Surgery and radiation therapy remain the standard treatment for localized prostate cancer, but other, less popular treatment options might be beneficial as well. As time goes on and the benefits of these treatment options are further explored, it’s possible that they will move more into the mainstream. For now, though, none are seen as standard treatments for localized prostate cancer.
Cryotherapy, also known as cryosurgery or cryoablation, has been around for years, but until a few years ago, it was rarely used. With this approach, probes are inserted into the prostate through the perineum (the space between the scrotum and the anus), and argon gas or liquid nitrogen is delivered to the prostate, literally freezing to death the prostate cells and any prostate tumors. (Review the roles of the prostate and the surrounding organs in the About the Prostate section.)
Over the years, a number of modifications were made to avoid freezing damage to the nearby structures, but the rates for both erectile and urinary dysfunction remain high, and data on long-term outcomes are limited.
Cryotherapy is also used as a secondary local therapy in men who underwent radiation therapy as initial treatment for early-stage prostate cancer. Note that men with more well-confined disease tend to fare better, while those who received hormone therapy in addition to radiation therapy tend to fare worse. Side effects of this focal therapy include further urinary or sexual problems such as urinary stricture, erectile dysfunction, and urgency. Rarely, cryotherapy can result in injury to surrounding tissues such as the rectum or bladder given the proximity of these structures to the prostate bed.
High-Intensity Focused Ultrasound
High-intensity focused ultrasound, or HIFU, works in exactly the opposite way compared with cryotherapy: with HIFU, the prostate cells are heated to death. A probe is inserted into the rectum, from which very high-intensity ultrasound waves are delivered to the target area. Although this technique remains experimental in the United States, it’s been used in Europe for a number of years with a fair amount of success. Side effects of HIFU are similar to those discussed above for cryotherapy and depend on the skill and experience of the surgeon using this technique.
Primary Hormone Therapy
Prostate cancer cells are like other living organisms—they need fuel to grow and survive. Because the hormone testosterone serves as the main fuel for prostate cancer cell growth, it’s a common target for therapeutic intervention in men with the disease. Hormone therapy, also known as androgen-deprivation therapy or ADT, is designed to stop testosterone from being released or to prevent it from acting on the prostate cells.
Although hormone therapy plays an important role in men with advancing prostate cancer, it is also increasingly being used before, during, or after local treatment. In some cases, hormone therapy may be used in conjunction with radiation therapy. If so, treatment with ADT is generally given before, during and after radiation therapy in the form of an LHRH agonist. LHRH, or luteinizing hormone releasing hormone, is one of the key hormones involved in the production of testosterone. This medicine works through a complicated feedback loop to lower the body’s testosterone. Note that LHRH is sometimes called GnRH, or gonadotropin-releasing hormone. Although there is little, if any, data to show that hormone therapy alone is an effective treatment strategy for men with localized prostate cancer, it is increasingly being used in this setting. Because it is not invasive, it is possible that the therapy is seen as a middle ground between active surveillance and local therapy. For men who are not good candidates for surgery or radiation, and who require immediate therapy, primary hormonal therapy is a reasonable option. However, hormonal therapy has a long list of side effects, and thus, the main question is whether therapy can be safely deferred in men who are not candidates for immediate surgery or radiation. Primary hormonal therapy is also a reasonable option in men who have metastatic disease (cancer spread beyond the prostate) when the diagnosis of prostate cancer is made. In these men, hormonal therapy will shrink the prostate gland and cancer and may delay any need for local therapy.