What to Know About Today’s Best Prostate Cancer Treatments

NOBODY WANTS TO find out they have prostate cancer. Yet the earlier it’s detected, the better. The cancer is very treatable when it’s discovered early; you’ll have the most treatment options, giving you the best chance of living longer.

“With the advances in treatment, men are doing better with treatment than they’ve ever done before,” says Christopher Barbieri, M.D., a urologist and urologic oncologist at Weill Cornell Medicine. “I think the fear of treatment a lot of times leads men to not get evaluated, and that can lead to bad outcomes.”

Doctors urge most men to get screened for prostate cancer starting at age 50, he says. But if you’re in a high-risk group, including Black men or anyone with a family history of the disease, get tested starting at age 40.

“When we catch it early, the prognosis is excellent,” Dr. Barbieri says.

During their lifetime, about one in eight men will be diagnosed with prostate cancer. It’s the second-leading cause of cancer death for men (behind lung cancer). Yet most who have prostate cancer survive the disease, according to the American Cancer Society.

Keep in mind, though, “not all prostate cancers are the same,” explains Bilal Siddiqui, M.D., a medical oncologist and prostate cancer researcher at the University of Texas MD Anderson Cancer Center.

When prostate cancer is detected, doctors will evaluate the stage of the cancer, including how it’s growing and whether it has spread outside the prostate. That will help determine which treatments will be most effective. Here’s an overview of the most common treatments available to treat prostate cancer today.

How Doctors Decide Which Treatment Is Best for You

ONCE PROSTATE CANCER is diagnosed, doctors determine what stage the cancer is in and how aggressive it is—and then recommend the most appropriate treatment, says Sunil Kakadia, M.D., a medical oncologist and research director at Genesis Cancer and Blood Institute.

Some prostate cancers are localized, meaning they’re only in the prostate gland, Dr. Sidddiqui explains. Other cancers spread outside the prostate, which are referred to as metastatic.

In choosing a treatment, doctors also consider a patient’s age and other medical problems, Dr. Kakadia says. They also factor in a treatment’s side effects, and how those might impact someone’s life, Dr. Barbieri adds.

Early detection is crucial, Dr. Kakadia emphasizes. Often, when prostate cancer is discovered early, it’s confined to the prostate and easier to treat. “Get checked is the message,” he adds.

The Most Common Prostate Cancer Treatments

TREATMENTS VARY, DEPENDING on individual cases of prostate cancer. If the cancer is caught early, many are treated “very effectively,” Dr. Barbieri says. Here are some of the most common treatments and when they’re recommended:

Active Surveillance

USUALLY FOR: Cancers confined to the prostate and that appear to be slow-growing.

In this case, doctors typically recommend regular monitoring with a plan to treat it if things change, Dr. Barbieri says. He calls active surveillance “the biggest advancement” in prostate cancer over the last decade.

Rates of active surveillance for low-risk prostate cancer more than doubled from 2014 to 2021, when nearly 60 percent of these cases were being managed with regular monitoring, according to the National Cancer Institute.

Knowing you have cancer but hearing that you don’t need treatment can cause anxiety for patients, Dr. Kakadia admits. “It’s a life-changing event, and that’s why we discuss the options.”

Dr. Barbieri agrees, “It’s a matter of educating the patients and reassuring them that not all these cancers are dangerous. We can take our time with this one, basically.”

Hormone Therapy

USUALLY FOR: Cancers that have spread outside the prostate.

Hormone therapy, also known as androgen deprivation therapy (ADT), is a “mainstay” of treatment for these cancers that have spread outside the prostate, Dr. Barbieri says.

“What that does is basically starve the cancer of testosterone, the food that it needs, and the cancer responds,” Dr. Siddiqui explains. He adds that levels of the prostate-specific antigen (PSA), which is the blood marker used to detect prostate cancer, “almost always” goes down after treatment.

The downside is that ADT doesn’t work forever; it typically works for about one to three years for most patients, Dr. Siddiqui says. “Prostate cancer is smart—it learns to grow despite this hormone therapy” by tapping into testosterone from other sources in the body.

Sometimes, ADT is combined with drugs to block testosterone, he adds. It might also be combined with chemotherapy or radiation, Dr. Barbieri says.

Hormone therapy may bring side effects, like reduced libido, erectile dysfunction, a shrinking penis or testicles, and mood swings, according to the ACS.

Chemotherapy

USUALLY FOR: Treating advanced prostate cancer when it’s progressed outside of the prostate gland, according to the ACS.

It works by attacking cells that are dividing quickly and might be used alone or with hormone therapy. However, Dr. Siddiqui says there’s evidence that earlier chemo can offer better survival for some patients. “Some patients live longer when we do that, so we’re moving beyond just doing hormone treatment right up front,” he explains.

Chemo can cause side effects like hair loss, nausea, vomiting, loss of appetite, and fatigue.

Radiation

USUALLY FOR: Targeting cancer that’s still in the prostate gland. It’s often used along with hormone therapy or surgery; it can also be used to control cancer that’s spreading.

Radiation therapy uses rays of intense energy to kill cancer cells.

Recently, the Food and Drug Administration approved Pluvicto, an injectible form of radiation that targets PSMA, a molecule that’s on the surface of cancer cells. Dr. Siddiqui says the drug is approved for patients with advanced prostate cancer whose cancer has grown after hormone therapy or chemotherapy.

“I describe it to patients as like a nuclear warhead,” he says. “It gets injected, it circulates in the body, and hones that radiation right into those cancer cells.”

Clinical trials showed that men who received Pluvicto lived longer compared to patients in the control group, Dr. Siddiqui says.

Surgery

USUALLY FOR: Cancers that haven’t spread outside the prostate.

With a prostatectomy, all or part of the prostate gland is removed. Tissues and lymph nodes surrounding the prostate may also be removed.

Sometimes, surgery is all a patient needs to become cancer-free. But hormone therapy or radiation might be needed after surgery, depending on the case, he adds.

After robot-assisted surgery, there’s usually a short recovery period, and men can resume their normal activities quickly, Dr. Barbieri says.

Immunotherapy

USUALLY FOR: Cases of advanced prostate cancer, meaning it’s grown, but hasn’t yet reached other parts of the body.

Immunotherapy boosts the body’s immune system to recognize, attack, and reject cancer cells. There are a few FDA-approved immunotherapy options for prostate cancer, including Sipuleucel-T, a vaccine comprised of individuals’ immune cells to boost their immune response. It’s approved for advanced prostate cancer.

Checkpoint inhibitors are also approved for certain patients with advanced prostate cancer. These drugs target “checkpoint” proteins on immune cells that turn immune responses on and off, and cancer cells sometimes use the checkpoints to prevent the immune system from attacking them.

There are several immunotherapy clinical trials going on for patients with prostate cancer, according to the Cancer Research Institute.

Targeted Therapy

USUALLY FOR: Metastatic prostate cancer.

Targeted therapies that block certain molecules or chemical reactions in tumor cells have been shown to help some men with metastatic prostate cancer. These drugs sometimes work when other treatments don’t, according to the ACS. The FDA has approved several of these drugs.

For example, PARP inhibitors block the proteins inside cells that prevent them from repairing damaged DNA, which makes it difficult for tumor cells to grow. Some people have mutations in the genes of these DNA repair proteins that stop them from working as they should. The drugs are helpful for patients whose cancer cells have changes in DNA repair genes, which can detected via a blood test.

New Advancements in Prostate Cancer Treatment

RESEARCHERS CONTINUE TO look for new treatments for prostate cancer, and a number of “exciting developments” are in the works, Dr. Siddiqui says.

These include advancements in testosterone-directed therapies, hormone therapy, immunotherapy, and injectible radiation, he says. For example, a class of immunotherapy drugs called T-cell redirectors is being studied, which activate T-cells in the body to go after cancer cells.