Weighing the Treatment Options for Prostate Cancer
Advocacy Men with prostate cancer face a difficult and often confusing decision among many available options, which range from active surveillance, surgery, or various types of radiation therapy. How should each patient make this decision?
The physician uses different measures to answer this question, including the prostate-specific antigen (PSA) blood test, biopsy findings (known as the Gleason score of the cancer), and stage of cancer. The physician will use these results to assess if a patient has “low risk” (least aggressive), “intermediate risk” (moderately aggressive), or “high risk” (most aggressive) prostate cancer. Not all options are suitable for every diagnosis. Intuitively, less aggressive cancers require less aggressive treatment.
For low-risk prostate cancer, active surveillance is often an appropriate option. In active surveillance, the physician has determined that the cancer is slow growing, and that monitoring—instead of treatment—is suitable. Monitoring involves regular PSA tests and prostate biopsies. If the cancer is detected to be growing, then treatment, like surgery or radiation therapy, can be performed at that time.
The benefit of pursuing the active surveillance option is that, for most patients with low-risk cancer, the cancer may not grow for several years — and this is a way to delay possible side effects from treatment. Active surveillance has been studied in thousands of patients and is known to be a safe option for low-risk patients, without compromising the chances for cure or long-term survival.
If a patient has more aggressive (intermediate or high-risk) cancer, then usually treatment is needed. Surgery and radiation therapy are the two main options, and are considered to be equally effective in curing prostate cancer.
However, they cause different side effects. Surgery usually causes more urinary leakage and erectile dysfunction, while radiation can cause more short-term urinary irritation and loose stools. Sometimes, hormone therapy, which is medication that eliminates testosterone, is added to radiation temporarily. This can affect sexual function, and cause hot flashes and weight gain.
In a setting of equally effective options, patients should consider their personal priorities in relation to the side effects and quality of life impact of surgery versus radiation therapy in making their treatment decisions.