What Are Your Options?

This section of the PCRI Decision Aide is designed to help you evaluate your prostate cancer treatment options to determine if and/or when you desire to undergo treatment. We hope that the subsections below (and the following two sections on Local Treatments and Systemic Treatments) will help you understand your options:

• What to Consider? –discusses how you can evaluate treatment options relevant to your risk level, overall health and quality of life concerns
• Active Surveillance –discusses delaying initial treatment for low-risk prostate cancer to see if it is likely to progress

Introduction

Now that prostate cancer is often a treatable disease (like hypertension or diabetes) new problems have surfaced regarding the need for and the timing of treatment. Selecting effective treatment has become complicated by a plethora of treatment options. Here is a brief introduction to the types of therapy available for men with newly-diagnosed or recurrent prostate cancer.

No Treatment – It is now becoming clear that thousands of men undergo aggressive treatment every year for a type of prostate cancer that will never be life-threatening. Active Surveillance, with appropriate monitoring and treatment only administered if the cancer risk increases, is becoming more popular and more accepted for men with low risk prostate cancer. This concept may also be appropriate for men with recurrent prostate cancer when progression is slow.

Local treatment options refer to strategies directed at eradicating the prostate and the cancer it contains. Examples of local treatments are surgery (radical prostatectomy), radioactive seed implantation, external beam radiation therapy, cryotherapy and some newer options. All these “local” treatments, when administered by accomplished experts, provide options that may eliminate the cancer within the prostate with a reasonable degree of consistency. However, there are potential drawbacks. The treatment can cause irreversible side effects to adjoining structures such as nerves that control erections, the urinary track and rectum. Also, the treatment may not cure the cancer. Sometimes the cancer has already spread outside of the prostate. Local treatments may also be options for salvage therapy after initial treatment failure.

Systemic treatment options are designed to stop cancer in the whole body, not just the prostate. These options include hormone therapy, immunotherapy, chemotherapy and a few other treatments. The disadvantages of systemic treatments are that some result in substantial side-effects and the treatments may only suppress the cancer rather than eradicate it. Effective systemic treatments aim to convert prostate cancer into a chronic, non-progressive condition which can be controlled for many years. Fortunately with systemic treatments the side effects are mostly reversible when treatments are discontinued.

Combination options (local plus systemic treatments) are used for selected patients who have a high risk of relapse with local therapy alone. Combination treatment offers the best chance for cure in patients with disease that is at greater risk of being outside the prostate. Combination options are normally reserved for high-risk situations because using two treatments together can cause an accumulation of side effects. Hormonal therapy may be used to shrink the prostate before seed implant or cryotherapy.

Page updated 8/1/11