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Understanding Prostate Cancer: When Should Treatment Begin?

5 min read


Understanding Prostate Cancer: When Should Treatment Begin?

Prostate cancer treatment looks a little different from other types of cancer treatments. That’s because prostate cancer often develops slowly. Sometimes, it is recommended to wait before starting treatment. This approach is a departure from the urgent nature of treatment for most other types of cancer. Learn why some men wait.

What Influences the Approach to Prostate Cancer Treatment?

Several factors help determine the best treatment method and timing for starting prostate cancer treatment.

  1. Stage of prostate cancer. Prostate cancer can be found early, but sometimes it isn’t detected until it is more advanced. The stage of the cancer gives you an idea of whether the cancer has spread beyond the prostate and will determine the pace and types of treatments that are needed. 
  2. Gleason score. This is a number that tells you how much the prostate cancer cells have changed from healthy cells. If your Gleason score is 8 or above on a scale of 1-10, treatment may be recommended immediately. If the Gleason score is lower (6-7), you may be able to delay treatment. If the score is lower than a 6, cancer is not present.
  3. Type of prostate cancer. There are different types of prostate cancer, and some are more aggressive than others. The most common type of prostate cancer is slow-growing and not very aggressive. If you have one of the rare, aggressive types of prostate cancer, your oncologist may recommend prompt treatment rather than waiting. 
  4. Personal preference. Treatment can also depend on how you feel about the individual treatment methods. Some men want to delay treatment to avoid certain side effects, while others prefer to start treatment as soon as possible. 

Your urologist will review the results of all diagnostic tests and work with you to determine the best treatment approach for your specific prostate cancer. In some cases, surgery is the first recommendation. However, before you schedule surgery, it’s a good idea to talk to an oncologist who specializes in treatment for prostate cancer to evaluate your options and the right timing of each type of treatment.

Related reading: How to Understand a Prostate Cancer Pathology Report

Prostate Cancer Treatment Can Include Watchful Waiting or Active Surveillance

If the cancer is the slow-growing type and hasn’t moved outside of the prostate, watchful waiting or active surveillance may be recommended.

Watchful waiting is most often recommended for older men who don’t want to move forward with treatment. In watchful waiting, you do not treat the cancer. Once the cancer begins to cause issues, such as symptoms that interfere with your daily life, treatment will focus on pain relief and comfort measures.  

Active surveillance is more focused on delaying treatment to avoid side effects and watching the cancer closely to look for progression. With active surveillance, you’ll see your doctor frequently, you will get lab work, and your biopsy may need repeating to determine if the cancer cells have progressed. Based on the test results, your oncologist may suggest a timeline for treatment.

Active surveillance is commonly recommended for men who have:

  • No symptoms
  • A small tumor confined to the prostate gland
  • A slow-growing tumor 
  • A lower PSA level

If any of these factors change or your prostate cancer doctor becomes concerned about the progression of your disease, you can jump quickly into treatment. 

What Are the Benefits of Waiting to Start Prostate Cancer Treatment?

The main benefit of waiting before you start prostate cancer treatment is avoiding side effects from treatment. For example, prostate surgery can cause negative side effects such as urinary incontinence and erectile dysfunction. These are side effects that impact your lifestyle long-term. Radiation therapy can also cause some side effects, however, many of them are usually temporary.

Delaying prostate cancer treatment also allows you to continue living your life mainly the same way you were before. Sometimes, starting cancer treatment can cost you a lot of your energy and time. These drawbacks are not always worth the benefits of treatment when the cancer is in its early stages. 

Common Active Treatment Approaches for Prostate Cancer

If your prostate cancer specialist finds your cancer needs treatment, they may recommend any of the following approaches. 

  • Radiation therapy (internal or external)
  • Hormone therapy
  • Surgery

Radiation Therapy for Prostate Cancer

Radiation therapy uses high-energy rays to kill cancer, and it can be internal or external. Internal radiation involves the placement of radioactive seeds into the prostate. These seeds will then slowly release radiation into the prostate to kill cancer cells. Radiation seeds may be given in high or low doses, depending on your unique situation. 

External radiation delivers radiation from outside of the body. External prostate cancer radiation is usually delivered using 3-dimensional conformal radiation therapy (3D CRT) or intensity-modulated radiation therapy (IMRT). These approaches are for more precision to help prevent damage to the surrounding tissues. 

Hormone Therapy to Treat Prostate Cancer

Prostate cancer growth is fueled by male hormones, so hormone therapy can be used to help reduce male hormone levels. These hormones are also sometimes referred to as androgens. Hormone therapy is usually used in combination with other treatments to help shrink a cancer tumor.

Surgery to Remove the Prostate

Sometimes, surgery is recommended to remove the prostate. Surgery is mainly recommended for men who have cancer that has not grown outside of the prostate, and it may be used in combination with chemotherapy and radiation to optimize treatment. Prostate surgery can cause negative side effects like urinary incontinence and erectile dysfunction, so it may be good to avoid surgery when possible. 

There are other treatments in the research process and others that are already approved for use in specific situations. Your oncologist will review what they recommend and why based on your specific situation.

When is the Right Time to Start Prostate Cancer Treatment? 

Every situation is different, which can make it difficult to pinpoint when exactly prostate cancer treatment should begin. If your test results show your cancer is spreading or your Gleason score is getting higher, this may mean it is time to start treatment. If you are starting to experience symptoms that are interfering with your day-to-day life, this may also be a sign that it is time to start treatment. 

Personalized Prostate Cancer Treatment in Virginia and Eastern North Carolina

Virginia Oncology Associates offers personalized treatment plans for men diagnosed with prostate cancer. If you have additional questions, our oncologists have answered commonly asked questions about prostate cancer and treatment for you to review. Our prostate cancer specialists consider your specific diagnosis and personal preferences before recommending treatment. Our practice serves Chesapeake, Elizabeth City, Newport News, Norfolk, Suffolk (Harbour View and Obici), Virginia Beach, and Williamsburg.

Find a Medical Oncologist at virginia oncology associates