To treat or not to treat?

I am going to re-post this video so that you can recall the steps made in a prostate cancer diagnosis: A physician will do a rectal exam where he feels the prostate and/or a PSA test (looking at the amount of PSA in the blood to see if it is abnormal, and assessing if the levels are due to cancer growth). A biopsy may also be done (where the doctor will use technology to gather tissue samples of the prostate and look closer at the cells).

Once a man is diagnosed with prostate cancer, there are several options available to him. Because there is no way to determine with certainty how aggressive a man's prostate cancer will be, deciding what to do can be a difficult decision. If you are diagnosed, you should learn about all of your options and decide which are best for you and your particular situation. Here are the main treatment options:

1) Active Surveillance- This means that no treatment will be done, and instead the prostate will be monitored over time so that if any significant changes happen in the future, perhaps then treatment may be considered. PSA tests and digital rectal exams (DREs) will be performed by a doctor at different scheduled times (usually 4 times per year). Many men who have prostate cancer that is confined to the prostate gland and hasn't spread choose this option.

2) Surgery- some men choose to have their prostate gland removed.  Complications from this can include urinary incontinence and sexual dysfunction

3) External Radiation Therapy-external radiation beams can be used to target specific areas of cancer to try and kill them. This is commonly done every week day for about 6 weeks, 15 minutes at a time. Side effects can include feeling very tired, sexual dysfunction, bladder irritation for short periods of time, and bowel dysfunction if the radiation beams hit the bowel or bladder.

4) Internal radiation therapy- "seeds" with radiation inside of them are planted in the prostate. This is also called "Brachytherapy." An irritated bladder and sexual dysfunction are possible side effects. Something else to note is that if a man has these seeds in him, he cannot be too close to women who are pregnant or could become pregnant, nor should he be near infants. The radiation can be very damaging to these groups of people, so men with wives of childbearing age and young children or grandchildren, for example, might not want to choose this option.

5) Chemotherapy-the use of medicine to kill cancer cell

I want to emphasize that there is no one "right" way to treat prostate cancer. This can be difficult, because oftentimes when people (myself included!) find out they are sick with something, they want a roadmap. They want an expert who can tell them what to do and explain exactly how different treatments will affect them. However, we don't know enough about prostate cancer to be able to answer these questions. Predicting prognosis is very difficult. The most important thing is that you talk with your doctor about all of the options available and weigh the pros and cons of each. Doctors can give you input and answer your questions, but ultimately it should be your informed decision. 

Here is a video that discusses treatment options and when someone might choose them:

Sources:

Cancer Research UK. (2014). Prostate Cancer Symptoms, Signs and Types. Retrieved from https://www.youtube.com/watch?v=3rVE_4toOWU

Cancer Research UK. (2014). Prostate Cancer Treatment. Retrived from https://www.youtube.com/watch?v=gQeYUEj9i_g&feature=iv&src_vid=3rVE_4toOWU&annotation_id=annotation_599983069

Centers for Disease Control and Prevention. 2015. How is Prostate Cancer Treated? CDC. Retrieved from http://www.cdc.gov/cancer/prostate/basic_info/treatment.htm

Berry, D. 2015. Prostate Cancer: The Key Points. Presentation given at University of Washington School of Nursing.