Information Spotlight: Prostate Cancer Treatment Options

It’s important for each man diagnosed with prostate cancer to work closely with his oncologist to create an individualized treatment plan based on his situation and all available treatment options.

The management of prostate cancer is fluctuating as new information and treatment options become available. However, doctors agree that management of the disease needs to be individualized for each patient’s situation.

There are three main options for prostate cancer treatment: intensive surveillance (close monitoring with treatment started if cancer worsens), surgery, and radiation.

There are two types of surgery (robotic and conventional). Recent studies suggest that the robotic technique may be less likely to cure patients than conventional surgery performed by an experienced surgeon. The experience of the surgeon (with either technique) is more important than the actual technique.

There are two main types of radiation techniques (and several subtypes) with similar results for some patients but not for others, making generalized recommendations difficult.

A patient’s age, baseline PSA level, tumor stage, Gleason score, other health conditions (if any), and personal preferences will determine the choice of therapy.

As a general guide:

• Surveillance is appropriate for patients with a tumor that is not palpable, PSA <10, Gleason less than 7, and life expectancy less than 20 years.
• Surgery and radiation are equally successful at treating small tumors. Large tumors that extend outside the prostatic capsule or invade the bladder or the seminal vesicles are better treated with radiation with or without medications to reduce testosterone levels.
• Surgery tends to cause more impotence than radiation, but radiation can cause more long term rectal and bladder problems. Both can cause incontinence.

While general guidelines can be confusing, a visit with an oncologist for an examination, a medical history, and a discussion of individual preferences will help each individual make a treatment decision. 

The links below provide more general information.

http://www.uptodate.com/contents/patient-information-prostate-cancer-treatment-stage-i-to-iii-cancer-beyond-the-basics

http://www.cancer.net/patient/Cancer+Types/Prostate+Cancer?sectionTitle=Treatment

http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient