Treatment for Localized Prostate Cancer

Treatment for Localized Prostate Cancer

Choosing the best treatment for localized prostate cancer (T1 or T2) is generally based on the patient's age, the stage and grade of the cancer, and the patient's knowledge and acceptance of the risks and benefits of each therapy.

Patients have three main options:

• Surgery (radical prostatectomy or cryosurgery) removes the prostate gland. The vessels that carry semen and surrounding tissue may also be removed.
• Radiation is used to destroy tumors.
• Watchful waiting (for selected patients with lower-risk tumors) involves lifestyle change and careful monitoring for cancer progression. Treatment at that point may be radiation or hormones depending on the extent of the cancer.

Additional treatments to suppress androgen (male hormones) may be helpful in some cases. Unfortunately, even the medical community is divided over the best treatment for localized prostate cancer. No treatment appears to have a clear survival advantage. The choice is often not an easy one, even for experts, for many reasons.

Conflicting Data on Survival Rates. To date, neither treatment nor watchful waiting has emerged with a definitive survival advantage. Several studies from 2005 and 2006 suggested that treatment provides a survival advantage over watchful waiting for some men with early-stage prostate cancer. A 2005 New England Journal of Medicine study reported that men who had a radical prostatectomy before age 65 had a reduced risk of death from prostate cancer, death from other causes, localized cancer progression, and metastases than men who chose watchful waiting.

Similarly, research presented at the 2006 Prostate Cancer Symposium found in a study of nearly 50,000 men with early-stage prostate cancer that men who had radiation or surgical treatment had a 30% lower risk of death than men who were randomly assigned to watchful waiting. However, a 2005 Journal of the American Medical Association study advised against aggressive treatment for localized low-grade prostate cancer. The study found that men with low-grade prostate cancer had a small risk of cancer progression even after 20 years of watchful waiting or hormonal drug therapy