Localized cancers may be treated with hormones and anticancer drugs, which shrink the prostate tumor and suppress its ability to metastasize (spread to surrounding tissue). Certain drugs can slow the cancer’s growth after it has spread beyond the prostate.
In many cases, a prostatectomy—the surgical removal of the prostate—is performed, often in conjunction with radiation. However, this surgery can cause impotence and urinary incontinence. An alternative is brachytherapy, or seed implant therapy, in which radioactive iodine “seeds” are inserted into the prostate. The procedure, performed under local anesthesia, spares healthy, nearby tissue and appears to be as effective as surgery for men with early stage prostate cancer. In men over the age of 70, the disease often progresses so slowly that death results from other causes before symptoms of prostate cancer have time to emerge. For this reason, some physicians believe that many patients in this age group can forego surgery and other treatments as long as their condition is regularly monitored—a treatment known as watchful waiting. Several potential treatments are under investigation, including cryosurgery, in which freezing temperatures destroy cancer cells, and gene therapy, which bolsters immune-system defenses against cancer.