Early-Stage Prostate Cancer Treatment
- When Alfred Fagan went to the doctor for a gym injury, he decided to talk about prostate cancer after seeing something on TV about black men being at higher risk for developing the disease. He was then diagnosed with the disease.
- The incidence of prostate cancer in African-American men is 60% higher, and they are two to three times more likely to die from the disease.
- Treatment for early-stage prostate cancer varies from person to person, and some people might not even need radical intervention techniques, like prostate removal or radiation, right away and can avoid the potential side effects.
- Men with early, low-risk prostate cancer may be able to monitor the disease for changes, such as through regular testing and exams. Research shows men who chose this path did not have an increase in their risk of death in 15 years.
- Surgery is also an option for early-stage prostate cancer, but it can come with side effects like leakage or erectile dysfunction.
- Patients are encouraged to discuss all their concerns and personal risk factors with their doctor to weigh the risk of possible side effects with the potential benefits of a particular treatment path.
Fagan hurt his back at the gym in 2013 when he was 50 years old. He was “fit and healthy,” but figured he should see a doctor for a quick check-up. And while he was at the doctor’s, he mentioned something he had recently learned about.
Read More“When I heard I had cancer, I thought I was going to die. What I know now is how lucky I was that I caught it early, because I got treated and now 10 years on, I'm still cancer-free,” he said.
"These days I spend a lot of time speaking to men about prostate cancer, which means I know first-hand how widespread these myths are … The main message I try to get across is that you just can't wait for symptoms, because if I had, I don't know if I'd have been diagnosed in time."
It’s true that Black men are at higher risk of developing prostate cancer. There is a 60% higher incidence of the disease in the community.
Talk to your doctor about the risk factors you may have for prostate cancer and what screening routine may be best for you.
Does Early Prostate Cancer Require Treatment?
Treatment for early-stage prostate cancer varies from person to person, and some people might not even need radical intervention techniques, like prostate removal or radiation, right away.
One option for people facing early-stage, low-risk prostate cancer is to monitor the disease:
There is watchful waiting the close monitoring of a patient's condition without giving any treatment until signs or symptoms appear or change. Another similar option is called active surveillance the close monitoring of a patient's condition without giving any treatment unless there are changes in test results. With this option, patients undergo certain exams and tests on a regular schedule.
Expert Resources on Prostate Cancer Treatment
"The concept of active surveillance is you're watching a man, and if something changes while the cancer is still in the prostate, you treat it then," Dr. James Brooks, the chief of urologic oncology at Stanford Medicine and director of the U54 Stanford O'Brien Urology Research Center, told SurvivorNet.
Active surveillance usually involves:
- A PSA test every six months
- Repeat digital rectal examinations no more frequently than once a year
- Repeat biopsies no more frequently than once a year.
Prostate-specific antigen (PSA) is the name of a protein secreted by the prostate gland. Men have a small amount of PSA in their blood all the time but large amounts may signal that something is brewing. When cancer cells grow, PSA spills into the blood.
"An ideal man for active surveillance might be a man, for instance, in his late 60s who has a barely elevated PSA, let's say just above 4, who undergoes a biopsy and is found to have one of the 12 biopsy cores with a small percent of low grade, what we call, Gleason grade 3 plus 3 prostate cancer.
"That man has a very low probability, it's certainly less than 1% chance, of dying of prostate cancer in 10 years."
MORE: The Benefits of Active Surveillance
One of the biggest pros of active surveillance is the fact that you still preserve your normal functioning.
"You don't have to suffer some of those potential side effects of sexual dysfunction or urinary dysfunction," Dr. Brooks said.
Even if you do opt for active surveillance, though, there is still the chance you'll need treatment later on. About 50% of men under active surveillance will have changes within five years that require active treatment, according to Dr. Brooks.
Still, recent research supported that men who managed their low-risk disease through monitoring did not have an increase in their risk of death in 15 years, highlighting that radical intervention such as prostate removal or radiation and the side effects of those treatments may not be immediately needed.
When people with early-stage prostate cancer do need active treatment, local options like surgery and radiation may rid the person of the disease completely.
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Options for Surgery and Radiation
Surgery options include traditional open surgery and laparoscopy with the latter being more commonly used today.
The main difference between the two is that traditional surgery requires a surgeon to make a large incision and laparoscopic surgery offers a smaller incision and a shorter recovery time.
A newer surgical approach called robotic-assisted laparoscopic prostatectomy (RALP), or robotic surgery, allows surgeons to make these small incisions with more precision.
Surgery for prostate cancer may cause side effects, so it's important to talk to your doctor about those before making a decision. Most men will have temporary leakage or erectile dysfunction, but the vast majority will regain nearly normal function in both areas with time.
In addition, men undergoing surgery for prostate cancer should know that shrinking of the penis is also a potential for side effect for some.
Your doctor may be able to recommend treatments or methods to help manage these side effects.
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Radiation options for prostate cancer include external beam radiation and brachytherapy (internal radiation).
Brachytherapy is an internal form of radiation that requires small radioactive seeds to be placed in the prostate. You can either undergo permanent low-dose brachytherapy or temporary high-dose brachytherapy.
The temporary option means you have an outpatient procedure that only takes about an hour or two, and the permanent option means the radioactive seeds are placed into the prostate and left there to slowly release radiation over the course of several weeks or months.
RELATED: The Benefits Of High-Dose Brachytherapy: Temporary and Fast
External beam radiation, on the other hand, is a non-invasive approach meaning no tools are needed to break the skin or physically enter the body where high doses of radiation are administered to the tumor.
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"Over the last ten to fifteen years, we have done remarkable things with our technology that allows us to aim much more carefully, reduce the amount of radiation that nearby critical structures get, and thereby get a higher dose in a quicker period of time," Dr. Patrick Swift, a radiation oncologist and a Clinical Professor of Radiation Oncology at Stanford, said.
There are also other options for early-stage prostate cancer that are either new or currently being tested, so it’s important to talk to your doctor about all potential options so you feel confident about whichever one you decide is best.
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Making a Treatment Decision With Your Doctor
It's important to talk with your doctor about your concerns and questions as you make your decision on how to treat your prostate cancer.
Weighing the risk of potential side effects with the benefits of a certain treatment path can help you make this important choice.
"Patients and physicians need to understand the surprising concept that prostate cancers are not all the same. Whether prostate cancer needs to be treated or monitored, depends on multiple risk factors," Dr. David Wise, director of genitourinary medical oncology at NYU Langone's Perlmutter Cancer Center, previously told SurvivorNet.
It's important to discuss your specific circumstances with your doctor to understand the best options available to you. As mentioned, the incidence of prostate cancer in African-American men is higher, and they are two to three times more likely to die from the disease. That's in part because they tend to get a more aggressive form, and they are also more likely to be diagnosed at a more advanced stage.
In addition, while the risk of death was comparable across the three treatment plans surveillance, surgery and raditation that could be because those with higher risk disease were treated appropriately. This means that active surveillance may be appropriate for some but not for others.
"The risk of the cancer is the key take home message from this trial," Dr. Wise added.
"Low-risk cancer can be safely monitored. Advances in monitoring on a formal active surveillance protocol with a urologic oncologist should be strongly considered. Surgery and radiation should only be considered after a discussion of the risks and benefits of these treatments given the lack of survival benefit reported in this study and others."
It's important to note that active surveillance requires regular, close monitoring. It is dependent upon the patient taking some charge of their care and responsibly showing up for their appointments and getting their lab work done.
If this seems like a treatment plan that would not be possible for you (for logistical or other reasons), then active surveillance may not be the right choice for you.
Questions to Ask Your Doctor
If you have been diagnosed with low-risk, early-stage prostate cancer and are considering your treatment options, here are some questions you may consider asking your doctor:
- Do you think I would be a good candidate for active surveillance?
- What routine tests would be part of your active surveillance plan?
- What other treatment options are available to me to treat the cancer?
- What are the potential side effects of those treatments?
- Do you have methods to help manage those side effects?
- Do those side effects outweigh the benefit of that treatment for my type of prostate cancer?
- I'm struggling to cope with my diagnosis, are their mental health resources available to help me?
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