How are low-grade and early prostate cancers treated?

When we do a biopsy of the prostate and the result is cancer, in over 50 percent of cases, the grade of the cancer is typically low. In these men, we begin an active surveillance program that usually avoids the need for surgery or other invasive treatments. For many men with low-grade prostate cancer, surgery and other forms of treatment may be avoided by diligent, increased surveillance.

For a man with low-risk prostate cancer who has more than a 10-year life expectancy, all treatment options are on the table: surgery, often using robotic technology, radiation therapy or active surveillance. The doctor should explain the risks and benefits of these options, and can recommend software that helps people with low-risk prostate cancer make a treatment choice. If a man does choose active surveillance, it is recommended that he get a study entry protocol and repeat biopsy with magnetic resonance imaging (MRI) guidance. That helps doctors make sure they are not missing anything elsewhere in the prostate gland—and if they're not, active surveillance is certainly a safe option.

Treating early-stage prostate cancer isn't like correcting a bad hairdo. You don't automatically snip and cut to fix it. What's called watch-and-wait (or active surveillance) is often smart because early-stage prostate cancer is usually small and slow-growing. For men over 70 or who have high-risk medical problems, the cancer often won't progress fast enough to shorten their life. If you're younger than 70, it may still be smart to put off treatment. Surgery and radiation are no picnic; neither are their possible side effects, including leaking urine (up to 25 percent of guys do) and sexual problems. Your doctors will want to see you often, usually for:

  • A prostate-specific antigen (PSA) test every 6 months and a digital rectal exam every 12 months.
  • A prostate biopsy in 6 to 18 months from time of diagnosis, and as needed thereafter.

It's also vital to get regular exercise, de-stress with at least 10 minutes a day of meditation or yoga, and eat a healthy diet by:

  • Adding lots more fruits and vegetables to your plate
  • Making sure all grains are 100 percent whole grains
  • Nixing foods with added sugars or syrups
  • Saying no (and we mean NO) to foods with saturated fat: red meat, poultry skin, all dairy that isn't fat-free, and anything with palm or coconut oils
  • Staying clear of trans fats

We're adamant about this because studies show that all of the above hold prostate and other cancers at bay.

If any signs of cancer activity develop, your options include surgery—frequently the first choice for younger men, when the cancer likely hasn't spread. Radiation is often a good choice for older guys who have additional health issues. Brachytherapy (inserting tiny radioactive "seeds" into the prostate) is for men of all ages with localized prostate cancer.

Our bottom line: Get a second opinion. It changes treatment (and even the diagnosis) about a third of the time. If another doc confirms this approach, go with it. If not, get a third opinion. And practice active surveillance yourself.

Three treatment options are generally accepted for men with low-grade localized prostate cancer: Radical prostatectomy, radiation therapy (with or without hormonal therapy) and active surveillance (also called watchful waiting).

Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection. However, nerve-sparing surgery is not always possible.

Radiation therapy involves the delivery of radiation to the prostate. Radiation therapy is usually administered in an outpatient setting using an external beam of radiation. Radiation can also be delivered in a technique known as brachytherapy, which involves implanting radioactive seeds directly into, or very close to, the tumor using a needle. Patients with high-risk prostate cancer are candidates for adding hormonal therapy to standard radiation therapy.

Active Surveillance (watchful waiting) may be an option recommended for patients with early-stage prostate cancer, particularly those who have low-grade tumors with only a small amount of cancer seen in the biopsy specimen. These patients have regular examinations, PSA tests, and, sometimes, scheduled biopsies. If there is evidence of cancer growth, active treatment may be recommended. Older patients and those with serious medical problems may also be good candidates for active surveillance.

This answer is based on source information from the U.S National Institutes of Health.

Prostate cancer certainly is a significant health problem, accounting for nearly one-third of cancers in men and nearly 40,000 deaths a year. Prostate cancer can be detected before it causes problems, but it is unique among cancers in that there is a large reservoir of latent or insignificant cancers that never cause problems. This means that many cases may be identified and treated unnecessarily.

The treatments for early prostate cancer, namely surgery to remove the prostate or radiation to kill cancer cells, have not been proven to reduce deaths or morbidity from prostate cancer. This does not mean that they do not; it simply means that the proper studies have not been done. The natural history of prostate cancer is not well understood. Doctors cannot tell which early cancers will progress to become life-threatening and which will remain latent. Autopsy studies suggest that about 30 out of 100 men over the age of 50 would, if biopsied, be found to have cancerous cells in their prostates, but in about 18 of these 30, the cancers would be insignificant and not likely to be life-threatening. And only 3 to 4 out of 100 men eventually die from prostate cancer. About 1 in 4 of those who are diagnosed with prostate cancer die from it.

If you consider the prevalence of unsuspected latent prostate cancer, this proportion is much less (about 1 in 10 or less). It is not clear why only a small proportion of all cases of prostate cancer progress to death. Digital rectal exams and prostate-specific antigen tests are both safe, but there have been problems documenting their accuracy. Therefore, there is controversy as to their usefulness as tests for screening the general population.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.