There is no “one size fits all” treatment for prostate cancer, so each man must learn as much as he can about various treatment options and, in conjunction with his physicians, make his own decision about what is best for him. Consultation with all three types of prostate cancer specialists — a urologist, a radiation oncologist, and a medical oncologist — will offer the most comprehensive assessment of the available treatments and expected outcomes.

A man diagnosed with localized or locally advanced prostate cancer has three major treatment options: active surveillance, surgery, and radiation. Choosing the best treatment for localized or locally advanced prostate cancer is generally based on the man's age, the stage and grade of the cancer, the man's general health, and the man's evaluation of the risks and benefits of each therapy option.

During active surveillance, the cancer is carefully monitored for signs of progression. A PSA blood test and DRE are usually administered every six months along with a yearly biopsy of the prostate. If symptoms develop, or if tests indicate that the cancer is growing, treatment might be warranted.

A radical prostatectomy is the surgical removal of the entire prostate gland plus some surrounding tissue. The procedure can produce significant side effects that might affect the quality of life, including erectile dysfunction and urinary incontinence. Improvements in surgical techniques have enabled many urologists to maintain high cure rates while minimizing side effects. Often, the experience and skill of the surgeon can be a major factor in the success of the surgery.

Radiation involves the killing of cancer cells and surrounding tissues with directed radioactive exposure. With external beam radiation, high-intensity beams of radiation are directed at the target area; with brachytherapy, tiny radioactive metal seeds or pellets are surgically inserted into the prostate. Hormone therapy is often given in conjunction with radiation, either before, during, or after treatment. Although high doses of radiation are needed to kill prostate cancer cells, higher doses can also increase the rate of side effects such as urinary problems, erectile dysfunction, and rectal bleeding. Improvements in technology have allowed for very precise targeting of radiation, enabling skilled and experienced radiation oncologists to deliver higher doses to more focused areas while minimizing side effects.

Side effects

The problem with all the above options is that the root cause of the cancer has not been traced. Removing the prostate or the tumor does not guarantee that the cancer will not return. Frighteningly, chemotherapy and radiation have a bad record, and cancer seems to re-occur within three to five years of the majority of cases.

To stop cancer from ever returning, you must completely stop cancer at its source. Cancer is foremost a psychological disease and its appearance in your body is a sign that at a deep level, your life is not working. Unless you approach and treat ALL the areas of your life, cancer is likely to re-occur.

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