Factors to Consider
There are several options for treating prostate cancer, but what's best for you may depend on a number of factors, including your age and condition.
Here's a look at some treatment alternatives, along with their potential pros and cons:
Active surveillance: In some cases, it's best for doctors to closely monitor a patient until symptoms occur rather than to introduce surgery or radiation therapy immediately. This is often the case in older men with other health conditions and in early stage disease.
- Pros: No side effects; you can still decide to undergo treatment.
- Cons: Possible anxiety about having cancer and not treating it.
Radiation therapy: Radiation therapy is used to kill cancers or keep them from spreading. With external radiation therapy, doctors use a machine to direct beams at the cancer. With internal radiation therapy, doctors insert radioactive substances in or near the cancerous area.
- Pros: No hospitalization required (both external and internal); no anesthesia risk (external); similar effectiveness to surgery over a 10-year period (external); can be easier on your body than surgery (internal).
- Cons: Common side effects include fatigue, dry and itchy skin, diarrhea and loss of sexual desire.
Surgery: Many complex surgeries may be performed with minimally invasive approaches. Depending on the extent of disease and the health of the patient, doctors may perform one of the following procedures:
Prostate lymphadectomy – Doctors remove lymph nodes from the pelvis to see if they have cancer; if they do, the doctor does not remove the prostate and recommends another form of treatment.
Radical prostatectomy – Doctors remove the prostate gland, surrounding tissue and seminal vessels.
Other surgeries – These include cryosurgery, in which doctors freeze and thaw tissue to kill cancer cells.
- Pros: Cancer cells are removed.
- Cons: Longer recovery period than radiation treatment; problems with incontinence and getting or maintaining an erection; may also affect fertility.
Hormone therapy: Prostate cancer cells need male hormones to grow; hormone treatments are designed to prevent this growth from happening. Surgery to remove the testicles, the main source of the hormone testosterone, is one form of hormone therapy, as are several drugs that block natural hormones.
- Pros: Can help prolong survival; is a noninvasive, easily tolerated treatment; can be used in conjunction with radiation therapy.
- Cons: Side effects include impotence, hot flashes, loss of sexual desire and weaker bones.
You should consider the following when deciding what treatment choice is best for you:
- Characteristics of your cancer, including the size of your prostate gland, the stage of cancer and your prostate-specific antigen (PSA) and Gleason scores.
- Other health problems – Heart disease, diabetes and other health conditions may affect your choice of treatment, because they affect how well you tolerate certain kinds of treatment. Whether or not you have had previous surgeries for an enlarged prostate may also be a factor.
- Age – Benefits and risks change with age.
Here are a few tips that have proven helpful to men facing a prostate cancer diagnosis:
- Educate yourself about all of the available treatment options.
- Don't base your decisions on old information; there have been many improvements in how prostate cancer is treated in the past 10 years.
- Seek second or even third opinions from doctors.
- Talk to your spouse or partner; he or she may be affected by your treatment decision, so it's a good idea to be open with each other about your respective concerns. Remember, it's possible to live a full life after a diagnosis of prostate cancer.