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What should I consider when deciding whether to treat prostate cancer?

Prostate cancer treatment is dependent on stage, symptoms, patient age and comorbid illnesses. In some cases, an oncologist may recommend that a patient not pursue medical treatment of prostate cancer. For example, if a patient has a low-risk prostate cancer confined to the prostate, then active surveillance may be used instead of treatment with either surgery or radiation therapy. Or, in those patients with higher-risk prostate cancer or more advanced cancer, when the patient has a comorbid illness—cardiac disease for example—treatment may be held because the other illness may pose a greater risk than the cancer or need to be addressed before prostate cancer treatment.

The decision to screen for prostate cancer assumes a decision to treat if cancer is detected. Several options are available for treating early-stage prostate cancer—that is, when it is still confined to the prostate gland. But your options are limited after it has spread beyond the gland, and there is little chance of curing it. There are three main things to consider when deciding whether to treat prostate cancer.

First, how is prostate cancer staged after it is detected? Unfortunately, this is a very inexact science. About one-half of men thought to have early disease are found at surgery to have more extensive disease. And it is virtually impossible to know for sure whether microscopic cancer cells may have escaped the prostate. At this time, it is very hard for surgeons to know if they have removed all of the cancer.

Second, the major treatment options are surgery, radiation and brachytherapy. Surgery is frequently used in younger men, based on its potential to cure the disease, and on the higher likelihood that it has not spread as far. Radiation is generally reserved for older men. Brachytherapy, a treatment in which very small radioactive “seeds” are inserted into the prostate, is used for men of all ages who have localized prostate cancer. All treatments usually cause some complications; they are generally somewhat worse with surgery. The two biggest problems with surgery have to do with urinary function and sexual function. These are less affected by radiation, but rectal problems are more common. Urinary function disruptions are common with brachytherapy.

Third, there is no definitive evidence at this time that any treatment reduces the chance of death or increases survival. At this time there simply are no good, long-term studies comparing the various approaches to treatment. There are studies that suggest a small survival advantage, but men have not been randomly assigned to treatments and have not been followed long enough. This is the downside of the generally slow growth of prostate cancer—it takes a long period of follow-up to document that survival is improved with treatment, and to be valid, such studies need to assign men randomly to the various types of treatment so that there would be no differences in those getting surgery, radiation, brachytherapy or no treatment. Such studies are now in progress, but it will be many years until the results are available.

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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.