Doctors may also classify prostate cancer based on the risk that it will recur after treatment. Men in the high-risk group are usually offered aggressive treatment. Those in the low-risk group may be offered active surveillance without immediate treatment.
There is no single option that’s right for every man with prostate cancer. Some tumors grow very slowly or not at all, so you may never need treatment. Others advance faster and spread to different places in your body.
If you are diagnosed with cancer, you should discuss your treatment options with a radiation oncologist, a cancer doctor who specializes in treating disease with radiation therapy, and a urologist, a surgeon who specializes in the urinary tract.
Options for dealing with prostate cancer include:
- Active surveillance
- External beam radiation therapy
- Prostate brachytherapy
- Hormone therapy
Sometimes a combination of treatments is best for your cancer, such as surgery followed by external beam radiation, or external beam radiation therapy with hormone therapy. Some men can safely postpone treatment and watch it closely until treatment is needed. This is called watchful waiting.
“Staging is important for prostate cancer, but now we use risk factors to help decide as to the chances the surgeon can remove the prostate cancer, which means probably removing the entire prostate,” says Dr. Lester. “If a patient has a very low-risk disease (cancer), they have the option to go with surgery or radiation.”
Because prostate cancer often grows very slowly, some men (especially those who are older or have other serious health problems) might never need treatment. Instead, their doctors may recommend watchful waiting, observing the situation and waiting until they have symptoms to initiate treatment.
With active surveillance, you may have regular PSA (prostate-specific antigen) blood tests, rectal exams, ultrasounds, and biopsies to see if the cancer is getting worse. If it starts to grow or spread, you can explore other treatment options.
Surgery is a common choice to try to cure prostate cancer if it hasn’t spread outside the prostate gland. The primary type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
“Younger patients in their early 50s often opt for surgery,” says Dr. Lester. “Patients 65 or older usually have radiation. Everyone in the middle has to determine which treatment modality is best for them. And it comes down to how they feel emotionally about the treatments regarding potential side effects. Patients will come in, we will discuss their options with them, we’ll review whether they understand all the options, and then we’ll make a decision.”
There are two forms of radiation treatment typically used for prostate cancer, radioactive seed implant and daily radiation treatment utilizing image-guided radiation therapy (IGRT) or intensity-modulated radiation therapy (IMRT) techniques. Many patients are candidates for both or a combination of the two treatments.
Image-guided radiation therapy (IGRT) is a type of conformal radiotherapy that allows higher doses of radiation to be given to the tumor while limiting the impact on healthy tissue. The method uses advanced imaging technology before and during radiation therapy to enhance the precision and accuracy of treatment delivery.
“Patients who have a higher-risk disease or possible positive margins or extension outside of the gland often opt for radiation because they don’t want to go through surgery and radiation,” says Dr. Lester. “Each patient has to individualize their treatment plan, know their options, and in the end, decide which way they would like to be treated. You must talk to your doctor, and you must get all your questions answered.”
According to Dr. Lester, having the presence and support of a loved one can be very helpful in helping patients understand all the options and determine which treatment would be best for them.
“It’s always good to bring a family member to the doctor’s office because it’s hard to remember everything,” he says. “Once you have all the facts, you can make your decision. Move forward with it, and don’t look back. Don’t regret your decision. Just move forward and do what’s best for you.”