How to choose your prostate cancer treatment

Prostate cancer can be managed conservatively or aggressively. The primary choices include observation, surgery, radiation, hormonal manipulation followed by radiation, and hormonal treatment. Some centers also offer cryotherapy for localized disease. So which approach is best for a given patient?

To help answer the crucial question of how to best treat prostate cancer, the American Urological Association convened a Prostate Cancer Clinical Guidelines Panel. But after reviewing more than 13,000 studies, the expert panel was unable to establish recommendations. That's because the studies differed substantially in such factors as patient age, disease stage, and follow-up, making direct comparisons impossible. New studies to resolve these issues will not be completed for years.

Until then, patients have to choose for themselves among several acceptable options. The June 2008 issue of Harvard Men's Health Watch outlines some general guidelines to help men decide which treatment is best for them. A man must know his cancer's stage and its Gleason score (a ranking that considers the cancer's aggressiveness). But other factors are important, too, including his age, general health, and life expectancy, and the experience and skills of his medical team. And every patient should consider how each treatment—and its side effects—will affect his quality of life.

In general, men with early disease have the most options, reports Harvard Men's Health Watch. Older men with small tumors and low Gleason scores often choose radiation or observation; younger men with higher scores often choose surgery or radiation. Most men with locally advanced cancer choose radiation, with or without hormonal treatment. Men with widespread disease might benefit from hormonal treatment known as androgen-deprivation therapy.

Harvard Men's Health Watch notes that these are only general guidelines. Each man should consider his options in detail, with input from his physicians and family.

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