Doctor wearing prostate cancer ribbon

Low-risk prostate cancer

If you are diagnosed with low-risk prostate cancer, you have a number of treatment options, including doing nothing. You may be anxious to start treatment as soon as possible, but it’s important that you take the time to fully understand all the options, benefits, and risks.

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Cancer management options

Active surveillance

This aims to monitor your prostate cancer for changes that may require further treatment. It is suitable for earlier cancers and involves regular tests. Some of the tests you may have include a prostate specific antigen (PSA) blood test, digital rectal examination (DRE), biopsy or imaging scans.

Radiation therapy

This treatment destroys cancer cells inside and around the prostate, using radiation. It can be given as “definitive” treatment instead of surgery, and it can also be used if the cancer comes back after surgery. It can either be External Beam Radiation Therapy which treats the prostate with high energy X-rays, or brachytherapy, which involves implanting radioactive “seeds” into the prostate to kill cancer cells.

Surgery

This aims to remove the entire prostate and some of the surrounding tissue. It could be done a number of ways, including keyhole surgery.

Hormone therapy

This treatment temporarily stops your body from making testosterone and aims to reduce the tumour size or slow down the tumour growth. It may be given short-term in conjunction with radiation therapy. Not everyone will receive hormone therapy.

Treatment isn’t always needed

Many men with low-risk prostate cancer are treated immediately, with surgery or radiation. However, for many men with low-risk prostate cancer, treatment is not necessary and it can cause sexual, urinary, and bowel problems.

Risk

Many prostate cancers are found with a prostate-specific antigen (PSA) blood test. Often these cancers are low-risk. This means:

  • The tumour is small.
  • It is contained within the prostate.
  • The PSA blood test is not very high (less than 10 µg/L).

For most men with low-risk prostate cancer, the tumour is probably growing so slowly that it will not become life-threatening. Usually a man with low-risk prostate cancer will die from something else, even if he doesn’t get treatment for prostate cancer.

Active surveillance

Active surveillance may help your quality of life. With active surveillance, you have regular checkups, including a PSA test and rectal exam. You’ll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.

Active surveillance is a good choice for many men with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.

Treatment side effects

Side effects from surgery or radiation may include:

  • Impotence – not getting erections that are firm enough to have sex.
  • Leaking urine. There may be complete loss of bladder control, but this is less common.
  • Frequent, urgent, bloody, or painful bowel movements.

When immediate treatment is needed

If your cancer is advanced or higher-risk, you will probably need treatment right away. Signs of higher-risk cancer include:

  • PSA value that is quite high (more than 10 µg/L) or rapidly rising.
  • Test results show that the tumour is outside the prostate gland. Or that the tumour is growing rapidly and is likely to spread outside the gland.

Ask your team if your cancer shows any of these signs. If so, active surveillance may not be a good choice.

Choosing a treatment

Most men with low-risk prostate cancer have time to think about their choices. These tips may help you reach a decision.

Review your health history

Give your cancer care team your full personal and family medical histories. Ask how your age and general health could affect treatment. Ask if you have any condition that might increase the risks of treatment, for example, conditions such as diabetes, heart problems, or bowel disease might increase your risk of sexual, urinary, or bowel problems.

Think about your values

Discuss these questions with your spouse or partner:

  • Do I want to get rid of my cancer, even if I might have sexual or urinary problems?
  • Which side effects would upset me most?
  • Would I be okay with active surveillance, even if I am worried and have to see the doctor more often?

Find out all of your treatment options

There are two specialists you should talk to – a radiation oncologist and a urologist. Your GP can give you referrals to both of these and help you make a decision that is right for you. Often this comes down to personal preference once you have all the information. Typically:

  • A radiation oncologist can discuss active surveillance and radiation treatment.
  • A urologist can discuss active surveillance and surgery.

For more information about prostate cancer visit:

It’s OK to ask questions

If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.

Supporting evidence

For a list of supporting evidence for the issues discussed in this resource, see:

  • choosingwisely.org.nz/professional-resource/ranzcr-radiationoncology
  • New Zealand Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer. Prostate Cancer Working Group and Ministry of Health. 2015. Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer. Wellington: Ministry of Health.

Developed by Choosing Wisely New Zealand, 2018. Adapted from Choosing Wisely Canada (2014), Low-risk prostate cancer: don’t rush to get treatment, and the Cancer Institute New South Wales, Australia (2016) Prostate cancer management options. Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.

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Choosing Wisely

This article is part of our content on Choosing Wisely, a campaign encouraging a change in thinking by health professionals and consumers to avoid unnecessary medical intervention.

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