Standard Treatment Most treatment aims to control symptoms—relieving obstruction or pain—and tries to prolong life. Radical surgery is generally not useful.
The standard treatment is hormonal manipulation through hormonal therapy or removal of the testicles. Hormonal therapy includes giving estrogens (diethylstilbestrol), antiandrogens (flutamide), luteinizing hormone-releasing hormone (LH-RH) agonists such as leuprolide, and progestational agents (Megace).
Impressive improvement often follows hormonal treatment, with reduction in pain and improvement in overall well-being. Voiding symptoms sometimes disappear, although this effect may take several months to occur. Relief of pain is often dramatic after the testicles are removed. This procedure produces the quickest results and does not require the use of any further medication for tumor control.
• A chemotherapeutic-hormonal agent called estramustine phosphate concentrates in the prostate cancer tissue
and is believed to have some direct action against the tumor. Whether this effect is because of the hormonal
activity or antitumor activity is not well understood. The role of this agent is still uncertain and it is used
mainly for patients who fail traditional hormone therapy measures.
• When voiding problems are severe and there is no time to wait, a transurethral prostatectomy (TURP) will
produce immediate relief of urinary obstruction. Incontinence (leakage of urine) is a risk in TURP because the
tumor may extend to the urethral sphincter muscle and prevent the canal from closing properly.
