Considering Prostate Cancer Treatment Options

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For most men diagnosed with prostate cancer, the cancer is found while it's still at an early stage -- it's small and has not spread beyond the prostate gland. These men often have several treatment options to consider.

Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors such as your age and general health, and the likelihood that the cancer will cause problems for you to consider before deciding what to do. You should also think about the possible side effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side effects such as incontinence or erection problems for as long as possible. Other men are less concerned about side effects and more concerned about removing or destroying the cancer.

If you're older or have other serious health problems and your cancer is slow growing (low-grade), you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may be more inclined to consider watchful waiting or active surveillance, and less inclined to consider treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best basis on which to make your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.

If you are younger and otherwise healthy, you might be more willing to accept possible side effects of treatment if they offer you the best chance for cure. Most doctors believe that surgery, external radiation, and brachytherapy all have about the same cure rates for the earliest stage prostate cancers. However, there are pros and cons to each type of treatment that should be considered, and the benefits should be weighed against possible risks and side effects.

Choosing among treatment options is complicated even further by the development of newer types of surgery (such as robotic-assisted prostatectomy) and radiation therapy (such as proton beam radiation) in recent years. Many of these seem very promising, but there is very little long-term data on them, which means comparing their effectiveness and possible side effects is difficult, if not impossible.

Getting help with treatment decisions

Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues.. It’s important to know that each man’s experience with prostate cancer is different. Just because someone you know had a good (or bad) experience with a certain type of treatment doesn’t mean the same will be true for you.

You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.

Some things to consider when choosing among treatments

Before deciding on treatment, here are some questions you may want to ask yourself:

Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects? Or would you be comfortable with watchful waiting/active surveillance, even if it means you might have more anxiety (and need more frequent follow-up) in the future?
Do you need to know right away whether your doctor thinks he or she was able to get all of the cancer out (a reason some men choose surgery)? Or are you comfortable with not knowing the results of treatment for a while (as is the case in radiation therapy) if it means not having to have surgery?
Do you prefer to go with the newest technology (such as robotic surgery or proton beam radiation therapy), which might have some theoretical advantages? Or do you prefer to go with treatment methods that are better proven and with which doctors might have more experience?
Which potential treatment side effects (incontinence, impotence, bowel problems) might be most distressing to you? (Some treatments are more likely to cause certain side effects than others.)
How important for you are issues like the amount of time spent in treatment or recovery?
If your initial treatment is not successful, what would your options be at that point?

Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the “wrong” one. In many cases, there is no single best option, so it’s important to take your time and decide which option is right for you.
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For most men diagnosed with prostate cancer, the cancer is found while it's still at an early stage -- it's small and has not spread beyond the prostate gland. These men often have several treatment options to consider.