Most men who learn they have prostate cancer will be told they have a relatively early stage of the disease. This article is for them. Not because later-stage disease is untreatable, but because men with early prostate cancer must choose among a wide range of different treatment options.
Having options is a good thing, but having to choose is hard. Each choice has its advantages -- and its disadvantages. And once most of these choices are made, there's no going back. Even if other options still remain, they will be affected by the original decision.
There are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen:
A frequent need to urinate, especially at night
Difficulty starting or stopping a stream of urine
A weak or interrupted urinary stream
Leaking of urine when laughing or coughing
Inability to urinate standing up
A painful or burning sensation during urination or ejaculation
Blood in urine or...
"Of the men today diagnosed with prostate cancer, 90% have localized cancer," says Peter Scardino, MD, chair of the urology department at New York's Memorial Sloan Kettering Cancer Center. "The dilemma they face is, 'What shall I do about this? Should I treat it at all, or is the word cancer scaring me into taking potentially dangerous treatments? It is an agonizing decision."
"You have to be aware of the risks -- and you have to make decisions," says Thomas Keane, MD, associate professor of urology at Emory University School of Medicine, in Atlanta. "The only way you can do that is to get the knowledge in the first place. If you are the kind of patient that doesn't do well with that, you need to sit down and spend a lot of time with your doctor."
To choose among treatment options, a man must know how aggressive the cancer seems to be and if the tumor is localized or if it has spread to the lymph nodes or other parts of the body.
A man with localized prostate cancer has four main treatment options:
Prostate cancer usually takes a long time to go from localized cancer to painful, metastatic disease. For a man in his late 70s or 80s with a non-aggressive tumor, it might be a good idea to do nothing at all except keep track of how the disease is progressing, and to deal with symptoms when and if they arise. This is called "watchful waiting." The idea is to wait until the cancer is serious enough to justify the risks of treatment.