Thinking About Your Options
Options for – include watchful waiting, prostate surgery, radiation, and hormone treatment. Deciding can be a challenge because there is a lot to think about. Research can’t tell us which option is best. All the active treatments can have long-lasting side effects. Many prostate cancers grow slowly over a lifetime. That means men can take time to learn about the cancer, the options, and the side effects.
The first thing to think about is whether to wait and watch the cancer or treat it right away. Options might be different based on your overall health and lab results.
What was your Gleason score at the time the cancer was found?
A lower Gleason score means the cancer usually grows slowly.
Tumors with higher Gleason scores (8 to 10) are called aggressive. They are very likely to grow and spread outside the prostate gland within 5 years. Men who have a higher Gleason score may think they need to get an active treatment. But research can’t tell us if watchful waiting or an active treatment is better for men with higher Gleason scores.
How will your age or other health problems affect your treatment choices?
Age and some health problems can make surgery more risky. If you have serious heart or lung problems, your doctor may talk to you about other options. If you have had radiation before, you may not be able to have radiation for prostate cancer. Talk to your doctor about your options.
Watchful waiting (also called active surveillance or expectant management) means seeing what happens with the cancer over time.
Watchful waiting is not the same as doing nothing. It means that you keep a careful watch on the cancer with regular checkups. When you visit your doctor or nurse, you might get a digital rectal exam, a PSA blood test, an ultrasound, or a biopsy to see if the cancer has grown.
How will watching and waiting affect your sense of well-being?
With watchful waiting, your cancer is not taken out or destroyed. You and your doctor will be checking for changes over time. The cancer may not spread. But if it does, your doctor will talk with you about your options for active treatment.
What about the side effects?
The main benefit of watchful waiting is that you can avoid the side effects of active treatment, like erectile dysfunction (ED) and urinary problems. Keep in mind that men who use watchful waiting may also get these problems. They can be caused by other health issues or medicines.
You and your doctor may decide on an active treatment instead of watchful waiting. If so, think about which one would be best for you. The main benefit with an active treatment is that there is a higher chance that the cancer can be taken out or destroyed. The trade-off is that all active treatments can cause side effects. Some side effects can be long-lasting.
Research Takes Time
This guide focuses on the long-term results of treatments. There isn’t research yet that compares the effects over time of all four treatments. But there is research that compares a few of the treatments to each other. Some treatments have been compared after 10 years and others after 5 years.
Most of the research so far started before PSA testing was common. Today, PSA testing is widely used. It helps find the cancers earlier and when they are smaller. Research today includes men whose prostate cancers are found by PSA testing. Not enough time has passed to know the long-term results of this research.