Once it is determined that you have prostate cancer, your doctor will explain the treatment options available to you and recommend the most appropriate option for you.

1. Watchful Waiting

   Watchful waiting (also called deferred therapy, active surveillance, or simply observation) puts off treatment for a program of regularly monitoring. Under this approach, your doctor will place you on a schedule of regular prostate exams, PSA blood tests, urinalysis, and consultations. Physicians who use this treatment approach will do so only in cases involving men who are not likely to live for several years even if their prostate cancer is successfully treated. Typically, these cases involve men who are in their mid 70s or older, who have other significant health risks, and who have prostate cancer that is believed to be a low-grade, small-volume disease.

   The problem with this approach, however, is that the grade and volume of the prostate cancer is often underestimated. Thus, the physician may estimate that the prostate cancer is small, is slow growing, and has not spread, while in actually the cancer is large and aggressive. This is why many urologists take the position that if prostate cancer has been detected because of an abnormality on the digital exam or because of elevated PSA levels, there is most likely a significant cancer present. Further, even if the cancer is not yet advanced or aggressive, 15% or more of men who do not undergo treatment eventually develop advanced prostate cancer and die from it within ten years. After ten years, the chances for rapid growth and spread of the cancer, and for death from the cancer, rise dramatically.

   Watchful waiting is thus an approach that can allow the prostate cancer to grow, become aggressive, and spread to other parts of the body. If this happens, an otherwise treatable disease may become untreatable and result in a decreased likelihood of survival or eventual death from the cancer.

2. Radiation Therapy

   Radiation therapy uses radiation to kill or inactivate the cancerous cells. The radiation is delivered by one of two main techniques. The first technique, called external-beam therapy (also known as teleradiotherapy), focuses external beams of high-energy radiation onto the prostate. This technique requires treatment five days a week for a period of approximately seven weeks. The second technique, called interstitial radiotherapy, which is also known as radioactive seed therapy or brachytherapy, inserts radioactive pallets within the prostate. This technique requires a treatment period of one to two days.

   Because malignant (cancerous) cells are less efficient in repairing radiation injury than normal cells, radiation therapy kills or inactivates the cancer cells while saving a sufficient number of normal cells to allow them to repair themselves and continue their normal function. Unfortunately, radiation therapy is not effective for large, aggressive, high grade cancers. It is also not effective if the cancer has spread. Men with a PSA of more than 10, a Gleason sum of 7 or more, or a large prostate, are thus likely to fail this treatment. For men with small volumes of low-grade cancer, a PSA of less than 10, and a small prostate, the survival results from radiation therapy are seven to ten years. Radiation therapy is thus typically used on such men if they (1) are older and have a life expectancy of approximately seven to ten years, and (2) cannot or will not have their prostate removed, or face a significant risk from surgery.

   One of the main problems with radiation therapy is that your doctor will not be able to evaluate the lymph nodes to be sure the treatment is the correct one. Thus, you may need to undergo a laparoscopic lymph-node dissection before starting radiation. Further, even when radiation therapy is successful, you must be continuously monitored with regular prostate exams and PSA tests. Radiation therapy is not a permanent cure. The cancer can return. The likelihood that the cancer will return increases greatly after seven to ten years.

3. Cryotherapy

   Cryotherapy, also called cryosurgery and cryosurgical ablation, is the controlled freezing of the prostate gland in order to kill the cancer cells in the prostate. In order to perform cryotheraphy, your doctor inserts probes throughout the prostate. Ultrasound is used to confirm the proper placement of the probes. Liquid nitrogen is then circulated through the probes, freezing the tissue of the prostate. A rectal ultrasound probe monitors the freezing and allows the surgeon to determine when enough prostate tissue has been treated. A catheter placed in the urethra circulates a warming solution to protect the urethra from damage during the procedure.

4. Radical Prostatectomy

   Radical prostatectomy is a surgical operation in which the entire prostate gland, attached seminal vesicles, and some nearby tissue are removed. It is one of the most common operations being performed today.

   Generally, the goal of the surgery is to remove the cancer from the body before it has had a chance to spread. As such, it is most often performed on men with prostate cancer in the early stages (Stages T1 and T2), when the cancer is located only within the prostate. Even if the cancer has already spread beyond the prostate, however, by removing the cancerous prostate, radical prostatectomy may make it easier for your body's immune system, assisted by medication and other treatments, to more effectively fight the cancer.

   Failure to recommend a radical prostatectomy to a patient whose cancer is in the early stages may result in the spread of the cancer, which can in turn lead to a reduced likelihood of survival. Similarly, failure to recommend a radical prostatectomy to a patient whose cancer has spread beyond the prostate can leave the patient with so much cancer in his body that his immune system, even with medication and other treatments, is unable to effectively fight the cancer. This patient may also experience a reduced likelihood of survival.

5. Hormone Therapy

   Because prostate cancer is hormone-sensitive, eliminating the male hormones removes a major stimulant of the cancer's growth. After hormone treatment, the cancer generally stops growing and may even enter a dormant stage. There are a number of treatments available to eliminate the male hormones from the body, including taking female hormones, orchiectomy (the surgical removal of the testicles), LHRH analog injection therapy, total androgen blockade, and antiandrogen monotherapy.

   Hormone therapy is typically used when there is widespread metastatic disease. Indeed, if the cancer has spread to the lymph nodes or to the bones, hormone therapy is generally considered the correct treatment option. Hormone therapy may be used before surgery and before or during radiation to reduce prostate size or keep the cancer in check.

   Failure to recommend hormone therapy, especially for a patient whose cancer shows signs of progression after radiation and/or surgery, may result in continued spreading of the cancer, which can in turn lead to a reduced likelihood of survival.