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Your Prostate Cancer Treatment Options

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WebMD Feature

The outlook for men diagnosed with prostate cancer has never been brighter. Doctors now have a variety of ways to treat prostate cancer, including surgery, radiation, and drugs that slow the growth of cancer cells. Both the safety and effectiveness of prostate cancer treatments has been steadily improving.

That’s good news, of course. But with so many different approaches to prostate cancer treatment, each with its own benefits and risks, weighing your options and choosing the most appropriate treatment can be complicated. The right treatment for each man depends on his stage of cancer and how aggressively the cancer cells are growing. For example, a man with early prostate cancer that is slow growing may opt for watchful waiting. Another man with early prostate cancer that is growing aggressively might choose surgery plus radiation, or another combination of therapies.

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Watchful Waiting: Active Surveillance of Prostate Cancer

Thanks to screening and early detection, many prostate cancers are first detected long before they pose a threat. Indeed, many of the cancers detected by PSA tests and biopsies prove to be very early cancers or so slow-growing that they never pose a life-threatening danger.

Because of early diagnosis, the best approach for a growing number of men is to monitor the cancer for signs that it is getting worse. Called active surveillance or “watchful waiting,” this strategy allows men with early-stage or very slow growing prostate cancer to avoid treatment and its side effects -- or actively monitor the disease and to take action if the cancer grows or spreads.

Experts say this approach could be appropriate for 40% of all men diagnosed with the disease in the U.S.

“Active surveillance is a choice to consider if your cancer is a less aggressive type, occurs only in a small part of the prostate gland, and has not spread outside the gland,” says Peter Carroll, MD, MPH, professor and chair of urology at the University of California, San Francisco. Other good candidates for active surveillance are men who are older or in poor health, when the risks of surgery or radiation may outweigh the benefits.

Active surveillance doesn’t mean doing nothing, Carroll says. Men are regularly monitored with PSA tests, digital rectal exams, imaging, and follow-up biopsies to make sure the cancer hasn’t progressed. The use of ultrasound, CT, bone scans, or MRI might also be used to watch for disease growth and the need for treatment.

In some cases, men who choose active surveillance may eventually need treatment. Others may not.

The risk, of course, is that by waiting you might miss the window of best opportunity for treating the cancer. “Still, by carefully monitoring the cancer and a patient’s condition, we think that risk is very small,” says Carroll, who is directing a large study of men who have opted for active surveillance.

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