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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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.
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.
This aims to remove the entire prostate and some of the surrounding tissue. It could be done a number of ways, including keyhole surgery.
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.
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.
Many prostate cancers are found with a prostate-specific antigen (PSA) blood test. Often these cancers are low-risk. This means:
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 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.
Side effects from surgery or radiation may include:
If your cancer is advanced or higher-risk, you will probably need treatment right away. Signs of higher-risk cancer include:
Ask your team if your cancer shows any of these signs. If so, active surveillance may not be a good choice.
Most men with low-risk prostate cancer have time to think about their choices. These tips may help you reach a decision.
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.
Discuss these questions with your spouse or partner:
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:
For more information about prostate cancer visit:
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
For a list of supporting evidence for the issues discussed in this resource, see:
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.
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.