Prostate Cancer

Treatment Overview

Your treatment decision will depend on:

• Your age.
• Any serious health problems.
• Your PSA level.
• What kind of cancer cells you have. This is called the grade or Gleason score of your cancer. Most prostate cancer cells grow very slowly. But some types of cells grow quickly and spread to other areas of the body.
• How far your cancer has spread. This is called the stage of your cancer.
• The side effects of treatment.
• Your personal feelings and concerns.

Treatment may be more successful if prostate cancer is found and treated early. But not all prostate cancers may need to be treated, at least not right away. Treating low-risk prostate cancer may be unnecessary, as some of these cancers grow so slowly that they will never cause problems during a man's lifetime. Unlike many other cancers, prostate cancer is usually slow-growing. For most men, this slow growth means they have time to learn all they can before deciding whether to have treatment or which treatment to have.

Types of treatment

The main treatments for prostate cancer include:

• Surgery to remove the cancer by removing the prostate gland. This operation is called a prostatectomy.
• Radiation treatments, which include external and internal radiation. These treatments have been improved with newer technologies that reduce side effects and other problems caused by radiation. To learn more, see Other Treatment.

Cancer that hasn't spread outside the prostate is called localized prostate cancer. Men with localized prostate cancer have options for their care. Tests show if a localized prostate cancer is likely to grow.

• Low-risk means that the cancer isn't likely to grow right away. Men have the option to choose active surveillance. This means their cancer will be watched closely by their doctors with regular checkups and tests to see if the cancer grows. This choice allows them to delay having surgery or radiation, often for many years. If the cancer grows very slowly, they may never need treatment.
• Medium-risk means that the cancer is more likely to grow. Some men may have the option to choose active surveillance. Most men will likely need treatment with surgery or radiation.
• High-risk means that the cancer will most likely grow right away. Men will likely need treatment with surgery or radiation.

Men who have prostate cancer that has come back or has already spread throughout the body may have other treatments, including hormone therapy.

A diagnosis of prostate cancer usually means that you will be seeing your doctor regularly for years to come. So it's a good idea to build a relationship that is based on full and honest information. Ask your doctor questions about your cancer so that you can make the best decision about treatment. Your doctor also may give you some advice on changes to make in your life to help your treatment succeed.

Additional information about prostate cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/prostate.

Side effects of treatment

Treatments such as surgery or radiation can cause serious side effects. Some are short-term problems. But a side effect can become a long-term problem.

• Surgery can cause leaking urine (urinary incontinence) and erection problems.
• Radiation can cause bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage. It can also cause bladder problems, such as a burning feeling when you urinate.

For men with high-risk prostate cancer, radiation treatment is given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.

In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.^{footnote 3}

Coping with cancer

A cancer diagnosis can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit the website at www.cancer.org.

Follow-up care

After surgery or radiation

If you choose surgery or radiation to treat your prostate cancer, it will be important to have regular checkups. If your cancer comes back, this will help your doctor find it early.

Treatment decisions

To make the decision that is best for you, take the time to understand your options and the medical facts about your cancer. Sometimes the medical facts will guide your decision. But a good decision also reflects what matters most to you. This includes how you feel about radiation or surgery and the likely side effects. It also includes deciding if you want any treatment if you are an older man or have other health problems.

• Age isn't a reason to avoid surgery. But if you are 70 or older, other medical conditions, such as heart disease, may affect your decision. Men who are older also have a higher rate of incontinence and impotence after surgery. Age is especially important to think about if you have early-stage cancer, which generally grows slowly.
• Get a second or even a third opinion before making your treatment decisions. You may hear differing advice or opinions, which may seem confusing. But talking with other doctors can help you make your decision. If your doctor is a medical oncologist, you may want to talk with other prostate cancer specialists, such as a urologist, a radiation or urologic oncologist, or a surgeon.
• Studies show that fewer side effects are reported at large medical centers, where the surgeons do prostatectomies more often and so are more experienced and skilled.^{footnote 4}