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Prostate cancer treatment: Know your options

African American man seated in a lunch room or café.

Discover what treatments are available—and how to choose what's best for you.

After skin cancer, prostate cancer is the most common cancer in American men. In fact, 1 in 9 men nationwide will develop it at some point. But you should know that most men with prostate cancer don't die from it.

If you're among the newly diagnosed, you almost certainly have questions about what comes next. Your doctor should be your first source for information. But in the meantime, here are a few answers to common questions from the National Cancer Institute, the American Cancer Society and other experts:

Q: Is it true that prostate cancer may not need treatment?

A: Yes, in certain cases. That's because prostate cancer often grows very slowly and might not cause any problems. This means some men with slow-growing tumors may not need treatment for a long time—or ever.

That's why your doctor may advise keeping a close eye on prostate cancer and treating it only if it progresses. This wait-and-see approach may be right for you if your cancer:

  • Isn't causing symptoms.
  • Is small.
  • Hasn't spread beyond your prostate.

Q: What happens if I choose to wait and see?

A: Your doctor will keep an eye on your prostate cancer in one of two ways: active surveillance or watchful waiting.

Active surveillance involves monitoring prostate cancer closely. Typically, that means you'll get a PSA blood test and digital rectal exam about every six months. Your doctor may advise yearly prostate biopsies too. If your test results change, then you might talk about treatment aimed at curing the cancer.

In contrast, watchful waiting is more hands-off. Tests aren't routinely performed. Your doctor will only order tests or start treatment if you develop symptoms, like pain or a blocked urinary tract. And in that case, treatment may only be focused on easing symptoms and improving your quality of life, not curing your cancer.

Some doctors may use the terms "watchful waiting" and "active surveillance" somewhat differently. So be sure to ask precisely what your doctor means.

Q: Why do some men choose to wait?

A: Treating prostate cancer can be rough on your body. Its side effects may include incontinence and trouble getting or maintaining an erection.

So if your cancer is not fast-growing or spreading, it's important to sort out whether you're more comfortable with the risks of waiting or the risks of treatment. That's a highly personal decision and one to weigh carefully with your doctor.

Q: What treatments are available?

A: Your doctor may recommend one or more of these:

  • Surgery. This can remove the prostate alone or the prostate along with surrounding tissues.
  • Radiation therapy. A machine directs high-energy rays at cancer cells to destroy them. Or your doctor may surgically implant radioactive seeds into or near the cancer.
  • Hormone therapy. This treatment uses drugs or surgery to lower or block the male hormones that can fuel this cancer's growth.
  • Chemotherapy. These powerful drugs shrink or kill cancer cells.
  • Biological therapy. These treatments are used to encourage your own immune system to attack cancer.

Other treatments are currently being studied. So ask your doctor about all your options.

Q: How do I decide what's right for me?

A: Work closely with your doctor to explore all your treatment options, their benefits and the possible risks.

Crucial things to factor in include:

  • The cancer's stage.
  • How fast it's growing.
  • Your age and likely lifespan.
  • Your overall health.

Be sure you understand how likely it is that a treatment will help you—and in what way. Feel free to seek out a second opinion. And weigh your feelings about possible side effects too. Together, you and your doctor can decide what makes the most sense for you.

reviewed 10/25/2019

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