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 prostate cancer?

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.

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