Treatment Options for Localized Prostate Cancer
If you or someone close to you has been diagnosed with localized, or early stage prostate cancer (T1 or T2), there are many treatment options available. The following prostate cancer treatment options are available for men with early-stage disease. Your doctor will discuss with you the pros and cons of each approach and find the option just right for each individual.
Active surveillance, also known as watchful waiting, is an approach to prostate cancer treatment that involves monitoring the disease and watching for progression, rather than undergoing surgery or radiation treatment right away. It requires close monitoring of the cancer through frequent physician visits. If the cancer progresses, treatment may be started immediately.
Who is a candidate for Watchful Waiting?
- Watchful waiting may be a viable option for patients with early-stage prostate cancer, especially elderly patients who have other significant health issues that may worsen the normal side effects of treatment.
- Patients with low-grade tumors may also consider this approach.
- If a patient is 75 years or older, has less than 10 years to live, or has a small amount of prostate cancer with a PSA level lower than 10, the risks of prostate cancer treatment may outweigh the benefits.
- We do not recommend watchful waiting for men who have ‘curable’ cancer or cancer that could benefit from treatment. We typically advise anyone younger than 75 to have some form of treatment, so long as they are healthy enough to make treatment worthwhile.
Radiation therapy is a type of cancer treatment that uses high-energy X-rays or radioactive seeds to directly target the cancerous cells in the prostate. The two types of radiation therapy are external beam radiation (using Intensity Modulated Radiation Therapy or IMRT) and brachytherapy (radioactive seeds implanted into the prostate gland). Choosing to undergo radiation therapy requires a formal consultation with a radiation oncologist to make a decision regarding your treatment.
- Brachytherapy is a treatment using radioactive seeds placed inside the prostate gland during a one to one and a half hour outpatient procedure. It is sometimes used alone for low-risk patients or combined with five weeks of IG-IMRT for patients with higher risk prostate cancers.
Cryotherapy, or cryosurgery, is a technique that involves controlled freezing of the prostate gland. It is most suitable for men whose cancer is confined to the prostate. This procedure is performed under anesthesia using transrectal ultrasound guidance. Freezing probes are inserted directly into the tumor within the prostate, thus freezing the cancer cells. Cryotherapy is used as a rescue therapy for men who have not responded to external beam radiation therapy or brachytherapy. Ideal candidates are men with a Gleason score lower than eight.
In some cases, hormone therapy is used temporarily around the time of radiation therapy to improve outcomes for certain cancers. The goal of hormone therapy is to eliminate androgens, which includes testosterone, that cause prostate cancer to grow.