Early Prostate Cancer (cont.)
How is localized prostate cancer treated?
Three treatment options are
generally accepted for men with localized prostate cancer: radical
prostatectomy, radiation therapy (with or without hormonal therapy), and
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 energy to the prostate.
The energy is usually delivered in an outpatient setting using an external beam
of radiation. The energy can also be delivered in a technique known as
brachytherapy, which involves implanting radioactive seeds in the prostate 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 testing, 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.
How does a patient decide what is the best treatment option for localized
Choosing a treatment option involves the patient, his family,
and one or more doctors. They will need to consider the grade and stage of the
cancer, the man's age and health, and his values and feelings about the
potential benefits and harm of each treatment option. Since both surgery and
radiation therapy are options for localized disease, consultation with both a
urologist and a radiation oncologist is recommended. Often it is useful to seek
additional opinions -- from the same type of doctor, an internist, a family
practice physician, or a medical oncologist. Because there are several
reasonable options for most patients, patients may hear different opinions and
recommendations and the decision can be difficult. However, patients should try
to get as much information as possible and allow themselves enough time to make
a decision. There is rarely a need to make a decision without taking time to
discuss and understand the pros and cons of the various approaches.