If you have prostate cancer, there are many important factors to take into account before deciding on a treatment option, such as your age and general health, and the likelihood that the cancer will cause problems for you. You should also think about which side effects you can live with. Some men, for example, can't imagine living with side effects such as incontinence or impotence. Other men are less concerned about these and more concerned about removing or destroying the cancer.

If you are older or have other serious health problems and your cancer is slow growing, you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may be more inclined to consider active surveillance (careful follow-up with your doctor) or hormone therapy, and less inclined to consider treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best basis on which to make your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.

If you are younger and otherwise healthy, you might be more willing to put up with the side effects of treatment if they offer you the best chance for cure. Most doctors now believe that external radiation, radical prostatectomy, and brachytherapy (radioactive implants) have about the same cure rates for the earliest stage prostate cancers. However, there are pros and cons to each type of treatment that should be considered, including possible risks and side effects (described above).

This is complicated even further by the explosion of newer types of surgery (laparoscopic prostatectomy and robotic-assisted prostatectomy) and radiation therapy (conformal radiation therapy, intensity-modulated radiation therapy, proton beam radiation, etc.) in recent years. Many of these appear very promising, but there is very little long-term data on them, which means comparing them to each other is very difficult, if not impossible.

Such a complex decision is often hard to make by yourself. You may find it helpful to talk with your family and friends before making a decision. It's important to note that prostate cancer is not a uniform disease, and each man's experience with it is different. Just because someone you know had a good (or bad) experience with a certain type of treatment doesn't necessarily mean the same will be true for you.

You may also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them may give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.

You might find that speaking with others who have faced or are currently facing the same issues is useful. The American Cancer Society's program, Man to Man, and similar programs sponsored by other organizations provide a forum for you to meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800- 227-2345 or visit our Web site at cancer.org.

The information in the following sections describes the main treatment options available for prostate cancer in different situations. Before deciding on treatment, here are some further questions you may want to ask yourself:

• Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects? Or would you be comfortable with watchful waiting, even if it means you might have more anxiety (and need more frequent follow-up) in the future?

• Do you feel the need to know right away whether your doctor thinks he or she was able to get all of the cancer out (a reason some men choose surgery)? Or are you comfortable with not knowing the results of treatment for a while (as is the case in radiation therapy) if it means not having to have surgery?

• Do you prefer to go with the newest technology, which may have some theoretical advantages? Or do you prefer to go with treatment methods that are better proven and with which doctors may have more experience?

• Which potential treatment side effects (incontinence, impotence, bowel problems) might be most distressing to you?

• How important for you are issues like the amount of time spent in treatment or recovery?

• If your initial treatment is not successful, what would your options be at that point?

Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the "wrong" one. In many cases, there is no single best option. It's important to take your time and decide which option is right for you.

Last Medical Review: 07/30/2009
Last Revised: 07/30/2009