Considering Treatment Options for Early Prostate Cancer

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

Deciding which option might be best for you

Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors to take into account, such as your age and overall health, and the likelihood that the cancer will cause problems for you, before deciding on 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 might be less concerned about these 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 (although it may cause symptoms you want to avoid). You may be more inclined to consider active surveillance or observation (watchful waiting), and less likely to lean toward treatments such as radiation and surgery, which may cause bothersome side effects. Of course, age alone is not the most important factor when making your choice. Many older men are still in good mental and physical shape, 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 to cure the cancer. Most doctors believe that surgery, external radiation, and brachytherapy all have about the same cure rates for the earliest-stage prostate cancers. However, each type of treatment has its own risks and benefits that should be considered.

Choosing among treatment options can be complicated even further by the development of newer types of treatment (such as newer surgery and radiation therapy approaches), which may provide even more options to consider.

Another consideration is the development in recent years of focal therapies, which are treatments aimed only at the area of the prostate containing the tumor. This is unlike surgery and most forms of radiation therapy, which affect the whole prostate. (For more on focal treatments, see Cryotherapy, HIFU, and Other Ablative Treatments for Prostate Cancer.) These types of treatments might be less likely to cause side effects, such as incontinence and erection problems. They might be additional options for some men who aren’t comfortable with active surveillance but who are concerned about possible side effects from surgery or radiation.

Many of these newer treatments are now available, but there is very little long-term data on them, which means it’s hard to compare their effectiveness and safety to more established treatments.

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. For more information about our programs, call us toll-free at 1-800-227-2345 or see Patient Programs and Services.

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. It is natural for doctors to favor the forms of treatment they’re most comfortable with. For example, surgical specialists such as urologists might favor surgery, while radiation oncologists might lean more toward radiation therapy. In the same way, 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?
• Would you be comfortable with active surveillance (or observation), even if it means you might have more anxiety and need more frequent follow-up visits and tests in the future?
• If it’s an option, would you consider a form of focal therapy to treat your cancer, which might have fewer side effects than surgery or radiation but is not yet well proven?
• Do you need to know right away whether your doctor was able to get all of the cancer out (as a result of surgery)? Or are you comfortable with perhaps not knowing the results of treatment for a while (as is the case in radiation therapy or focal therapies) if it means not having to have surgery?
• Are you more inclined to go with a newer technology (such as proton beam radiation therapy), which in theory might have some advantages, even if it’s not yet well proven?
• Which potential treatment side effects (incontinence, erection problems, bowel problems) might be most distressing to you?
• How important for you are issues like the amount of time spent in treatment or recovery?
• If your initial choice of treatment isn’t successful, what would your treatment options be at that point?

Many men find it very stressful to have to choose between treatment options, and they might worry they will choose the “wrong” one. But in many cases, there is no single option that is clearly better than all the others. What’s more, unless the cancer is known to be growing quickly or has other concerning features, it most likely won’t need to be treated right away, so it’s important to take your time to consider your options carefully when deciding which one is right for you.