What might surprise men diagnosed with prostate cancer is how many treatment options there are. How do you know where to start?
"Unlike other cancers where there's a well-defined treatment pathway, this particular cancer has many treatment options," said Jonathan Tward, M.D. Ph.D., a physician who specializes in prostate cancer treatment at the University of Utah's Huntsman Cancer Institute.
"The large menu of options is overwhelming to a lot of men who are faced with a new diagnosis of early stage cancer. Should they choose a surgery? Should they choose one of the various form of radiation therapy? Should they simply closely watch it and not seek immediate treatment? It's a big struggle for a patient who is contemplating their mortality to also have to go through the various treatment options and side effects. … it can paralyze people with anxiety over 'am I choosing the right thing?' "
Tward said he recommends that patients with a new diagnosis of prostate cancer speak to both a urologist and a radiation oncologist, who will present differing view points on treatment options. Both specialists will be able to talk about surgical and non-surgical treatment options, including side effects that may alter the urinary tract, bowel or sexual function.
Here's a closer look at options for treating early-stage prostate cancer:
• Watchful waiting (also known as active surveillance or expectant management). The goal of watchful waiting is to monitor or check cancer that is growing very slowly and will not likely do any harm for a long time, if ever. Sometimes the treatments for prostate cancer can cause more harm than living with the disease. This may be a strategy for you as long as the cancer seems to be: (1) localized to the prostate, (2) not bothersome, and (3) not likely to shorten your life or interfere with the quality of your life. Other treatments, such as surgery, radiation therapy, or hormone therapy, may be considered if at some point it becomes clear that the cancer is growing or if it begins to cause symptoms.
• Surgery. The main goal of surgery is to cure you of prostate cancer by removing the tumors. This requires removing your prostate and possibly the surrounding tissue and lymph nodes. This operation is known as a prostatectomy. When the cancer cannot be surgically removed, your doctor may suggest other procedures, such as radiation therapy, or treatments designed to alleviate symptoms of urinary bother like a transurethral resection of the prostate (TURP).
• Radiation therapy. Like surgery, the goal of radiation is to cure the prostate cancer. Radiation therapy is as likely to cure prostate cancer as surgery. It is a good alternative for men who either prefer to not have surgery or who are not healthy enough to tolerate a big surgery. There are two ways to get radiation. You may have a machine direct radiation from the outside of your body. This is called external radiation or XRT, which is completely non-invasive. Or you may receive it internally with a minimally invasive surgery that involves the placement of tiny radioactive sources your doctor places into your prostate using thin, hollow needles. Internal radiation is also called brachytherapy. Local treatments may include XRT alone, brachytherapy alone, or the two of them together. If the cancer has spread to areas near the prostate, you may also have hormonal therapy along with the radiation.
• Cryotherapy. This treatment is also called cryosurgery. The goal of cryotherapy is to freeze the cancer cells before they have a chance to spread. The doctor freezes them by making a tiny incision and inserting a probe into the prostate that sends nitrogen to freeze the cancer cells. Most doctors still consider this less-effective as a first treatment for prostate cancer.
It's important to learn all you can about your disease and treatment choices so that you can help make decisions about your care. One of the best ways to get the information you need is to ask your doctor and other health care professionals. Make sure that you ask how the treatment will change your daily life. Find out how your diet might have to change and how you will look and feel. Ask how successful the treatment usually is and find out about the risks and possible side effects.
Want to connect with a University of Utah Health Care physician to get more of your prostate cancer questions answered? Call 801-585-0100.
Melinda Rogers is a communications specialist at University of Utah Health Care. Contact her by e-mail at Melinda.email@example.com or on Twitter: @mrogers_utah.