For men facing a prostate cancer diagnosis, the landscape of treatment is evolving. While the disease remains common – about 1 in 8 men will be diagnosed in their lifetime, with an average age of 67 – advances in early detection and treatment mean that fewer than 1% of the estimated 3.5 million men living with prostate cancer are expected to die from it.
Understanding Prostate Cancer
Prostate cancer develops in the prostate gland, a small, walnut-shaped organ located below the bladder and in front of the rectum. This gland produces fluid that is a component of semen. While some prostate cancers are aggressive, many grow slowly and may not cause problems for years, or even a lifetime. This variability is driving a shift towards more personalized approaches to management.
Active Surveillance: A Growing Trend
Traditionally, many men were offered immediate treatment upon diagnosis. However, for those with low-risk prostate cancer, research suggests that active surveillance – closely monitoring the cancer without immediate intervention – yields outcomes comparable to surgery or other therapies. Approximately 60% of patients are now opting for this approach, avoiding potential side effects associated with treatment.
Active surveillance involves regular blood tests, imaging, and biopsies to track the cancer’s progression. Treatment is initiated only if the disease shows signs of advancing. This strategy is particularly appealing for men with other health conditions or those who prefer to avoid the potential complications of treatment when the cancer is unlikely to cause immediate harm.
Treatment Options for Aggressive or Recurring Cancer
For fast-growing, localized prostate cancer, surgery and radiation therapy remain standard treatment options. These approaches aim to eliminate cancer confined to the prostate gland. However, these treatments can have side effects, including urinary incontinence and erectile dysfunction.
If prostate cancer returns after initial treatment, hormone therapy is often recommended. This therapy can reduce the risk of death by more than 40%, depending on the stage and recurrence of the disease. Hormone therapy works by reducing the levels of testosterone, a hormone that fuels prostate cancer growth. However, it can also cause side effects such as fatigue, reduced libido, bone mineral density loss, and cardiovascular complications.
Emerging Focal Therapies
In recent years, newer focal therapies have emerged as potential alternatives to traditional treatments for certain patients. These therapies target only the cancerous areas of the prostate, rather than the entire gland, potentially minimizing side effects.
One such option is high-intensity focused ultrasound (HIFU), which uses ultrasound energy to destroy cancer cells. Recovery from HIFU is typically quicker than from surgery or radiation, with less pain and reduced impact on urinary control and sexual function. Focal therapies are generally best suited for localized cancers with intermediate risk.
Who is Affected?
Prostate cancer primarily affects men age 50 and older. However, men with a family history of the disease are at increased risk and may benefit from earlier screening. The decision to undergo screening and treatment should be made in consultation with a healthcare provider, considering individual risk factors and preferences.
The diagnosis can apply to men with low-, intermediate-, or high-risk prostate cancer, as well as survivors experiencing recurrence. Medical experts emphasize the importance of open communication between patients and their doctors to discuss screening recommendations and all available treatment options.
The Focus on Quality of Life
As survival rates improve, the focus is increasingly shifting towards quality of life and personalized care. Determining whether a tumor is aggressive or slow-growing is a crucial step in guiding treatment decisions. The goal is to balance the potential benefits of treatment with the risk of side effects, ensuring that patients receive the most appropriate care for their individual circumstances.
