How Long Can You Live Without Prostate Cancer Treatment?

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if the cancer has spread (metastasized) to other parts of the body, and the age and overall health of the patient. Closely monitoring and watchful waiting are treatment options for small, localized, slow-growing prostate cancer, but not for fast-growing cancer or metastasized cancer (cancer is likely to have spread outside the prostate).

Prostate cancer occurs when cells in the prostate grow out of control. The prostate is a gland in men that helps produce fluid that goes into semen. The prostate is located in front of the rectum and just below the bladder. 

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if the cancer has spread (metastasized) to other parts of the body, and the age and overall health of the patient. Routine screening tests allow prostate cancer to be detected early, before the cancer has spread to the bone and other organs. When detected early, there are a number of treatment options and a good chance of a cure.

There are two methods used to monitor small, localized, slow-growing prostate cancer that do not involve treatment:

• Active surveillance is when the cancer is monitored closely
  • Usually involves prostate-specific antigen (PSA) blood tests about every 6 months and a digital rectal exam (DRE) at least once a year
  • Prostate biopsies and imaging tests may be done every 1 to 3 years 
  • If test results change, treatment options may be considered 
• Watchful waiting (observation) 
  • Describe a less intensive follow-up that can mean fewer tests 
  • Relies more on changes in a man’s symptoms to decide if treatment is needed
  • Meant to control cancer symptoms, but not cure them
• Active surveillance or watchful waiting may be considered for men with slow-growing cancers because it is not known if surgery or radiation will help them live longer. Some studies have compared watchful waiting and surgery for early-stage prostate cancer, but results have been mixed. Some studies found that men who have surgery might live longer, while others did not find a difference in survival. 
• A few studies have compared active surveillance, surgery, or radiation therapy and found that men who undergo surgery or radiation do not appear to live longer than those that undergo active surveillance, but those who receive treatment may have less spread of the cancer and the cancer may stay in remission longer. 

Active surveillance or watchful waiting may be recommended if the prostate cancer:

• Does not cause symptoms
• Is expected to grow slowly 
• Is small
• Is localized to the prostate
• Is associated with low PSA level (less than 10ng/ml)

Active surveillance or watchful waiting are generally not considered viable options for men who have fast-growing cancer or if the cancer is likely to have spread outside the prostate (metastasized). 

If treatment for prostate cancer is recommended, it may include one or more of the following:

• Surgery: removal of the entire prostate and some nearby tissue
• Radiation therapy
  • Brachytherapy (internal radiation)
  • External beam radiation
  • Cryotherapy (also called cryosurgery or cryoablation)
• Uses very cold temperatures to freeze and kill prostate cancer cells and most of the prostate
• Hormone therapy
  • Androgen deprivation therapy (ADT) uses surgery or medicines to lower the levels of androgens made in the testicles
  • Orchiectomy (surgical castration)
  • Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles (also called medical castration)
    • Goserelin (Zoladex)
    • Histrelin (Vantas)
    • Leuprolide (Lupron, Eligard)
    • Triptorelin (Trelstar)
  • LHRH antagonists
    • Degarelix (Firmagon) 
    • Relugolix (Orgovyx) 
• Chemotherapy 
  • Cabazitaxel (Jevtana)
  • Docetaxel (Taxotere)
  • Estramustine (Emcyt)
  • Mitoxantrone (Novantrone)
• Immunotherapy 
  • Cancer vaccine (doesn’t stop prostate cancer from growing, but may help men live several months longer): Sipuleucel-T (Provenge) 
  • Immune checkpoint inhibitors
  • PD-1 inhibitor: pembrolizumab (Keytruda) 
• Targeted therapy 
  • PARP (poly(ADP)-ribose polymerase) inhibitors
    • Olaparib (Lynparza) 
    • Rucaparib (Rubraca) 
• Treatments for prostate cancer spread to bones
  • Bisphosphonates: zoledronic acid (Zometa) 
  • Denosumab (Xgeva) 
  • Corticosteroids
  • External radiation therapy
  • Radiopharmaceuticals
    • Radium-223 (Xofigo)
    • Samarium-153 (Quadramet)
    • Strontium-89 (Metastron)
  • Surgery
    • Kyphoplasty: stabilizes a painful collapsed bone in a spine that is weakened by prostate cancer
  • Pain medicines