Statistically speaking, 15 percent of men born today will develop prostate cancer at some point. The good news is — when found early — most forms of prostate cancer are slow-growing and curable.
“Healthy men who are diagnosed with early stage prostate cancer have a long natural life expectancy, so for many patients, a prostate cancer diagnosis does not require urgent, immediate treatment decisions,” says Michael Kosty, MD, medical director of cancer care at Scripps Clinic and Scripps Green Hospital. “Men who have just been diagnosed can often take the time to make thoughtful decisions about how to proceed, based on factors like their age and overall health, lifestyle and goals. This is not a one-size-fits-all diagnosis.”
Physicians will help patients weigh the risks and benefits of each approach. For men diagnosed at an early stage, options include active surveillance, traditional or minimally invasive surgery, hormone therapy and radiation treatment.
All curative treatment options (those designed to cure, rather than delay or observe, cancer) are equally effective, according to Dr. Kosty. A patient’s individual choice often comes down to which potential treatment side effects he may be most willing to risk.
Sometimes called “watchful waiting,” active surveillance involves several visits per year to the physician for blood tests and examinations that monitor the growth of prostate cancer. Annual biopsies also monitor the nature of the tumor. Treatment is deferred until or unless the tumor changes from slow-growing to aggressive cancer. Men who choose active surveillance may have underlying medical issues that make treatment difficult, or do not want to risk the undesirable potential side effects of treatment.
- Benefits: Avoid the undesirable side effects of more active treatment.
- Risks: Each biopsy carries the low but real risks of any surgery, including discomfort, bleeding or infection.
If a prostate tumor’s growth rate is significantly driven by the hormone testosterone, drugs can be used to delay or slow its growth (or even shrink the tumor in some cases.)
- Benefits: Hormone treatment is minimally invasive and may be used in men who have medical issues that preclude surgery or radiation. It is also an active intervention, as opposed to mere surveillance.
- Risks: Lowering testosterone in the body causes side effects like hot flashes, loss of libido and loss of bone mass. It is also not curative; it only slows the progression of cancer.
Options for prostate cancer surgery are numerous. Depending on the type, size and nature of the tumor, a surgeon may remove the diseased tissue in a traditional open surgery, either through the abdomen or the perineum. For early stage cancer that has not spread, there are also minimally invasive surgical options.
- Benefits: Surgery removes the prostate cancer.
- Risks: Open surgery carries surgical complication risks including bleeding and infection, and risks from general anesthesia. With minimally invasive or robotic-assisted surgery, recovery is quicker, the hospital stay is shorter and surgical risks are lower. In any prostate surgery, complications may include loss of continence and/or erectile function.
Radiation treatment for prostate cancer takes many forms, including internal and external methods. It is best suited to men whose cancer is confined to the prostate and has not spread to the neighboring lymph nodes.
- Benefits: As a noninvasive treatment, radiation treatments let men avoid the risks of surgery, including general anesthesia.
- Risks: Sensitive anatomic structures including the bladder and rectum are near the prostate. During X-ray radiation, these structures also receive a radiation dose. As a result, they may become irritated. In a worst case scenario, x-ray radiation may cause side effects including permanent cystitis (urinary irritation) or radiation proctitis (bowel irritation). Short term side effects may also include fatigue and urinary or rectal symptoms.