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Pondering prostate cancer

Unlike most cancers, prostate cancer may not be best treated aggressively. Because it can be slow growing, some men opt to delay treatment. But choosing how—or whether—to treat prostate cancer can be a difficult decision.

Time may be on your side

Early prostate cancer is confined to the prostate, a walnut-sized gland under the bladder that produces seminal fluid. Although prostate cancer cells eventually spread to other parts of the body, they often grow slowly. In fact, autopsy studies show that many elderly men who died of other diseases also had undetected prostate cancer. Experts say, therefore, that aggressive treatment for a slow-growing cancer means some men may be forced to cope with side effects when they could have been symptom-free and complication-free for years, if not life.

Nevertheless, some prostate cancers are aggressive, and men of all ages do die from it. The best course of treatment depends on the cancer’s stage, the tumor’s grade and the patient’s symptoms, general health and tolerance for side effects.

If you’re faced with deciding how to treat prostate cancer, your healthcare provider will consider one or more of these options:

  • Surgical procedures involve removing the entire prostate gland, called a prostatectomy, or only a portion of it, called a resection. A prostatectomy can be performed through an incision in the perineum or the abdomen or as a laparoscopic procedure through several small abdominal incisions. Recovery time for each procedure varies. Side effects may include incontinence and impotence. In some cases, surgeons can perform nerve-sparing surgery, which helps avoid impotence.
  • Radiation therapy uses high-energy rays to kill cancer cells in a specific area, sparing healthy tissues. You may have radiation in place of surgery or following surgery to target any remaining cancer cells. One type, external radiation, uses radiation from a large machine to destroy cancer cells. With internal radiation, also called implant radiation or brachytherapy, surgeons place radioactive implants or seeds inside the body at the cancer’s site. Side effects may include fatigue, hair loss in the treated area, impotence and bowel and urinary problems.
  • Hormone therapy deprives cancer cells of the male hormones or androgens they need to grow. Various drugs block the androgens’ action or prevent the adrenal glands or the testicles from making testosterone. Surgery to remove the testicles also reduces androgen levels. Hormone therapy often controls prostate cancer that’s spread—for a time. Eventually, most prostate cancers grow with little or no androgens, and therapy becomes ineffective. Side effects include impotence, hot flashes, loss of sexual desire, weaker bones, nausea, diarrhea, breast growth and liver problems.
  • Watchful waiting means undergoing no treatments but being frequently monitored for changes in symptoms or rising levels of PSA, or prostate-specific antigen (a protein made by prostate cells and measured by blood tests). Your doctor may suggest watchful waiting if you have an early-stage, slow-growing cancer, low PSA levels, are older or have other serious health problems. You may choose watchful waiting if you decide the treatment’s risks and potential side effects outweigh your expected benefits. You can opt to begin treatment at any time.