Prostate cancer: Treatment options
A diagnosis of prostate cancer is not a death sentence. What is important after the diagnosis is knowing the grade and stage of cancer, as well as the specific treatment options (ranging from surgery to no intervention, often called "watchful waiting").
Stage and grade for prostate cancer
Grade. Most grading of prostate cancer uses one of two ratings/numbers to describe the grade of the tumor. The higher the rating, the higher the grade of tumor. One rating uses a scale G1to G4, and the other assigns a rating/score from 2 to 10. The tumor tissue in a low-grade cancer (G1 or 2, depending on the scale used) more closely resembles normal prostate tissue. High-grade tumors tend to grow more quickly and have an increased likelihood to spread (versus low-grade tumors).
Stage. There are four stages. The extent of prostate cancer in stages I and II is said to be localized; that is, still contained within the prostate gland itself and not spread outside of it. Stage III is sometimes called locally advanced cancer, and includes the seminal vesicles, another nearby gland. Stage IV describes a cancer which has spread further to other tissues, organs or the lymph nodes.
Treatment options for prostate cancer
Generally, there are three: surgery, radiation and watchful waiting (also called surveillance).
Surveillance, taking a wait-and-see approach, may be recommended for patients with early-stage prostate cancer, particularly those who are older or have other serious medical conditions. These patients have regular examinations. If there is evidence of cancer growth, active treatment may be recommended.
Radiation therapy involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered by implanting radioactive seeds in the prostate using a needle.
Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection.
Because the specific treatment decision depends on a variety of factors (grade and stage, age, health, attitudes toward treatment, etc.), it is important to get as much information as possible and make an informed decision. The National Cancer Institute notes, for example, that "There is rarely a need to make a decision without taking time to discuss and understand the pros and cons of the various approaches."
Seek more than one opinion from a doctor if you can. There are usually several possible options
for treatment, all reasonable. Gaining more than one perspective can be helpful in the process.
Review the resource links for additional information and support groups.
