Q&A: What are the treatment options for prostate cancer?

Prostate cancer is the most common cancer in American men, other than skin cancer. About one in every nine men will be diagnosed with prostate cancer during his lifetime, which is why it is vital to understand what prostate cancer is and what treatment options are available.

Prostate cancer is a result of out-of-control cell growth in the prostate gland, which is located below the bladder and in front of the rectum. More often than not, prostate cancer does not present with any noticeable signs or symptoms, so it is important for men to discuss the risks and benefits of prostate cancer screening with their doctor. Prostate cancer screening includes a digital rectal examination combined with a simple blood test. This test is called a Prostate-Specific Antigen, or PSA.

For most men, prostate cancer screening is recommended to begin at age 50. However, some men are at higher risk for developing prostate cancer. Those at higher risk include African Americans, and men who have a family history of prostate or breast cancer. These men should talk to their doctor and consider starting prostate cancer screening at age 40. There is now conclusive evidence that screening, when performed appropriately, decreases the risk of dying from prostate cancer.

To formally diagnose prostate cancer, your doctor may need to perform a prostate biopsy. The results of the biopsy will determine the “grade” of the cancer. The higher the grade, the higher the risk of cancer spreading beyond the prostate. Your doctor may recommend additional tests to determine whether the cancer is still confined to the prostate gland.

Treating prostate cancer can look different for each patient because the type of treatment is dependent on your overall health, age, grade of the cancer and whether the cancer has spread. Fortunately, most patients are diagnosed with low-risk prostate cancer, which doesn’t require immediate treatment. Instead, the patients are carefully monitored with a clinical protocol called active surveillance.

Active surveillance involves very close PSA monitoring and repeated biopsies with intervention if the grade, PSA or volume of cancer changes during surveillance. Recently, a high-quality trial (ProtecT) assessed comparative efficacy of active monitoring, radical prostatectomy and radiotherapy in 1,643 men who were randomized to the three treatment options. At 10 years, there was no significant difference in the risk of dying from prostate cancer among the three groups. However, higher rates of cancer progression and metastatic disease were seen in patients randomized to active monitoring.

High-grade prostate cancer should be treated. The treatment options include surgical therapy, radiation therapy, cryotherapy, hormonal therapy and, sometimes, chemotherapy. Focal therapies that treat only a portion of the prostate containing the cancer are being developed, as well. It is important to remember that most patients who present with prostate cancer can be cured.

I strongly encourage men to discuss prostate cancer screening with their doctor.

Ilia S. Zeltser is a urologist specializing in the treatment of prostate cancer with MidLantic Urology in Bryn Mawr, Pa.