You have now returned to your doctors’s office with you spouse or significant other and have completed the evaluation that was requested. This probably involved imaging studies that include a bone scan and a CT scan. Fortunately, like most patients with early stage and low grade prostate cancer, the x-ray studies that were performed for you were both negative. We now have to make a decision about the best treatment for early stage and grade prostate cancer.
The decision about what treatment to undergo should definitely consist of a dialog between you and your physician. This conversation must involve all treatment options that are available to you. Be weary of a surgeon who does not want to discuss the various options that are available to you. If the surgeon were to say that there is only one choice of treatment - surgery - it would probably be a good idea to seek a second opinion. This would be the same if the physician were to only recommend any of the other choices such as radiation therapy, cryotherapy or high intensity focused ultrasound (HIFU).
Lately, the treatment of prostate cancer has come under much scrutiny. The controversy surrounding PSA testing has led to most of this discussion, with the suggestion being made that the use of PSA screening does not lead to significant increases in survival. Additionally, some have questioned that overtreatment of prostate cancer has occurred. But many urologists - including myself - feel that there is a potential benefit from PSA screening as well as treating the appropriate patients who have been diagnosed with disease. Questions that remain unanswered deal with who the ideal candidate may be for active surveillance of prostate cancer, and the correct manner in which patients should have surveillance.
Regardless of this, most patients who have been diagnosed with this disease want to be treated and many of them should be. However, the removal of the prostate with a radical prostatectomy is not necessarily the treatment of choice or the recommendation for many patients. Many patients will choose alternatives other than radical surgery. Patients who are older, have low volume disease, or have focal disease may opt for other alternatives other than radical surgery.
Choices are available that are less invasive than radical prostatectomy but have comparable results with regards to obtaining disease-free status and overall survival, as well as demonstrating a similar safety profile. Some of these options include radiation therapy, cryotherapy and HIFU (although it is not offered in the US at the present time). Some urologists are now even offering focal therapy that only treats the areas of the prostate cancer while sparing the normal tissue.
So prior to determining the treatment of choice, be sure to have a lengthy conversation with your urologist that includes a discussion of all the treatment options that are available.
Published On: February 27, 2013