Choosing a prostate cancer treatment

Making the choice
When Doug was diagnosed with prostate cancer, his first response was to get information. He read countless books, articles, and studies on prostate cancer, which made him feel more prepared for the hard times that lay ahead. He also sought out a second opinion for peace of mind. His wife was of great support, connecting him with the "Man-to-Man" support group of prostate cancer survivors.

If you are diagnosed with prostate cancer, an oncologist (a doctor specializing in treating cancers) will give you your treatment options and will be responsible for your care. You may have to try more than one treatment, or combine treatments, depending on your age, medical condition, and overall health, and on the size, aggressiveness, and spread of the cancer.

Doctors gave Doug a choice between radiation and removal of the prostate. Both specialists told him surgery for total removal of the prostate, called a radical prostactectomy, was the best option, but it was his decision.

Making a decision about cancer treatment is tough. "The key is to do your research – no one choice is right, it has to be right for you. Do it, get on with it and don't ever regret," Doug reflects. In the end, he chose surgery.

What treatment(s) are available for prostate cancer?

  • Surgery (prostatectomy) – removal of the prostate gland. The entire tumour is normally removed in a one-time procedure. Surgery is often used when the cancer is limited to the prostate area.   
  • Radiation/brachytherapy – tumour cells are killed by external beam radiation therapy (EBRT) or brachytherapy (surgical implantation of radioactive seeds).  
  • Hormone therapy – blocks hormones such as testosterone from helping tumours grow. This therapy targets testosterone, which is known to help tumours grow; this therapy can thus help cause the tumours to shrink. It may also be used to treat prostate cancers that spread outside of the prostate or used in conjunction with other types of treatments.
  • Cryotherapy – freezing the tumour with liquid nitrogen to kill cancer cells. This treatment avoids surgery and may be more suitable for men who are not good surgery or radiation therapy candidates.
  • Chemotherapy – drugs that can target and destroy cell that grow rapidly, such as cancer cells. Chemotherapy travels in the blood stream and can reach cancer cells in distant organs that may have not been removed by surgery or may not be the target of radiation treatment.
  • Targeted therapy – drugs that target specific molecules in or on cancer cells. Targeted therapy helps to not only treat cancer, but avoids harming your normal cells. This option might be used if your cancer doesn't respond well to hormone therapy or if there are certain genetic mutations.

Prostate cancers that are detected and treated at the earliest stages are often cured, but often at the expense of some degree of continuing incontinence or impotence. Nevertheless, in some cases, the cancer can recur or spread to other organs in the body. Frequent physical exams and PSA blood tests are used to determine whether the cancer has returned.

Is treatment always necessary?
Some slow-growing early-stage prostate cancers may not require immediate therapy. Through regular testing, the progress of the disease and the level of your physical comfort can be monitored. For older men with other medical problems, this "active surveillance" may be less disruptive than starting cancer therapy. "Active surveillance" may also be an option for those where the cancer isn't causing symptoms or if you have health problems and cannot receive treatment.

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