Editor's note: Because prostate cancer is one of the most common types of cancer in men, more and more men and their loved ones are taking steps to understand it, prevent it, and make wise and informed decisions if a prostate cancer diagnosis is made.

This is the second part of a two-installment article.

Radiation therapy
Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:

• Radiation that comes from outside your body (external beam radiation). You lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays, to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks.
• Radiation placed inside your body (brachytherapy). Many rice-sized radioactive seeds are placed in your prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. Your doctor implants the radioactive seeds in your prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don't need to be removed.

Side effects of radiation therapy can include painful urination, frequent urination, and urgent urination, as well as rectal symptoms such as loose stools or pain when passing stools. Erectile dysfunction can also occur.

Hormone therapy
Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:

• Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone.
  
• Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells. These drugs typically are given along with an LH-RH agonist or given before taking an LH-RH agonist.
• Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body. The effectiveness of orchiectomy in lowering testosterone levels is similar to that of hormone therapy medications, but orchiectomy may lower testosterone levels more quickly.

Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy. This can make it more likely that radiation therapy will be successful. Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind.

Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of muscle and bone mass, reduced sex drive, and weight gain. Hormone therapy also increases the risk of heart disease and heart attack. Doctors believe long-term use of hormone therapy and the low hormone levels that result may lead to cardiovascular problems.

Surgery to remove the prostate
Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue, and a few lymph nodes. Ways the radical prostatectomy procedure can be performed include:

• Making an incision in your abdomen. During retropubic surgery, the prostate gland is taken out through an incision in your lower abdomen. Compared with other types of prostate surgery, retropubic prostate surgery may carry a lower risk of nerve damage.
  
• Making an incision between your anus and scrotum. Perineal surgery involves making an incision between your anus and scrotum to access your prostate. The perineal approach may allow for quicker recovery times, but this technique makes removing the nearby lymph nodes and avoiding nerve damage more difficult.
• Laparoscopic prostatectomy. Several small incisions are made in the abdomen. The doctor inserts special surgical tools through the incisions, including a long, slender tube with a small camera on the end (laparoscope). The laparoscope sends images to a monitor in the operating room. The surgeon watches the monitor as he or she guides the instruments. Laparoscopic surgery may offer a shorter hospital stay and quicker recovery than traditional surgery.
  
• Using a robot to assist with surgery. During robotic laparoscopic surgery, the instruments are attached to a mechanical device (robot). The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Using a robot during laparoscopic surgery may allow the surgeon to make more precise movements with surgical tools than is possible with traditional laparoscopic surgery. Discuss with your doctor which type of surgery is best for you.

Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction. Ask your doctor to explain the risks you may face based on your situation, the type of procedure you select, your age, your body type, and your overall health.

Freezing prostate tissue
Cryosurgery, or cryoablation, involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images for guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue. Original attempts to use cryosurgery for prostate cancer resulted in unacceptable side effects. Doctors hope newer technologies will make cryosurgery safer.

Heating prostate tissue using ultrasound
High-intensity focused ultrasound treatment uses powerful sound waves to heat prostate tissue, causing cancer cells to die. The procedure is done by inserting a small probe in your rectum. The probe focuses ultrasound energy at precise points in your prostate. High-intensity focused ultrasound treatments are being studied in clinical trials. More study is needed to understand the benefits and risks of this treatment.

Chemotherapy
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form, or both. Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don't respond to hormone therapy. Doctors are studying whether chemotherapy is helpful when combined with radiation therapy or surgery.

Alternative treatments
No complementary or alternative treatments will cure prostate cancer. However, complementary and alternative prostate cancer treatments may help men cope with the side effects of cancer and its treatment.

Alternative prostate cancer treatments that may help you cope with the stress and anxiety you may experience after your diagnosis include art therapy, dance or movement therapy, exercise, meditation, music therapy, relaxation techniques such as guided imagery or muscle relaxation, and expressions of spirituality. Ask your doctor to refer you to a professional who can help you do these activities. Some require instruction, while others can be done on your own.

When you receive a diagnosis of prostate cancer, you may experience a range of feelings—disbelief, fear, anger, anxiety, depression. With time, each man finds his own way of coping with a prostate cancer diagnosis. Until you find what works for you, try to:

• Learn enough about prostate cancer to feel comfortable making treatment decisions. Learn as much as you can about your cancer and its treatment. Having a better idea of what to expect from treatment and life after treatment can make you feel more in control of your cancer. Ask your doctor, nurse, or other health care professional to recommend reliable sources of information to get you started.
  
• Keep your friends and family close. Your friends and family can provide support during and after your treatment. Friends and family can help with the small tasks you won't have energy for. And having a close friend or family member to talk to can be helpful when you're stressed or overwhelmed.
  
• Connect with other cancer survivors. Because friends and family can't always understand what it's like to face cancer, other cancer survivors provide a unique network of support. Ask your doctor or other member of your health care team about support groups or organizations in your community that can connect you with other cancer survivors. Organizations such as the American Cancer Society offer online chat rooms and discussion boards. www.cancer.org or 816-842-7111.
  
• Take care of yourself. Take care of yourself during cancer treatment by eating a diet full of fruits and vegetables. Try to exercise most days of the week. Get enough sleep each night so you wake feeling rested.
• Continue sexual expression. If you experience erectile dysfunction, your natural reaction may be to avoid all sexual contact. But consider touching, holding, hugging, and caressing as ways to continue sharing sexuality with your partner.

Prevention
You can reduce your risk of prostate cancer if you:

• Choose a diet full of fruits and vegetables. Avoid high-fat foods and focus on choosing a variety of fruits, vegetables, and whole grains. Fruits and vegetables contain many vitamins and nutrients that can contribute to your health. One nutrient that is consistently linked to prostate cancer prevention is lycopene, which can be found in raw or cooked tomatoes. Whether you can prevent prostate cancer through diet has yet to be conclusively proven. But eating a healthy diet with a variety of fruits and vegetables can improve your overall health.
  
• Choose healthful foods over supplements. No studies have shown that supplements play a role in reducing your risk of prostate cancer. While there has been some interest in vitamin C, vitamin E, and selenium to lower prostate cancer risk, studies haven't found a benefit to taking supplements to create high levels of these nutrients in your body. Instead, choose foods that are rich in vitamins and minerals so you can maintain effective levels of vitamins in your body.
  
• Exercise most days of the week. Exercise improves your overall health, helps you maintain your weight, and improves your mood. There is some evidence that the men who get the most exercise have a lower incidence of prostate cancer than men who get little or no exercise. Try to exercise most days of the week. If you're new to exercise, start slowly and work your way up to more exercise time each day.
• Maintain a healthful weight. If your current weight is healthful, maintain it by exercising most days of the week. If you need to lose weight, add more exercise and reduce the number of calories you eat each day. Ask your doctor for help in creating a plan for weight loss.
• Talk to your doctor if you think you have an increased risk of prostate cancer. Men with a high risk of prostate cancer may consider medications or other treatments to reduce their risk.

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