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    Prostate Cancer - Other Treatment

    Active surveillance or watchful waiting

    Active surveillance means that you will be watched closely by your doctor. If you are a younger or active man who is at low risk, this will mean regular checkups. If the cancer starts to grow more quickly, you will need to have other treatment, such as surgery. Your regular checkups may include digital rectal exams, PSA tests, and biopsies.

    Active surveillance is a good treatment choice for younger or active men who have low-risk cancer that hasn't spread.5

    • The main reason to choose active surveillance is to avoid or delay the side effects of treatments.
    • The main reason to choose other treatment (and not active surveillance) is to not miss the chance to cure the cancer. If the cancer grows and spreads, it may be harder to treat.

    Watchful waiting also means that you will be closely watched by your doctor. But the goal of watchful waiting is to treat symptoms that cause problems rather than to cure the cancer. For some older men or those who aren't expected to live more than 10 years, the main reason to choose watchful waiting is to have the best possible quality of life.

    Radiation therapy

    Radiation therapy may be used alone or combined with hormone treatment or surgery to treat prostate cancer. Like surgery, it is most effective in treating cancer that hasn't spread outside the prostate. When combined with surgery, radiation is used to destroy any cancer cells that might be left behind and to relieve pain when the cancer has spread.

    Radiation treatment for prostate cancer includes:

    • External radiation. Also called external beam radiotherapy, or EBRT, radiation therapy uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may make your symptoms worse. The most common forms of external radiation are:
      • Conformal radiotherapy (3D-CRT). It uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
      • Intensity-modulated radiation therapy (IMRT). It uses newer 3D-CRT technology to target the cancer.
      • Proton beam therapy. This is radiation therapy that uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which protects nearby healthy tissues (especially the rectum). Sometimes proton beam therapy is combined with X-ray therapy. (It is available only at big medical centers.)
    • Internal radiation (brachytherapy). Brachytherapy is a one-time radiation treatment that uses tiny radioactive seeds. After you are given anesthesia, the doctor uses a needle to inject the seeds into your prostate, where they slowly release radiation directly into the cancer. Sometimes external radiation or hormone therapy is added to brachytherapy. If you already have urinary problems, brachytherapy may make your symptoms worse.
      • High-dose-rate (HDR) brachytherapy. For this form of brachytherapy, radioactive material is placed into the prostate for a very brief period of time (seconds to minutes) and then removed. The radiation is delivered this way several times.
    Prostate Cancer: Should I Have Radiation or Surgery for Localized Prostate Cancer?
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