Hearing the word “cancer” might bring to mind things like chemotherapy, surgery or radiation.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
But if it’s prostate cancer that you’ve been diagnosed with, take heart – those things may not necessarily be part of your future.
There definitely will, however, be some important decisions to make. Your loved ones and your care team can help you decide the best next steps after diagnosis.
Assessing whether the cancer should be treated
Eric Klein, MD, a urologist and surgeon, explains that as you talk through treatment options with your care team, there are some key factors to consider:
- Aggressiveness of the cancer.
The cancer’s aggressiveness will be determined primarily by what a pathologist sees when he or she looks at the biopsy from your prostate, including the grade of the cancer (how aggressive it looks) and the volume of the cancer (how much is in the biopsy), as well as PSA levels.
Some prostate cancers are slow-growing and low-risk, meaning it may be years before they cause any symptoms or health problems — if they ever do at all. In some cases, men may decide that these low-risk cancers, combined with the potential for serious side effects associated with treatment, warrant holding off on treatment until it’s absolutely necessary. This process of closely monitoring the cancer’s progress over time is called active surveillance.
Genomic tests can help distinguish low- and intermediate-grade cancers that need treatment immediately from those that may be appropriate for active surveillance.
If you have a higher-grade cancer, you can expect to have an imaging study, like an MRI of the pelvis or a bone scan, to determine if the cancer has spread.
Your cancer care team
A multidisciplinary care team will be there to counsel you as you go through this process. It will likely include a urologist, a radiation oncologist, a primary care physician and perhaps a medical oncologist.
Your spouse and/or family members are also important players on the team.
A word about active surveillance
It’s important to note that deciding to take the active surveillance path isn’t the same as not doing anything; rather, it’s closely monitoring the status of your cancer and deferring treatment until the cancer shows signs of progressing. By now it’s a widely adopted and well-studied approach for men with low-risk cancers.
“It’s definitely been embraced by the urologic community as we’ve learned how to use it,” Dr. Klein says. “We know who’s a candidate and who isn’t. For the right patient with low-volume, low-grade cancer, then active surveillance is actually the recommended choice.”
Your doctors will always want to do a second test to reduce the likeliness of testing error and confirm that a higher-grade cancer hasn’t been overlooked. The second test could be a repeat biopsy, an MRI or a genomic test.
If you are a good candidate for active surveillance and choose to go that route, your surveillance plan may involve a digital rectal exam and PSA test every six months, as well as an MRI once a year and periodic repeat biopsies.
An arsenal of therapies
If a tumor is judged to need treatment, there are several treatment options to be explored:
- Radical prostatectomy: A surgeon removes the prostate and lymph nodes.
- External beam radiation therapy: High-energy rays are emitted from a machine outside the body to kill cancer cells and shrink tumors.
- Brachytherapy: Small “seeds” that release radiation over time are inserted into the prostate. This treatment may be appropriate for men with a cancer that is contained within or near the prostate.
There are also some alternative therapies that may be used in special circumstances, such as cryotherapy, where a probe is used to freeze and kill cancer cells, or high-intensity focused ultrasound, which uses high-energy sound waves to kill cancer cells.
An up-and-coming treatment called focal therapy aims to destroy small tumors in the prostate in a targeted fashion using a variety of noninvasive techniques. This could be appropriate for men with low- or intermediate-risk cancers with tumors that have not grown beyond the prostate, but Dr. Klein says there isn’t a lot of experience with it yet.
Surgery, radiation, and brachytherapy have been refined and improved over many years. Today, prostate cancer has one of the highest survival rates of any type of cancer. So, do not despair. Take the time you need to find doctors you trust and make a decision that you feel comfortable with.