Treatments currently used

• Active surveillance – Involves closely monitoring small, low-risk, slow-growing prostate cancer.
• Radical prostatectomy (open, laparoscopic, robotic) – Surgery that completely removes the prostate gland, as well as part of the urethra within the prostate and the seminal vesicles.
• Radiation therapy (external beam, brachytherapy) – Radiation therapy uses radiation to shrink tumours and kill cancer cells.
• Brachytherapy – Brachytherapy irradiates the prostate from an internal source to shrink tumours and kill cancer cells.
• Hormone therapy – Hormone therapy deprives cancer cells of the male hormones (e.g., testosterone) they need in order to grow.
• Chemotherapy – Drugs that treat aggressive cancer. These drugs affect both cancer cells and healthy cells. Healthy cells tend to regenerate whereas cancer cells struggle to do so.

There are also several approaches and strategies for preventing or treating bone metastases, treat them or to relieve symptoms and bone pain.

Note

Focal therapy – Other options such as cryotherapy and IFHU/HIFU are currently under study. It should be noted that these are not standard treatments. They are used when the cancer is believed to be still limited to the prostate. However, neither of these techniques can currently be considered a viable alternative to standard prostate cancer treatment options. And since their long-term effectiveness is not known, few healthcare centers offer them in Canada.

Clinical trials

One way to access new treatments before they become widely available is to participate in clinical trials. A clinical trial is a research study that uses volunteers, called participants, to test new ways of preventing, detecting, treating, or managing prostate cancer or other illnesses. Some clinical trials help determine whether or not a new drug or device is effective and safe.

Participating in a clinical trial is a valuable contribution to research as clinical trials answer important questions that can lead to better health outcomes. Participation can be a good way for participants to access free and new treatments and to be closely monitored by healthcare workers. To learn more about clinical trials, speak with your healthcare team.

Finding a clinical trial can be a difficult and tedious process. To address this issue, our partner Q-CROC developed Onco+, a free support service available to anyone looking for an oncology clinical trial in Quebec.

If you would like to learn more about oncology clinical trials in Quebec and consider whether participating in a clinical trial might be an option for you, please visit the website of our partner Q-CROC.

Additional clinical trial sites:

• Clinical Trials: clinicaltrials.gov
• Canadian Cancer Trials: canadiancancertrials.ca

Alternative medicine

Complementary and alternative treatments include a wide range of approaches and therapies. It is important to understand the differences between conventional medicine, complementary therapies, and alternative therapies.

• Traditional medicine – Medical or surgical treatments that are accepted and practiced within the Canadian healthcare system. The best available research has shown these treatments to be effective and safe. Radiation therapy is an example of conventional medicine.
• Complementary therapies – Therapies used with or alongside conventional medicine, often to help people cope with cancer, treatment, or side effects. More research is needed to find out if they are safe and effective. An example of a complementary therapy is using meditation to help with stress or anxiety during treatment.
• Alternative therapies – Therapies used instead of conventional medicine. Alternative therapies have not been scientifically proven to be safe and effective. Following a special diet to treat prostate cancer instead of conventional treatments is an example of alternative therapy. Delaying or refusing conventional therapies in preference of using alternative therapies can have serious health consequences.

Discuss all treatment decisions with your healthcare team.

The diagnosis of prostate cancer greatly influences the choice of treatment. In fact, the results of the biopsy and the various tests determine two key indicators, namely the grade (Gleason score) and the stage of prostate cancer. The grade specifies the degree of aggressiveness of cancer while the stage indicates its degree of spread. These two indicators make it possible to determine the level of evolution of prostate cancer: localized, locally advanced, or metastatic. Our diagnostic page deals in detail with the type and risk of progression.

Risk of progression of prostate cancer

Prostate cancer can also be classified according to the risk of progression or recurrence – low risk, intermediate risk, or high risk of progression. For this evaluation, which may influence the therapeutic approach, consideration is given to the clinical stage, PSA, and Gleason score.

For example, your doctor may suggest a more aggressive treatment if your risk of recurrence is high. On the other hand, if your risk of progression is low, you could be offered active surveillance without receiving immediate treatment.

Localized prostate cancer

Localized prostate cancer is contained within the prostate, in other words, it has not spread outside of the prostate. Many localized cancers are often not very aggressive and tend to grow slowly. Because of this, chances are high that this type of cancer will not cause you any problems in your lifetime. However, some localized cancers grow more quickly than others and can spread to other parts of your body. There is no perfect treatment for localized cancer; each treatment has its strengths and weaknesses. Discuss the possible courses of treatment with your urologist.

Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that has begun to break out of the prostate, but not too far. It may have spread beyond the boundaries of the prostate (capsule) into the neighboring regions of the seminal vesicles, pelvic nodes, bladder, rectum, or pelvic lining. Selecting the best treatment depends on the extent of its spread.

Metastatic prostate cancer

Metastatic prostate cancer is cancer that has spread to other parts of your body — far from your prostate. Metastases originating from the prostate most often develop in the bones and lymph nodes. Bone pain, fatigue, and weight loss are all symptoms associated with advanced cancer. Advanced prostate cancer cannot be cured. There are, however, many treatments that can help reduce symptoms and keep your cancer under control for several years.

In recent years, several treatments initially used after the failure of hormone injection, such as chemotherapy and/or next-generation hormone therapy in the form of tablets, are now sometimes used when a new diagnosis of metastatic prostate cancer is made.

What 2023 research says

In patients with prostate cancer that has spread significantly throughout the body, treatment options beyond just hormone injections, such as triple therapy (standard hormone therapy, chemotherapy and oral tablets), should be discussed with your doctor. As such, here is a video clip that might interest you with Dr. Aly-Khan Lalani, Medical Oncologist at the Juravinski Cancer Centre and Assistant Professor at McMaster University, in Ontario, Canada, following the ASCO-GU scientific conference in 2023.

Other types of prostate cancer

Recurrence

The recurrence of cancer can happen when some cancer cells survive after your initial treatment. Cancer can recur in the same place or it can be detected in another part of your body. The latter is also known as a metastatic recurrence. The next treatment step depends on the location of the recurrence.

Castrate resistant prostate cancer (CRPC)

Hormone therapy can keep the spread of cancer under control for a number of years. However, with time, cancer may become castrate-resistant and start to grow again. That is to say, cancer is able to replicate despite castration (the low level of testosterone). The following terms were also used in the past in reference to castrate-resistant prostate cancer (CRPC): hormone-resistant prostate cancer, androgen-independent prostate cancer, and hormone-refractory prostate cancer.

Treatments exist to cure this type of cancer but differ depending on whether metastases are present or not: new generation hormone therapy – apalutamide (Erleada), enzalutamide (Xtandi) and abiraterone acetate (Zytiga) – is part of the combination treatments to treat this type of cancer.

What the research says in 2023

The addition of a targeted therapy like PARPi, a new approach in the therapeutic arsenal, the fruit of intensive research in recent years, should be discussed with your doctor, given their results on the progression of the cancer and on the potential improvement in the lifespan of the patients. It goes without saying that scientists are still trying to determine which patients are best suited to these types of combinations.

As such, here is a video clip that might interest you with Dr. Aly-Khan Lalani, Medical Oncologist at the Juravinski Cancer Centre and Assistant Professor at McMaster University, in Ontario, Canada, following the ASCO-GU scientific conference in 2023.

Who will care for you?

Once prostate cancer has been diagnosed, it is usually urologists and radiation oncologists who treat your cancer. If metastases are present, especially when using chemotherapy, a medical oncologist will often consult other health professionals.

Your healthcare team—consisting of your family doctor, radiation oncologist technicians, and volunteers—is there for support and comfort.

Factors to consider

Prostate cancer is a complex disease. Many personal or cancer-related factors may influence the choice of treatment in a given patient. It is important that you learn as much as you can about your cancer and the treatment options available to you, including potential side effects. This will allow you to have an informed discussion with your doctor and establish a treatment plan that is right for you. Decisions about your treatment are normally based on:

• Your type of prostate cancer
• Your PSA rate
• Your stage and grade (Gleason score)
• Your age and your life expectancy
• Your general state of health
• Your personal preference for treatment

Keep in mind that a positive diagnosis does not mean that you will be automatically treated and that an early detected cancer can be curable, if not controllable in the long term.

Choosing treatment can be difficult

Be sure to take the time to think about what is good for you and to get all the information you need. You will have an informed discussion with your doctor and choose the treatment option that is right for you.

You should also be aware that research is now providing increasingly precise treatments that target specific forms of cancer. In addition, treatment protocols now include many strategies to treat advanced disease. Click here  to learn more about your treatment options based on your type of cancer.