Considering Treatment Options for Early Prostate Cancer

For most men diagnosed with prostate cancer, the cancer is found while it’s still at an early stage, when it’s small and hasn’t spread beyond the prostate gland. These men often have several treatment options to consider.

Deciding which option might be best for you

If you have early-stage prostate cancer, there are many factors to take into account, including your age and overall health, and the likelihood that the cancer will cause problems for you. You should also think about the possible side effects of treatment and how likely they are to bother you.

Some men may want to avoid possible side effects for as long as possible. Others might be less concerned about these side effects and more concerned about removing or destroying the cancer.

Many men find it very stressful to have to choose between treatment options, and they might worry they will choose the “wrong” one. But in many cases, there is no single option that is clearly better than all the others.

Unless the cancer is known to be growing quickly or has other concerning features, it most likely won’t need to be treated right away, so it’s OK to take your time and consider your options when deciding which one is right for you.

What studies show about different treatments

A large study followed men for 15 years. It found that surgery and external radiation led to similar survival rates for early-stage prostate cancer. Most doctors think brachytherapy works as well too, but it hasn't been tested against the other 2 treatments in as big a study. However, each type of treatment has its own risks and benefits that should be considered.

Newer types of surgery and radiation therapy may provide even more options to consider. And newer focal therapies, such as cryotherapy, HIFU, and other ablative treatments, might be less likely to cause side effects. These treatments are generally not FDA-approved specifically for prostate cancer, but they've been studied in some clinical trials, and some doctors and patients choose them as an alternative to active surveillance in lower-risk prostate cancer, for men who are not comfortable simply monitoring their cancer but are concerned about side effects from surgery or radiation.

Many of these newer treatments are now available, but there is very little long-term data on them, which means it’s hard to compare their effectiveness and safety to more established treatments.

Considering your age and overall health

If you’re older or have other serious health problems and your cancer is slow-growing (low-grade), you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death (although it may cause symptoms you want to avoid). You may be more inclined to consider active surveillance or observation (watchful waiting), and less likely to lean toward treatments such as radiation and surgery, which may cause bothersome side effects.

Of course, age alone is not the most important factor when making your choice. Many older men are still in good mental and physical shape, while some younger men may not be as healthy.

If you are younger and otherwise healthy, you might be more willing to accept possible side effects of treatment if they offer you the best chance to cure the cancer.

Weighing what matters most to you

Each option for early stage prostate cancer has risks and benefits. This means you can often weigh each option and choose based on what you value most.

Treating, monitoring, and newer options

• Would you prefer to treat the cancer now, with the possibility of serious side effects?
• Would you be comfortable with active surveillance or observation, even if it means you might have more anxiety about the cancer and need more frequent follow-up visits and tests in the future?
• If you aren’t comfortable with active surveillance but are worried about possible side effects from surgery or radiation, would you consider a newer treatment, such as focal therapy, that might cause fewer side effects even if it’s not yet well proven?

Other treatment considerations

• Which potential treatment side effects (incontinence, erection problems, bowel problems) might be most distressing to you?
• How important for you are issues like the amount of time spent in treatment or recovery?
• How do you feel about choosing a newer treatment that might have some advantages, but has less long-term information about its effectiveness and safety?
• How important is it to know right away whether your doctor was able to get all of the cancer out, as with surgery? Or are you comfortable with not knowing the results of treatment for a while, as can be the case with radiation therapy or focal therapies, if it means avoiding surgery?

Getting help with treatment decisions

Making such a complex decision is often hard to do by yourself. Talking to others can help.

Talk to your doctors

Consider getting more than one medical opinion, perhaps even from different types of doctors. It is natural for doctors to favor the forms of treatment they’re most comfortable with. For example, surgical specialists such as urologists might favor surgery, while radiation oncologists might lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies.

Talking to each of them might 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.

Ask your doctors about what your treatment options might be if your initial choice of treatment isn’t successful.

Talk to your loved ones

Family and friends can help you think through your priorities and how you value the different risks and benefits of each option.

Talk to other people with prostate cancer

You might also find it helpful to speak with others who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can 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 see Patient Programs and Services.

It’s important to know that each person’s experience with prostate cancer is different. Just because someone you know had a good (or bad) experience with a certain type of treatment doesn’t mean the same will be true for you.