Prostate Cancer: Choosing a Treatment

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How will my doctor determine the best treatment for my prostate cancer?

Sheldon Marks, MD
There are a number of different factors that play into whether this prostate cancer is going to be significant. Obviously we want to know the volume of the cancer. Is there a lot there? The more there is, obviously it's worse. And we want to know the grade of the cancer. How aggressive it is. Is this like a little Poodle puppy or is it like a Doberman with rabies? The more aggressive the cancer, the worse the prognosis, the more likely you'll need aggressive therapy. And the larger volume also plays a role. And we also do studies to evaluate has it spread, is it just in one little area, or if it has spread. So that's the tumor specific factors that we look at in determining how aggressive this cancer will or will not be for you. Then we have to look at the factors that relate to you. What's your health, what's your age? If your father is 50 years old when he died and you're 47, then we may not be as aggressive with higher-risk treatments. If on the other hand you're 57 and your father is 94 and still active, vibrant, healthy, then we need to consider that you probably have 40 years ahead of you and we'll be aggressive. We also need to look at your health. If you have any heart disease, blood vessel disease, diabetes. If you're out climbing mountains and hiking the Grand Canyon and you're 63, then we're going to want to be more aggressive as well. So all of those factors play into determining the nature of what the threat is, because we never want the treatment worse than the disease. We know that for the majority of men, prostate cancer will not kill them so we want to customize each treatment. If you're young and healthy we may be more aggressive. If you're older and have health problems we may choose a more conservative option.