The progression stages of prostate cancer are highly variable and there is no "one size fits all" treatment for this disease. When prostate cancer is detected, the patient is encouraged to understand as much as possible about the treatment options, as the decision taken may have long term consequences. Current treatments include Prostatectomy (Surgery), Radiation Therapy, Hormone Therapy and Chemotherapy – more information on existing therapies, and on the risks associated with them, is included at Appendix 1. New therapies are also emerging. However, most are based on efforts to improve the targeting of existing conventional therapies.

Prostatectomy (Surgery)
A surgical approach can be used to remove all or part of the prostate. Typically, men with early-stage disease will undergo radical prostatectomy, or surgical removal of the entire prostate gland plus some surrounding tissue. Other surgical procedures may also be performed.

Radiation Therapy
Radiation involves the killing of cancer cells and surrounding tissues with directed radioactive exposure. Procedures include External Beam Radiation Therapy, which combines CT scans and MRIs to allow targeting and outcome assessment. A second technique, Intensity-modulated radiation therapy (IMRT), allows oncologists to modulate, or change, the intensity of the doses and radiation beams to better target the radiation delivered to the prostate. A third approach, Brachytherapy, uses small metal pellets containing radioactive iodine or palladium which are inserted into the prostate.

Hormone Therapy
Prostate cancer cells are dependent on androgens for growth and “maintenance” and these hormones offer a useful therapeutic target. Hormone therapy, also known as androgen-deprivation therapy or ADT, is designed to stop testosterone from being released or to prevent the hormone from acting on the prostate cells. Although hormone therapy plays an important role in men with advancing prostate cancer, it is increasingly being used before, during, or after local treatment as well.

The majority of cells in prostate cancer tumours respond to the removal of testosterone. But some cells grow independent of testosterone, and therefore remain unaffected by hormone therapy. As these hormone-independent cells continue to grow unchecked, over time, hormone therapies have less and less of an effect on the growth of the tumour. Hormone therapy is therefore not a perfect strategy in the fight against prostate cancer, and does not cure the disease.

Although ADT may be effective in initially controlling prostate cancer growth, the loss of testosterone confers significant side effects in nearly all men. Hormone therapies include Orchiectomy (removal of the testicles, which cuts off 90% of the body’s androgen production) and LHRH Agonists (which interferes with androgen production). Drugs in this class include leuprolide (Eligard, Lupron, and Viadur), goserelin (Zoladex), and triptorelin (Trelstar).

Chemotherapy
Chemotherapeutic approaches relate to therapies which are designed to kill or halt the growth of cancer cells. Until recently, chemotherapy was used only to relieve symptoms associated with very advanced or metastatic disease. Publication of two studies in 2004 showing that the use of Docetaxel (Taxotere) can prolong the lives of men with prostate cancer that no longer responds to hormone therapy. Few chemotherapy agents have been approved by the FDA for use in prostate cancer, but doctors have found that some medications used in other types of cancers can also be used with prostate cancer.

There are also a number of emerging therapies based on improved targeting, interference with cell signalling and metastatic cancer spread.

Risks of Current Therapies
Although several current prostate cancer therapies directly attack prostate cancer cells, destroying them and shrinking the cancer, long term cure rates are poor in most cases. It has also now emerged that whilst short term success for therapies is recognised, the incidence of cancer return in patients is high, at which point the disease appears largely untreatable. This is due to the development of a sub-population of cells described as “androgen independent” cancer cells, which are not amenable to androgen inhibiting drugs. More fundamentally, current therapies do not target the fundamental precursor to proliferating prostate cancer cells, namely, the prostate cancer stem cells.

One of the most widely reported risks of prostate cancer relates to surgery. The prostate gland is particularly inaccessible to surgery and is surrounded by complex nerve and muscle systems. Almost all surgical interventions result in muscle and nerve damage around the prostate and this can lead to variable degrees of incontinence and/or loss of sexual function. In many cases, surgery may only offer a short or medium term cure and it is extremely difficult to remove all affected tissue.