Treatment for your prostate cancer is usually only chosen after a thorough evaluation. Your doctor will discuss the benefits and risks of each treatment choice.

Sometimes, your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Other times, your doctor will talk with you about two or more treatments that could be good for your cancer.

Factors you and your doctor must think about include:

• Your age and other medical problems you may have
• Side effects that occur with each type of treatment
• How much the prostate cancer has spread
• Your Gleason score, which tells your doctor how likely it is that cancer has already spread elsewhere

See also: Prostate cancer staging

Ask your doctor to explain the following about your treatment choices:

• Which choices offer the best chance of curing your cancer or controlling its spread for a long time
• How likely it is that you will have different side effects and how they will affect your life.

Surgery to remove the prostate and some of the tissue around it is an option when the cancer has not spread beyond the prostate gland. This surgery is called radical prostatectomy.

Healthy men who will probably live 10 or more years often have this procedure.

Note: it is not always possible to know for certain before surgery is done whether the prostate cancer has already spread beyond the prostate gland.

Possible problems after surgery include difficulty controlling urine or bowel movements and erection problems.

Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It may also be used after surgery, if there is a risk that prostate cancer cells may still be present. Radiation is sometimes used for pain relief when cancer has spread to the bone.

External beam radiation therapy uses high-powered x-rays pointed at the prostate gland.

• It is done in a radiation oncology center usually connected to a hospital. You will come to the center from home 5 days a week for the treatments. The therapy lasts for 6 - 8 weeks.
• Before treatment, a therapist will mark the part of the body that is to be treated with a special pen.
• The radiation is delivered to the prostate gland using a device that looks like a normal x-ray machine. The treatment itself is generally painless.

Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions, rectal burning or injury, diarrhea, bladder urgency, and blood in urine. There are reports of secondary cancers arising from the radiation field as well.

Proton therapy is another kind of radiation used to treat prostate cancer. Doctors aim proton beams onto a tumor, so there is less damage to the surrounding tissue. This therapy is not widely accepted or used.

Brachytherapy is often used for men with smaller prostate cancer that is found early and is slow-growing. It also may be given with external beam radiation therapy for some patients with more advanced cancer.

Prostate brachytherapy involves placing radioactive seeds inside the prostate gland.

• A surgeon inserts small needles through the skin beneath your scrotum to inject the seeds. The seeds are so small that you don't feel them.
• They are permanent.

Side effects may include:

• Pain, swelling, or bruising in your penis or scrotum, red-brown urine or semen
• Impotence, incontinence, urinary retention, and diarrhea.

Testosterone is the body's main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is any treatment that decreases the effect of testosterone on prostate cancer.

Hormone therapy is mainly used in men whose cancer has spread to help relieve symptoms. These treatments can prevent further growth and spread of cancer but do not cure the cancer.

The primary type is called a luteinizing hormone-releasing hormones (LH-RH) agonist:

• These medicines block the body from making testosterone. The drugs must be given by injection, usually every 3 - 6 months.
• They include leuprolide, goserelin, nafarelin, triptorelin, histrelin, buserelin, and degarelix.
• Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, decreased muscle mass, weight gain, and impotence.

The other medications used are called androgen-blocking drugs.

• They are often given along with the above drugs. They include flutamide, bicalutamide, and nilutamide.
• Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.

Much of the body's testosterone is made by the testes. As a result, removal of the testes (called orchiectomy) can also be used as a hormonal treatment.

Chemotherapy and immunotherapy are used to treat prostate cancers that no longer respond to hormone treatment. An oncology specialist will usually recommend a single drug or a combination of drugs

Antonarakis ES, Eisenberger MA. Expanding treatment options for metastatic prostate cancer. N Engl J Med. 2011 May 26;364(21):2055-8.

Wilt TJ, MacDonald R, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148(6):435-448.

Prostate Cancer Treatment (PDQ®) Last Modified: 06/01/2011

Review Date: 10/27/2011

Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Endometriosis is a condition in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility.

The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. However, the implants can occur in other areas of the body, too.

Each month a woman's ovaries produce hormones that stimulate the cells of the uterine lining (endometrium) to multiply and prepare for a fertilized egg. The lining swells and gets thicker.

If these cells (called endometrial cells) grow outside the uterus, endometriosis results. Unlike cells normally found in the uterus that are shed during menstruation, the ones outside the uterus stay in place. They sometimes bleed a little bit, but they heal and are stimulated again during the next cycle.

This ongoing process leads to symptoms of endometriosis (pain) and can cause scars (adhesions) on the tubes, ovaries, and surrounding structures in the pelvis.

The cause of endometriosis is unknown, but there are a number of theories. One theory is that the endometrial cells loosened during menstruation may "back up" through the fallopian tubes into the pelvis. Once there, they implant and grow in the pelvic or abdominal cavities. This is called retrograde menstruation. This happens in many women, but there may be something different about the immune system in women who develop endometriosis compared to those who do not get the condition.

Endometriosis is a common problem. Sometimes, it may run in the family. Although endometriosis is typically diagnosed between ages 25 - 35, the condition probably begins about the time that regular menstruation begins.

A woman who has a mother or sister with endometriosis is six times more likely to develop endometriosis than women in the general population. Other possible risk factors include:

• Starting menstruation at an early age
• Never having had children
• Frequent menstrual cycles
• Periods that last 7 or more days
• Problems such as a closed hyman, which block the flow of menstrual blood during the period

Pain is the main symptom for women with endometriosis. This can include:

• Painful periods
• Pain in the lower abdomen or pelvic cramps that can be felt for a week or two before menstruation
• Pain in the lower abdomen felt during menstruation (the pain and cramps may be steady and dull or severe)
• Pain during or following sexual intercourse
• Pain with bowel movements
• Pelvic or low back pain that may occur at any time during the menstrual cycle

Note: Often there are no symptoms. In fact, some women with severe cases of endometriosis have no pain at all, whereas some women with mild endometriosis have severe pain.

Tests that are done to diagnose endometriosis include:

• Pelvic exam
• Transvaginal ultrasound
• Pelvic laparoscopy

Treatment options include:

• Medications to control pain
• Medications to stop the endometriosis from getting worse
• Surgery to remove the areas of endometriosis
• Hysterectomywith removal of both ovaries

Treatment depends on the following factors:

• Age
• Severity of symptoms
• Severity of disease
• Whether you want children in the future

Some women who do not ever want children and have mild disease and symptoms may choose to just have regular exams every 6 - 12 months so the doctor can make sure the disease isn't getting worse. They may manage the symptoms by using:

• Exercise and relaxation techniques
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), acetaminophen (Tylenol), or prescription painkillers to relieve cramping and pain.

Treatment may involve stopping the menstrual cycle and creating a state resembling pregnancy. This is called pseudopregnancy. It can help prevent the disease from getting worse. It's done using birth control pills containing estrogen and progesterone.

• You take the medicine continuously for 6 - 9 months before stopping the medicine for a week to have a period. Side effects include spotting of blood, breast tenderness, nausea, and other hormonal side effects.
• This type of therapy relieves most endometriosis symptoms, but it does not prevent scarring from the disease. It also does not reverse any physical changes that have already occurred.

Another treatment involves progesterone pills or injections. Side effects may be bothersome and include depression, weight gain, and spotting of blood.

Some women may be prescribed medicines that stop the ovaries from producing estrogen. These medicines are called gonadotropin agonist drugs and include nafarelin acetate (Synarel) and Depo Lupron.

• Potential side effects include menopausal symptoms such as hot flashes, vaginal dryness, mood changes, and early loss of calcium from the bones.
• Because of the bone density loss, this type of treatment is usually limited to 6 months. In some cases, it may be extended up to 1 year if small doses of estrogen and progesterone are given to reduce the bone weakening side effects.

Surgery is an option for women who have severe pain that does not improve with hormone treatment, or who want to become pregnant either now or in the future.

• Pelvic laparoscopy or laparotomy is done to diagnose endometriosis and then remove or destroy all of endometriosis-related tissue and scar tissue (adhesions).
• Women with severe symptoms or disease who do not want children in the future may have surgery to remove the uterus (hysterectomy). One or both ovaries and fallopian tubes may also be removed. One out of three women who do not have both of their ovaries removed at the time of hysterectomy will have their symptoms return and will need to have surgery at a later time to remove the ovaries.

Hormone therapy and pelvic laparoscopy cannot cure endometriosis. However, it can partially or completely relieve symptoms in many patients for a number of years.

Removing the uterus (hysterectomy), both ovaries and tubes give the best chance of a cure for endometriosis. You may need hormone replacement therapy after your ovaries are removed. Rarely endometriosis can come back, even after a hysterectomy.

Endometriosis may result in infertility, but not in every patient, and especially if the endometriosis is mild. Laparoscopic surgery may help improve fertility. The chance of success depends on the severity of the endometriosis. If the first surgery does not aid in getting pregnant, repeating the laparoscopy is unlikely to help. Patients should consider further infertility treatments.

Endometriosis can lead to problems getting pregnant (infertility). Other complications include:

• Chronic or long-term pelvic pain that interferes with social and work activities
• Large cysts in the pelvis (called endometriomas) that may break open (rupture)

Other complications are rare. In a few cases, endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.

Very rarely, cancer may develop in the areas of endometriosis after menopause.

Call for an appointment with your health care provider if:

• You have symptoms of endometriosis
• Back pain or other symptoms come back after endometriosis is treated

Consider getting screened for endometriosis if your mother or sister has been diagnosed with endometriosis, or if you are unable to become pregnant after trying for 1 year.

Birth control pills may help to prevent or slow down the development of the disease.

Lobo R. Endometriosis: etiology, pathology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap. 19.

Mounsey AL. Diagnosis and management of endometriosis. Am Fam Physician. 2006;74(4):594-600.

Davis L, Kennedy S. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2007;(3):CD001019.

Levy BS. The complex nature of chronic pelvic pain. J Fam Pract. 2007;56:S16-S17.

Bulun SE. Endometriosis. N Engl J Med. 2009;360:268-279.

Jacobson TZ, Barlow DH, Koninckx PR, Olive D, Farquhar C. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev;2002;(4):CD001398.