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Treating Prostate Cancer
Part 1

A Guide for Men with Localized Prostate Cancer


Prostate Cancer Image

Most men have time to learn about all the options for treating their prostate cancer. You have time to talk with your family and to discuss your options with your doctor or nurse. This guide can help you think about what is best for you – now and in the future.

This guide can help you work with your doctor to treat localized prostate cancer. The information comes from a government-funded review of research about treatments for localized prostate cancer. It covers research about four common prostate cancer treatments and their side effects: watchful waiting, prostate surgery, radiation, and hormone treatment.

This guide does not cover how to prevent prostate cancer. It also does not talk about other treatments, like ultrasound treatment, cryotherapy (freezing treatment), laparoscopic surgery (also called bandaid or keyhole surgery), or robotic surgery. These are newer treatments.

The first thing to think about is whether to wait and watch the cancer or treat it right away.

This guide also does not cover herbal products (like green tea) or vitamins and minerals (like selenium). It does not include treatments, like chemotherapy, for prostate cancer that has already spread outside the prostate gland.

This guide focuses on the long-term results of treatments. There isn’t research yet that compares the effects over time of all four treatments. But there is research that compares a few of the treatments to each other. Most of the research so far started before PSA testing was common. Today, PSA testing is widely used. It helps find the cancers earlier and when they are smaller. Research today includes men whose prostate cancers are found by PSA testing. Not enough time has passed to know the long-term results of this research.


Thinking About Your Options
Options for localized prostate cancer include watchful waiting, prostate surgery, radiation, and hormone treatment. Deciding can be a challenge because there is a lot to think about. Research can’t tell us which option is best. All the active treatments can have long-lasting side effects. Many prostate cancers grow slowly over a lifetime. That means men can take time to learn about the cancer, the options, and the side effects.

The first thing to think about is whether to wait and watch the cancer or treat it right away. Options might be different based on your overall health and lab results, such as your Gleason score. A lower Gleason score means the cancer usually grows slowly. Tumors with higher Gleason scores (8 to 10) are called aggressive. They are very likely to grow and spread outside the prostate gland within five years. Men who have a higher Gleason score may think they need to get an active treatment. But research can’t tell us if watchful waiting or an active treatment is better for men with higher Gleason scores.

You and your doctor may decide on an active treatment instead of watchful waiting. If so, think about which one would be best for you. The main benefit with an active treatment is that there is a higher chance that the cancer can be taken out or destroyed. The trade-off is that all active treatments can cause side effects. Some side effects can be long lasting.

Age and some health problems can make surgery more risky. If you have serious heart or lung problems, your doctor may talk to you about other options. If you have had radiation before, you may not be able to have radiation for prostate cancer. Talk to your doctor about your options.


Watchful Waiting
(also called active surveillance or expectant management) means seeing what happens with the cancer over time. Watchful waiting is not the same as doing nothing. It means that you keep a careful watch on the cancer with regular checkups. When you visit your doctor or nurse, you might get a digital rectal exam, a PSA blood test, an ultrasound, or a biopsy to see if the cancer has grown.

With watchful waiting, your cancer is not taken out or destroyed. You and your doctor will be checking for changes over time. The cancer may not spread. But if it does, your doctor will talk with you about your options for active treatment.

The main benefit of watchful waiting is that you can avoid the side effects of active treatment, like erectile dysfunction and urinary problems. Keep in mind that men who use watchful waiting may also have these problems. They can be caused by other health issues or medicines.

 

Read Treating Prostate Cancer - Part 2

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Source: U.S. Department of Health & Human Services Agency for Healthcare Research and Quality

This article was published in Coping® with Cancer magazine, January/February 2009.

Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.