Patient education: Choosing treatment for low-risk localized prostate cancer (The Basics)

What is low-risk localized prostate cancer? — Low-risk localized prostate cancer is prostate cancer that is very slow growing and only in the prostate gland (figure 1). It has not spread outside of the prostate gland.

Because this type of prostate cancer usually grows slowly, it does not usually lead to death from the cancer. Many men with low-risk localized prostate cancer die from other medical problems, such as heart disease, and not from their prostate cancer.

But some low-risk localized prostate cancers will become serious and can lead to death if not treated. Unfortunately, doctors often can't tell for sure which low-risk localized prostate cancers will never cause any problems and which ones are more serious.

What are the treatment choices for low-risk localized prostate cancer? — In general, most men can choose from the following different treatments for low-risk localized prostate cancer:

●Active surveillance – If you choose this option, you will not have treatment for your cancer right away. But your doctor will do exams and tests on a regular basis. This is to check whether the cancer is growing or becoming more aggressive. If and when it does, you will then start active treatment. Many but not all men who choose active surveillance end up having treatment for their cancer at some later point.

●Prostatectomy, which is surgery to remove the prostate gland

●Radiation therapy – Radiation kills cancer cells. You can get radiation therapy in 2 different ways:

•In "external-beam radiation therapy," the radiation comes from a machine that is outside the body. This involves getting radiation every day, Monday through Friday, for 4 to 8 weeks.

•In "brachytherapy," the radiation comes from a source of radiation that is put into the prostate gland. This involves a 1-time treatment.

Some men, especially those who are older or have serious medical conditions, might choose not to do any of the above. Instead, they might choose "watchful waiting." Watchful waiting is not exactly the same as active surveillance. It does not require regular testing, but involves treating symptoms if they happen.

How do I choose among the different treatments? — First, make sure you understand all the facts about your choices (table 1). Ask your doctor any questions you have. Then to help you decide, think about how you feel about:

●What the treatment involves

●Benefits of the treatment – With active surveillance, you can delay and perhaps avoid the side effects from surgery or radiation. With surgery, external-beam radiation therapy, and brachytherapy, your cancer is treated right away before it can grow or spread.

●Downsides and side effects of the treatment – If you choose active surveillance, you will need to be monitored by your doctor for a long time, possibly for the rest of your life. This might include having many biopsies and/or imaging tests. Another downside of active surveillance is knowing you have cancer and worrying about it. Also, sometimes the cancer starts growing quickly and becomes harder to treat.

Surgery, external-beam radiation therapy, and brachytherapy can all cause problems with sex. This includes trouble getting or keeping an erection. With surgery, this problem usually happens right away. With external-beam radiation therapy and brachytherapy, this problem can happen later on.

Surgery can cause incontinence, or leaking of urine. Also, side effects such as pain, infection, and bleeding can happen with any type of surgery.

External-beam radiation therapy and brachytherapy have short-term and long-term side effects. Short-term, they can cause frequent bowel movements and other bowel problems. They can also cause problems with urination, including the need to urinate often or pain with urination. Long-term, these treatments sometimes cause incontinence, but this is less common than with surgery.

●How the treatment could affect your sex life – An important issue for many men is how treatment can affect their sex life. Active surveillance doesn't usually affect your sex life. But surgery, external-beam radiation therapy, and brachytherapy can cause trouble getting or keeping an erection. If you have problems with these, there are treatments (medicines or devices) that might be able to help.

Your treatment might also depend on your age and general health. For example, younger men in good health often choose surgery. Older men, especially those with other medical conditions, might choose active surveillance.

Also, people with certain medical conditions cannot have some treatments. For instance, men with long-term diarrhea usually can't have external-beam radiation therapy or brachytherapy. Brachytherapy is not usually recommended for men who have very a large prostate that is causing problems with urinating.

What are the chances my cancer will come back after treatment? — After treatment with surgery or radiation therapy, there is a very low chance that your cancer will come back.

How do I work with my doctor to make a decision? — To make a decision, let your doctor know how you feel about the different treatments and whether there is something specific that worries you. Then listen to what your doctor has to say about their experiences with men who had situations similar to yours. Together, you can decide which treatment is right for you.

More on this topic

Patient education: Prostate cancer (The Basics)
Patient education: Prostate cancer screening (PSA tests) (The Basics)
Patient education: Brachytherapy (The Basics)
Patient education: Radiation therapy (The Basics)
Patient education: What are clinical trials? (The Basics)
Patient education: Sex problems in males (The Basics)
Patient education: Prostate biopsy (The Basics)
Patient education: Prostate removal surgery (The Basics)

Patient education: Prostate cancer screening (Beyond the Basics)