When choosing prostate cancer treatment, factors to consider include the stage, grade, extent of disease and the physical condition of any one patient. Also, what may be right for one person may be wrong for another in the same exact condition because of differences in their outlook, goals and lifestyle priorities. Many men with prostate cancer may also not need to be treated and may be appropriate for “active surveillance” as opposed to more aggressive treatment such as prostatectomy or one of the forms of radiation therapy.
There are a number of tools and resources made available by some of the major prostate cancer medical practices than can help guide your treatment decision, whether it be for initial treatment, additional treatments or salvage treatments after surgery or radiation. For example risk assessment tools such as the UCSF-CAPRA Score and the D’Amico classification as well as a number of nomograms can help guide your decision making process. Memorial Sloan-Kettering Cancer Center has also developed a series of Nomograms that aid in the prediction of a number of events including:
- For men who have received no primary treatment, the nomogram calculates the statistical probability of a cancer remaining progression-free after receiving one of three treatment options: prostatectomy, external beam radiation therapy, and brachytherapy.
- For men who have been treated with a prostatectomy, the tool predicts probability of survival.
- For men who have experienced a recurrence of their prostate cancer after being treated with a prostatectomy, the tool predicts treatment success for salvage radiation therapy (SRT).
- For men who have received either prostatectomy or radiation therapy and are considering hormone refractory treatment (HRT), the tool predicts one- and two-year survival after HRT.
- This tool can also be used to predict the probability and time to the development of metastatic disease as well as prostate volume, which is used to interpret PSA results.
A key factor you also need to consider, and which many people neglect, is choosing your doctor. Generally, doctors who treat prostate cancer tend to recommend the procedures they are accustomed to performing. Therefore a surgeon will recommend surgery, a radiation oncologist will suggest radiation, and so on. Keep this in mind when you are considering your treatment options and make sure you explore all the options before making a decision. Whatever options you are considering, you should set aside time with all the members of your treatment team to discuss all the available choices as well as all aspects of the treatment both pre and post procedure. This includes preparing for the treatment, other treatment options, the treatment process as well as short- and long-term side effects.
Finally, on hearing a diagnosis of prostate cancer, usually all the patient wants to do is get rid of the cancer no matter what and he neglects to take advice on the long-term implications of the treatment given the patient’s individual circumstances. However, after the treatment, and once you get back to your normal life, issues such as incontinence, erectile dysfunction, secondary treatments and other sexual health issues usually become the subject of greater focus. It is best to discuss these post treatment side effects with your medical team as part of your treatment decision before deciding on the best treatment for your situation. Prior to treatment, it is also wise to talk to your doctor about a penile rehabilitation program as part of your post treatment recovery plan. In addition, no matter what treatment option is chosen, you need to also consider lifestyle and diet considerations, as maintaining maximum immunity and health is fundamental to recovery and long-term wellness.