- To provide definitive treatment for men with localized cancers that are likely to progress; and,
- To reduce the risk of treatment-related, quality-of-life side effects such as incontinence and impotence for men with cancers that are not likely to progress.
Active surveillance is not appropriate for every prostate cancer patient. You are typically a good candidate if you are a patient with a lower grade localized prostate cancer, a low PSA level, a low Gleason Score, and an appropriate clinical stage. Additional factors that you need to consider are your age, general health, life expectancy, psychological makeup and your family’s expectations
A typical program of active surveillance may include the following: a review of the candidate criteria described above; a discussion with your urologist regarding all possible treatment options; and, if appropriate, an active surveillance plan customized to your specific situation. The plan would typically include periodic physical exams and PSA testing as well as periodic biopsies as appropriate.
Your goal is to be able to react quickly to seek additional treatment promptly if a worsening of the cancer occurs.
A radical prostatectomy is the surgical removal of the entire prostate gland. Many experts tend to recommend surgery when the cancer is thought to be contained within the prostate, such as in stage T1 and T2 cancers, and when the man is relatively young and healthy. During surgery, the entire prostate gland plus some surrounding tissue is removed. The surgery is almost always performed under general anesthesia. It is important to note that the experience and skill of the surgeon can be a major factor in the success of the surgery. This is true in all surgical procedures, but is particularly true with a radical prostatectomy because of the challenging location of the prostate and the critical anatomy near the prostate.
If you choose surgery, be sure that you know the experience level and skill of the surgeon. Ask about the surgeon’s training and how many prostatectomies he or she performs on a regular basis. A skilled and experienced surgeon will have performed hundreds of prostatectomies and will typically perform multiple prostatectomies each week. Also, know the hospital.
There are two major categories of radiation therapy:
- External beam radiation, which is a non-invasive procedure in which high-intensity beams of radiation are directed at the target area; and
- brachytherapy, which involves the implantation of radioactive metal seeds or pellets into the prostate either permanently or temporarily.
Based on the most recent data, cure rates appear to be similar to those of radical prostatectomy in patients with low-grade and low-stage
localized prostate cancer. In more advanced disease, radiation is sometimes used to treat a wider area surrounding the prostate and to include irradiation of regional lymph nodes, to destroy locally advanced cancer.
Cryotherapy requires less time in the hospital than some other treatments and is less invasive than radical prostatectomy. However, erectile dysfunction, urinary problems and rectal damage may occur. There is not a large volume of data on the long-term effectiveness of cryotherapy.
If prostate cancer is diagnosed at an advanced stage (when it has spread beyond the prostate) or if the cancer returns after localized therapy such as surgery or radiation, additional treatment with hormonal therapy is typically initiated.
Recent studies have also shown that hormonal therapy, initiated prior to and following radiation therapy, may be more beneficial than radiation alone.