Your treatment decision will depend on:
- Your age.
- Any serious health problems, including any urinary, bowel, or sexual function problems.
- Your PSA level.
- What kind of cancer cells you have. This is called the grade or Gleason score of your cancer. Most prostate cancer cells grow very slowly. But some types of cells grow quickly and spread to other areas of the body.
- How far your cancer has spread. This is called the stage of your cancer.
- The side effects of treatment.
- Your personal feelings and concerns.
Treatment may be more successful if prostate cancer is found and treated early. Unlike many other cancers, prostate cancer is usually slow-growing. For most men, this slow growth means they have time to learn all they can before deciding whether to have treatment or which treatment to have.
Types of treatment
The main treatments for prostate cancer include:
- Surgery to remove the cancer by removing the prostate gland. This operation is called a prostatectomy.
- Radiation treatments, which include external and internal radiation. These treatments have been improved with newer technologies that reduce side effects and other problems caused by radiation. To learn more, see Other Treatment.
Men who have low-risk cancer that has not spread outside the prostate may choose to have active surveillance.
Men who have prostate cancer that has come back or has already spread throughout the body may have other treatments, including hormone therapy.
A diagnosis of prostate cancer usually means that you will be seeing your doctor regularly for years to come. So it's a good idea to build a relationship that is based on full and honest information. Ask your doctor questions about your cancer so that you can make the best decision about treatment. Your doctor also may give you some advice on changes to make in your life to help your treatment succeed.
Additional information about prostate cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/prostate.
Side effects of treatment
Treatments such as surgery or radiation can cause serious side effects. Some are short-term problems. But a side effect can become a long-term problem. Common side effects from surgery and radiation include:
- Bladder problems, such as a burning feeling when you urinate, blood in your urine, and not being able to control your bladder (urinary incontinence).
- Erection problems that happen right away (with surgery) or develop over time (with radiation).
- Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
For men with high-risk prostate cancer, radiation treatment is given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.
In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.3
Coping with cancer
A cancer diagnosis can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit the website at www.cancer.org.
After surgery or radiation
If you choose surgery or radiation to treat your prostate cancer, it will be important to have regular checkups. If your cancer comes back, this will help your doctor find it early.
If you choose active surveillance
If you decide on active surveillance, you will have regular checkups and tests, including prostate biopsies. If there is no change in your condition, you may continue active surveillance. If tests show that your cancer is growing, you will need to have other treatment.
Right now there isn't strong evidence to show whether surgery or radiation helps a man live longer. High quality studies that compare surgery with radiation for men who have localized prostate cancer haven't yet been completed. But a study is currently being done to compare the treatments.4
Researchers have studied the past medical records of men who had prostate cancer. Most of these studies found that men who had surgery for localized prostate cancer were less likely to die from prostate cancer than men who had radiation therapy (external-beam radiation therapy). This seemed to be especially true for healthier men who were younger than age 65.5, 6 Older men (over 80) and men who also had other serious health problems did better with radiation treatment.6
- Age isn't a reason to avoid surgery. But if you are 70 or older, other medical conditions, such as heart disease, may affect your decision. Men who are older also have a higher rate of incontinence and impotence after surgery. Age is especially important to think about if you have early-stage cancer, which generally grows slowly.
- Get a second or even a third opinion before making your treatment decisions. You may hear differing advice or opinions, which may seem confusing. But talking with other doctors can help you make your decision. If your doctor is a medical oncologist, you may want to talk with other prostate cancer specialists, such as a urologist, a radiation or urologic oncologist, or a surgeon.
- Studies show that fewer side effects are reported at large medical centers, where the surgeons do prostatectomies more often and so are more experienced and skilled.7