radiation may be used to shrink the size of the tumor and to provide relief from symptoms.

There are generally two types of radiation therapy:

• External radiation (external beam therapy)– a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are similar to getting X-rays – they are painless and usually last a few minutes. This type of radiation therapy may be given daily for several weeks.
• Internal radiation (implant therapy) – a procedure that uses small, radioactive seeds (each about the size of a grain of rice) that are implanted directly into the cancerous prostate tumor. The implanted seeds may be left in permanently or may be only temporary. The seeds emit small amounts of radiation for a period of weeks or months.

Hormone therapy: Produced mainly in the testicles, male hormones such as testosterone cause prostate cancer cells to grow. Reducing hormone levels can sometimes make the prostate cancer shrink or slow its growth. The goal of hormone therapy is to lower the level of male hormones in the body. Hormone therapy does not cure the cancer and is often used to treat people whose cancer has spread or recurred after treatment.

There are several types of hormone therapy, including the following:

• Orchiectomy – the surgical removal of the testicles to prevent the male hormones that stimulate growth of the prostate cancer from being produced.
• LHRH (luteinizing hormone-releasing hormone) analogs – drugs that decrease the amount of testosterone produced in a man’s body by interfering with the normal chemical signals sent from the pituitary gland in the brain to the testicles. Drugs include Lupron®, Viadur®, Eligard®, Zoladex®, and Trelstar™.
• LHRH antagonist – a drug that also lowers testosterone levels but may cause fewer problems when first given than LHRH analogs. It is given by injection under the skin. The only LHRH antagonist used at this time is Firmagon.
• Anti-androgens – substances that block the body’s ability to use androgens (male hormones), because even after orchiectomy or LHRH-analog treatment, a small amount of androgens may still be produced in the body. Other hormonal drugs may be used for periods of time during treatment. Drugs include Eulexin®, Casodex®, and Nilandron™.

Chemotherapy: The use of drugs to treat cancerous cells, chemotherapy is rarely the primary therapy for men with prostate cancer, but it may be used when prostate cancer has spread outside of the prostate gland, especially if hormone therapy is no longer effective.

Chemotherapy is not a standard treatment for early prostate cancer. And although it may slow tumor growth and reduce pain in more advanced cancers, it does not cure them.

Docetaxel (Taxotere), along with the steroid drug prednisone, is usually the first chemotherapy drug given. A second drug, cabazitaxel (Jevtana), may be used (along with prednisone) if docetaxel is not effective. Both of these drugs have been shown to improve survival times by an average of several months. Other chemotherapy drugs may also be tried if these no longer work.

Angiogenesis inhibitors: A chemical that interferes with the signals to form new blood vessels is referred to as an angiogenesis inhibitor. This treatment may prevent the growth of cancer by blocking the formation of new blood vessels.

Thalidomide has been identified as having mild activity as an angiogenesis inhibitor in some cancers. A newer version of this medication is lenalidomide (Revlimid), which has fewer side effects than thalidomide.

Another medication, bevacizumab (Avastin®), has been approved by the US Food and Drug Administration (FDA) to aid in the treatment of colorectal, lung, and some other cancers. Two newer additions to antiangiogenesis therapy include sunitinib (Sutent®) and sorafenib (Nexavar®). Many other angiogenesis inhibitors are now being studied as well