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Choosing your treatment for prostate cancer

Many men and their families are distressed by a diagnosis of prostate cancer. The range of treatment options before them can be daunting and a number of factors need to be taken into consideration when making an informed decision.

If you have an early prostate cancer diagnosis, the treatment options will depend on factors such as the grade and stage of the disease, your age, general health, personal preferences and priorities. There is little unbiased evidence to suggest that one treatment is any better than another, which can make it difficult for patients to make a treatment decision.

It is very important that all treatment options, together with their risks and benefits are discussed with Dr Swindle, prior to making an informed decision.

Your treatment plan may be one or a combination of options. The major ones include:

  • Watchful waiting and active surveillance – close monitoring of your prostate cancer
  • Surgery – radical prostatectomy (open technique, laparoscopic technique and robotic prostatectomy)
  • External beam radiotherapy
  • Brachytherapy – low dose rate brachytherapy (permanent seeds) or high dose rate brachytherapy (temporary rods)
  • Hormone therapy
  • Chemotherapy

The following parameters are all taken into account in the decision making process:

Stage

Following the biopsy, the cancer’s stage needs to be determined via a number of investigations. These include the presence of lymph node involvement or metastases (distant spread), the size of the tumour and what it feels like on rectal examination. Staging provides one of the most important factors in determining your treatment. A CXR (chest x-ray), CT scan of the abdomen and pelvis, a bone scan and a PSMA PET CT scan are all tools that can be used to determine the spread of the cancer.

Risk stratification

In order to help with treatment decisions and help with research, patients can be separated into three risk groups – low risk, intermediate risk and high risk. There are many classifications for risk stratification but one common risk stratification method is known as the D’Amico method and it is as follows:

  • Low risk: PSA < 10 and Gleason score < 6 and the percentage of involved cores is < 50% or intermediate risk with only 1 positive core
  • Intermediate risk: Gleason score of 7 or PSA of 10-20 low risk with > 50% of positive cores or high risk and only 1 positive core
  • High risk: Gleason > 8 or PSA > 20 and more than 1 positive core or intermediate risk and more than 50% positive cores

Your age and life expectancy

Prostate cancer is slow growing and in general it is recommended that patients have a life expectancy of greater than 7-10 years to gain benefit from treatment of their prostate cancer.

As many men with low grade prostate cancer do not die from their disease, they may choose not to be treated. Men with a life expectancy greater than 10 years will have a different decision making process to a man who has a life expectancy of less than 10 years, who may choose to live with his cancer rather than risk side effects of treatment when the cancer may not be life threatening.

Your health

The better your overall health, the more likely you are to recover quickly from treatment. If you have significant health issues, then these have the possibility of shortening your life and thus lessening the benefit of treatment for your prostate cancer or alternatively, can impact on the type of treatment you are suitable for.

Grade of the prostate cancer

Not all prostate cancers behave the same. Some cancers are aggressive and some cancers are not so aggressive. The behaviour of the individual cancer is described by the Gleason Score. Your Gleason score impacts on the type of treatment that you are suitable for. Some treatments are not appropriate for certain Gleason Scores.

Values and priorities

Treatment for prostate cancer is a personal decision and you must be as well informed as possible in making this decision. Please discuss any issues or concerns that you may have with Dr Swindle. Some men for example, can’t imagine living with side effects such as incontinence or impotence. Others are less concerned about these and more concerned about removal of the cancerous tumour.

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