Men with low-grade prostate cancer have four main options for treatment: active surveillance, radical prostatectomy, external beam radiation therapy, and brachytherapy.
In active surveillance, you forgo immediate treatment but are closely monitored for progression of the cancer. If the cancer progresses, you can decide at that point whether to have treatment. Active surveillance is a valid option for many men with prostate cancer as this type of cancer often progresses more slowly than other types. A randomized trial published in the New England Journal of Medicine in 2016 found that men with early prostate cancer lived just as long with active surveillance as with up-front treatment, even though they had a significantly higher risk of developing metastatic disease.
In radical prostatectomy, a surgeon removes the entire prostate gland, along with some surrounding tissue and two glands called the seminal vesicles.
External beam radiation therapy involves targeting the prostate with beams of radiation, whereas brachytherapy is a type of radiation therapy in which tiny radioactive pellets are implanted directly into the prostate.
Active surveillance
Advantages:
- Avoids side effects from radiationtherapy or radical prostatectomy
- No hospitalization or surgical risks
Disadvantages:
- Requires close monitoring (regular digital rectal exams, prostate-specific antigen [PSA] tests and prostate biopsy) to monitor for signs of progression
- May be psychologically stressful knowing that cancer will not be actively treated until it progresses
Radical prostatectomy
Advantages:
- Proven to reduce prostate cancer death rates
- Removed tissue allows accurate staging
- PSA levels reliably predict recurrence
- Fewer bowel/rectal problems than with external beam radiation therapy (EBRT)
- Less urinary urgency and frequency than with EBRT or brachytherapy
Disadvantages:
- General risks of surgery
- Hospitalization required
- Catheter in place for 7-10 days
- Recovery period: at least 1 month
- Incontinence: 5-20% (mostly stress incontinence)
- Erectile dysfunction: 30-50% at 5 years (with nerve preservation surgery)
External beam radiation therapy (EBRT)
Advantages:
- No hospitalization or surgical risks
- Activities unrestricted
- Low risk of urinary incontinence (1-2%)
- Less urinary retention than with brachytherapy
Disadvantages:
- No post-treatment staging information
- Treatment typically 5 days a week for 6-9 weeks
- Fatigue is common
- Erectile dysfunction: 30-50% at 5 years
- Bowel/rectal problems: 5-10% (urgency, pain, diarrhea or bleeding) but typically improve after treatment
- Bladder irritation: 5% (urinary frequency, urgency, discomfort)
Brachytherapy
Advantages:
- No hospitalization or surgical risks
- Less radiation damage to healthy tissue
- One treatment
- Low risk of urinary incontinence (1-2%)
Disadvantages:
- No post-treatment staging information
- Less favorable option for men with intermediate- or high-risk
- Urinary retention, urgency and frequency more common than with other treatments, especially in men with lower urinary tract symptoms before treatment
Also see Prostate Cancer Test Pros & Cons and Is Metastatic Prostate Cancer 'Skyrocketing'?
