Prostate cancer is the most common malignancy in men in the United States, yet most men with prostate cancer will not die of their disease. This is because it is most often diagnosed in an early state with a very sensitive blood test, the Prostate Specific Antigen. An abnormal test may prompt a biopsy, which can help predict how the cancer may behave.
Not all prostate cancer needs to be treated aggressively. Early-stage prostate cancer does not usually cause symptoms. If the cancer is slow-growing and has not spread, a man may live a normal lifespan. It is only once the cancer spreads to bones and other organs that it causes symptoms of pain and can be life-threatening.
Active surveillance is an option for men with low-risk prostate cancer or if their predicted life expectancy is short. With this approach, the PSA is tested about every six months and repeat biopsy may be performed periodically. If the cancer seems to be advancing and if the man is healthy enough, treatment may be offered later.
Curative treatments offer a high chance of controlling prostate cancer if it has not yet spread. All treatments pose a risk of causing symptoms, including erectile dysfunction, which may be permanent. Treatments include:
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▪ Surgery. Surgical treatment offers the most immediate information about whether the cancer appears to have been completely removed. It involves early symptoms of loss of bladder control, which usually improve over time.
▪ Radiotherapy. Usually consists of daily outpatient treatments, five days a week for up to two months. Radiotherapy is also highly effective but the PSA may decline slowly. Most radiation treatment-related symptoms — including temporary worsening of bladder-emptying symptoms, loose stool or fatigue — develop gradually and improve after treatment is complete.
▪ Brachytherapy. Some men are candidates for this outpatient procedure in which radioactive pellets (seeds) are placed in the prostate gland. These seeds give off radiation to treat the cancer over several months without the need for daily treatments.
▪ Stereotactic body radiotherapy. This treatment, delivered by CyberKnife, is a newer, externally directed therapy delivering five concentrated doses of radiation to the prostate gland over one week, without the need for anesthesia. This method has the lowest reported risk of erectile dysfunction.
A cancer diagnosis can be scary, but for most cases of newly diagnosed prostate cancer, men do not need to make an immediate decision about if and how it is treated. Men should talk to their doctor about all options in order to make a decision that is best for them.
Dr. Alan Beckman is medical director of the Radiation Oncology and CyberKnife Treatment Center at Baptist Health Lexington.