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Prostate Cancer Questions to Ask Your Doctor -- and Yourself

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What are the risks and benefits of my treatment options?

Prostate cancer can be treated in a variety of ways, including surgery, radiation, and medication. Even within these categories, researchers have developed a variety of techniques, including three different ways to perform surgery, two approaches to radiation therapy, and several drugs that suppress prostate cancer. “With so many choices, doctors can tailor treatment better than ever before,” says Howard I. Scher, MD, chief of genitourinary oncology at Memorial Sloan-Kettering Medical Center. But the range of treatments also means doctors and patients must weigh many factors. That’s why it’s crucial to talk to your doctor about the risks and benefits of all your options.

What about practical considerations of treatment?

Risks and benefits aren’t the only criteria for evaluating treatment options. There are also practical factors. Consider the choice of radiation therapy. One approach, called external beam radiation, requires going in for short treatments five days a week for 8 to 9 weeks of treatment. Radioactive seeds, by comparison, can be implanted in a simple surgical procedure that takes less than two hours. Some men would rather avoid surgery and opt for external radiation; others prefer the convenience of having radioactive seeds implanted during a single clinic visit. Talk to your doctor about what how each therapy is performed before you make your decision.

If I opt for watchful waiting, how often will I need to be monitored?

Active surveillance, also called “watchful waiting,” involves careful observation to detect any change in the cancer that would indicate it is progressing and requires more active treatment. Watchful waiting usually includes PSA tests every few months, periodic imaging studies, and repeat prostate biopsies.

Should I get a second opinion from a doctor who specializes in another approach?

Doctors who treat prostate cancer often specialize in a particular treatment approach, which inevitably influences what they recommend. A doctor who specializes in radiation oncology, for example, is likely to recommend radiation. A surgical oncologist will feel most comfortable recommending surgery. To get an unbiased view of all of your options, consider getting a second and even a third opinion before deciding on your treatment. If your doctor discourages you from getting another opinion, find another doctor.

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