Prostate Cancer (cont.)
What are Treatments of Prostate Cancer?
- Treatments for prostate cancer are generally effective in most men. Different treatment options are indicated depending on the severity of the disease.
- Treatment for localized prostate cancer include:
- Active surveillance
- Radical prostatectomy
- Radiation therapy
- Cryotherapy and HIFU
- Treatment for advanced disease includes:
- A combination of factors defines the severity of the disease or the prognosis (including the chances of dying of the disease).
- Specifically these factors include:
- Tumor stage, defined by the extent of the disease (localized vs advanced) given by TNM staging.
- Tumor grade, defined by the pathologists report on the biopsies or surgical specimen given by the Gleason score.
- PSA value (Prostate Specific Antigen blood test).
- In addition, the therapeutic plan takes into consideration potential benefits vs. side effects of the treatment but also individual factors including the patient's biological -- as opposed to their chronological -- age as well as the presence or absence of comorbidities (other diseases).
- A man's treatment plan should be tailored to his individual case and it may be adjusted according to his expectations, specific needs, and feelings about the different options available.
- It is important that a man understands and discusses his treatment plan with his medical team and specifically with his urologist and/or oncologist (cancer specialist).
What is Active Surveillance (Deferred Treatment)?
Active surveillance is an appropriate management for selected patients with localized disease. This involves monitoring one's cancer to see if it gets worse and how quickly, while not doing anything else to treat it at the present time.
- Often, many PSA-detected prostate cancers are small, well differentiated, and thought to have a relatively low risk of progression. For this reason, many men will receive no active treatment or they will postpone it for some time without significantly decreasing the chance of cure.
- The goal of active surveillance is to avoid treatment-related complications for men whose cancers are not likely to progress while maintaining an opportunity for cure in those who show evidence of progression.
- Active surveillance is a conservative regimen that includes regular visits to the urologist for digital rectal exams, PSA measurements, and, if necessary, imaging tests and/or repeated prostate biopsies to assess if the cancer is becoming more aggressive over time.
- One benefit of active surveillance is that one does not experience the side effects of treatment. On the other hand, symptoms (if any) will continue. In some cases, symptoms can be at least partly relieved with medication.
- Active surveillance is most often used for men who have very early-stage cancers and for men who are not candidates for surgery and other aggressive therapies.
- If the cancer starts to grow, the urologist may recommend treatment.
- Active surveillance should be distinguished from "watchful waiting," which is based upon the premise that some men will not benefit from definitive treatment of localized prostate cancer.
- For patients managed with watchful waiting, the decision is made at the outset to forego definitive treatment and to provide palliative treatment (typically androgen-deprivation therapy) for symptomatic local or metastatic progression.
- Watchful waiting may be an acceptable alternative for elderly men or those with substantial comorbidities.
Medically Reviewed by a Doctor on 3/31/2015
Pierre-Alain Hueber, MD, PhD
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