High-energy X-rays are focused at the prostate tumors to destroy them. The painless radiation is given in short bursts so that normal cells have time to recover. However, some healthy cells around the prostate may also be affected.  This treatment requires treatments 5 days a week for 7-8 weeks. Each appointment lasts about 10-30 minutes.

Tiny, radioactive “seeds” are placed into the prostate gland to shrink it. This 1-2 hour day surgery procedure is a way of delivering focused and higher dosages of radiation. Thin needles are computer guided to put the seeds into the prostate; the seeds are permanent.

Cryotherapy is only available in a few centres in Canada.  Thin needles are inserted into the prostate gland and extremely cold gas is used to freeze the prostate gland. It is allowed to thaw and is then frozen again. This process destroys the cancerous cells and usually takes 1-2 hours, in the operating room. It requires a one-night stay in the hospital and a suprapublic catheter until the associated swelling subsides.

Most prostate cancers depend on the male hormone testosterone for their growth. Removing testosterone, or blocking its action, causes prostate cancer cells to regress. This is generally referred to as hormonal therapy but correctly called Androgen Deprivation Therapy (ADT). Unfortunately, resistant cells eventually develop which can survive and grow in the absence of testosterone. ADT can very effectively improve symptoms and quality of life. As well, ADT may also prolong life. ADT is generally used in the treatment of more advanced prostate cancer, but may be useful in combination with surgery or radiation.

ADT can be achieved in a variety of ways:

• Surgical removal of the testes.
• Medications that cause the testicles to stop making testosterone.

Chemotherapy uses anticancer medications (given by intravenous infusion or pills) to destroy or prevent the growth of cancer cells. Chemotherapy is most commonly used in treating prostate cancer that has reoccurred in men, or if the cancer has spread to another part of their body. Usually, it helps slow the spread of the prostate cancer, prolong life and relieve the pain that occurs in the later stages of cancer.

While some prostate cancers grow rapidly and metastasize or spread, others grow very slowly and are unlikely to metastasize. This low risk prostate cancer may not need to be treated as soon as they are diagnosed. Slow growing prostate cancer may not have time to cause significant problems and the complications and side effects of treatment (such as decreased erectile function or bladder control) may outweigh the advantages. In active surveillance, you will be carefully monitored by having regular PSA blood tests and Digital Rectal Exams (DRE) to determine if a repeat biopsy is required. Treatment can be given if the cancer is progressing or if the patient decides on further treatment.

Surgery is an option when the cancer hasn’t spread and is confined to the prostate. This can either be done by making an incision and removing the prostate (open surgery).

Or by having a few smaller incisions with the doctor guiding robotic arms to perform the operation (robotic surgery).

  
Lymph nodes may also be taken to see if the cancer has spread. Afterwards, you can expect a hospital stay of 2-3 days, a catheter to drain the urine (for 1-2 weeks) and approximately 3-6 weeks recovery time.

The 2 main side effects include:

• Erectile dysfunction – Most men cannot have an erection right after surgery because the nerves need time to heal. This may improve within 12 months to 4 years with no guarantee of erections coming back. However, there are treatment options that may help.

• Incontinence (loss of bladder control) – This is usually resolved within 9 months. During that time, wearing absorbent pads will help with protection.