Which prostate cancer treatment is right for me?

Erik Busby, MD

Urology

Aside from skin cancer, prostate cancer is the most common cancer in American men. The prostate is a gland that sits below the bladder and produces fluid that nourishes and transports sperm. There are many controversies about screening and treating prostate cancer due to the side effects of the various treatment options. Urologist Erik Busby, MD, explained what those options are and how to know which treatment is right for you.

How is prostate cancer treated?

Prostate cancer is often a slow-growing disease. However, there are many scenarios where it needs to be treated and can often improve a man’s survival. 

“After a man is diagnosed with prostate cancer, which typically requires a biopsy for an elevated PSA, he needs to have a well-informed and detailed discussion with his physician to determine the best next steps,” said Dr. Busby. “This involves assessing a man’s health, life expectancy, and most importantly, his preferences.”

Active surveillance

“As we have learned about the behavior of prostate cancer, it has become clear that many times the most appropriate approach is to do nothing. When we say this, we really are not doing nothing, but rather watching it closely to ensure that it is not growing or becoming more aggressive,” he said. “If it does demonstrate these changes, it may become time to perform active treatment.” 

Active treatment

Active treatments for prostate cancer typically involve radiation or surgical removal.

• Radiation can be administered in different fashions, including multiple small doses over 6–7 weeks, higher less-frequent doses (high-dose radiotherapy), and insertion of radioactive seeds into the prostate (brachytherapy). 
• Surgery is typically performed using a robotic approach, which is a minimally invasive laparoscopic approach allowing prostate removal through small port sites on the abdomen. This requires an overnight hospital stay in most cases.  

There are other options as well, including:

• Cryotherapy (freezing the prostate)
• High-intensity focused ultrasound (HIFU)
• Focal therapy (targeting an area in the prostate) 

Technological advancements, including more accurate radiation techniques and robotic surgery, have improved outcomes as well as recovery periods. 

What are the side effects of prostate cancer treatment?

Regardless of the active treatment, Dr. Busby said the side effects are real and vary from man to man, with some men having very few and some having more significant issues. The main side effects a man may encounter include urinary symptoms or sexual side effects that may result in erectile dysfunction. 

“While individual outcomes are dependent on a man’s anatomy, having an experienced physician can make a difference. Having your treatment at a high-volume facility where the physician does a large number and is very experienced can reduce your chance of having side effects,” he said. 

Which treatment is right for me?

Ultimately, the most appropriate treatment for any man needs to be carefully discussed and considered to ensure that the patient is well informed and aware of what to expect. 

“While younger men often undergo surgery and those of more advanced ages choose radiation, it is by no means always the case,” said Dr. Busby. “Always ask your physician about both and do not hesitate to seek an opinion from both the radiation oncologist and urologic surgeon.”

Bottom line

There needs to be a tailored approach with the decision made between the physician and patient.