Treatment Options

Treatment Options

1. Active Surveillance — The "Wait and See" Approach

Sometimes, doctors don't rush into treatment. If your cancer is slow-growing and isn't causing problems, they might suggest active surveillance: regular PSA tests, digital rectal exams, and biopsies to monitor the situation. If the cancer starts becoming aggressive, treatment begins.

Best for: Low-risk, slow-growing cancers in men who want to avoid treatment side effects.

2. Watchful Waiting

Similar to active surveillance, but less intensive monitoring. Instead of testing frequently, this approach focuses on managing symptoms rather than treating the cancer itself. Often used for older men or those with other serious health conditions.

3. Surgery — Radical Prostatectomy

If the cancer is still confined to the prostate, a radical prostatectomy removes the entire prostate gland. Two main approaches:

Open Surgery

Traditional method: a single large incision in the lower abdomen. Gives the surgeon a clear view of the area but involves longer recovery, more blood loss, and a larger scar.

Robotic-Assisted Surgery

The modern, minimally invasive option. Small incisions, precise robotic tools controlled by the surgeon. Benefits:

• Less pain and blood loss
• Shorter hospital stay
• Quicker recovery
• Better early recovery of bladder control and sexual function in many cases

4. Radiation Therapy

Instead of removing the prostate, radiotherapy kills cancer cells with high-energy rays:

• External Beam Radiotherapy (EBRT): Radiation directed at the prostate from a machine outside your body. Multiple sessions over several weeks.
• Brachytherapy: Small radioactive seeds placed directly inside the prostate to target cancer cells.

Side effects can include fatigue, bowel changes, and erectile dysfunction, but these can often be managed effectively.

5. Hormone Therapy

Prostate cancer feeds on testosterone. Hormone therapy reduces testosterone levels or blocks its effects, slowing cancer growth. Often used when cancer has spread beyond the prostate, or combined with other treatments.

Options include:

• LHRH agonists/antagonists: Drugs that lower testosterone levels
• Anti-androgens: Medications that block testosterone's effect on cancer cells

Side effects may include hot flashes, fatigue, and reduced libido. All manageable with proper care.

6. Chemotherapy

Used when prostate cancer has spread beyond the prostate. Powerful drugs attack fast-growing cancer cells. Not usually the first treatment, but effective for advanced cases.

7. Newer Treatments: HIFU & Cryotherapy

• HIFU (High-Intensity Focused Ultrasound): Focused ultrasound waves heat and destroy cancer cells. Less invasive, increasingly used for localised prostate cancer.
• Cryotherapy: Extreme cold destroys cancerous tissue. Less common, but an option for some early-stage cases.

8. Emerging Therapies

• Immunotherapy: Helps your immune system recognise and attack cancer cells. Promising for advanced cases.
• Targeted Therapy (PARP inhibitors): Targets specific genetic changes, including BRCA mutations more common in Black men.
• Bone-Directed Therapy: Protects bones if cancer spreads, using bisphosphonates or denosumab.

Medications & Access in Nigeria

Finding and affording prostate cancer medication in Nigeria can be challenging. Resources available:

• Government/Teaching Hospitals: Best access to subsidised medications via the Chemotherapy Access Partnership (50% cheaper chemo at select hospitals)
• Nigeria Cancer Health Fund (CHF): Ask your hospital about this at Lagos University Teaching Hospital, National Hospital Abuja, and others
• Private cancer centres: Lakeshore Cancer Centre stocks newer treatments
• NGOs: Project Pink Blue and the Nigerian Cancer Society sometimes assist with medication sourcing