What to Know About Your Treatment Choices for Prostate Cancer

Researchers are continually finding new ways to treat prostate cancer. Men diagnosed with it now have more hope for survival than ever before.

The choices that you have for treatment depend on these factors:

• Type, size, and location of the tumor in your prostate

• Results of lab tests

• Extent of the disease called the stage

• Status of your health and your age

• Your personal concerns and preferences

Many men want to learn all they can about their disease and treatment choices so that they can make confident decisions about their care. If you’re one of them, you’re likely to have many questions. For instance, most men with prostate cancer want to know if treatment will affect their urinary or sexual function. And they want to know if they’ll have to change their normal activities. Your doctor is the best person to answer your questions.

Your doctor may recommend a specific treatment. Or he or she may offer more than one, giving you a choice of which one you’d like to follow. This can be a hard decision to make. There is often more than one right answer with different possible benefits and possible risks. It’s important to take the time you need to make the best decision for you.

Types of treatment for prostate cancer

Treatment for prostate cancer is either local or systemic.

Local treatments remove, destroy, or control the cancer cells in one certain area. Surgery and radiation are local treatments. They may be your doctor’s first recommendation if it doesn’t look like your cancer has spread outside of the prostate. Sometimes, prostate cancer may be likely to grow so slowly that surgery or radiation therapy may do more harm than good. In such cases, following the cancer closely with frequent doctor visits and prostate specific antigen (PSA) levels may be a good option. Doctors refer to this monitoring as "watchful waiting" or "active surveillance. In this approach, treatment will be started only if it becomes clear that the cancer is growing or if it is causing symptoms.

Systemic treatments destroy or control cancer cells throughout the entire body. They are typically used if the cancer has spread beyond the prostate. Hormone therapy, chemotherapy, and prostate cancer vaccines are systemic treatments.

Determining the stage and grade of your tumor helps your doctor predict about how fast your cancer will grow and how easy it will be to cure. You doctor also needs to know whether or not the cancer has spread. In some cases, the doctor gets enough information from your lab tests (such as the PSA level) and the prostate biopsy, so no further tests may be needed. In others, the doctor may look to see if the cancer has spread by doing a CT scan or MRI along with a bone scan. You may need to have some lymph nodes removed before your doctor advises you on treatment. This is called a lymph node dissection. It may also be called a lymph node biopsy. All of this information will help you decide whether to go with a local treatment, a systemic treatment, or watchful waiting. You’ll also want to consider these other issues and talk with your doctor about them:

• Any other serious health conditions you have

• Your feelings about the side effects of each treatment

• Your ideas about your age

• Anyone you know who has had cancer, which can affect your expectations of treatment

• How likely it is that the treatment will cure your cancer—some cancers can be cured, while others can’t

The type of treatment you have depends on how the cancer has spread. If it is confined to a local area—to the prostate or spread nearby—you have early-stage cancer. In this case, you may have treatment for local prostate cancer. If the cancer has spread to other places in the body, it’s called metastatic or advanced prostate cancer. Systemic treatments such as hormone therapy may be a better option if this is the case.

More aggressive treatments, which have more side effects, make sense when the goal is to cure the cancer. Less aggressive therapies make sense when the goal is to control or to slow the cancer’s growth.

Doctors are always finding new ways to treat prostate cancer. These new methods are tested in clinical trials. Before beginning treatment, ask your doctor if there are any clinical trials that you should consider.

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