At the 2008 Prostate Cancer Conference, PCRI launched a new initiative and pamphlet to emphasize the need for a patient to fully evaluate his risk factors in determining whether (and when) treatment is in the his best interest. The following contains the text of the pamphlet with links to PCRI Papers that expand on the concepts presented. If you have questions, please contact the PCRI Helpline.
Prostate Cancer is Different from Other Cancers
Not all forms of prostate cancer are life-threatening. As a result, not all prostate cancer requires treatment. The need for treatment is determined by a man’s “Risk Level.” Men with the Low-Risk type of prostate cancer can safely be monitored without treatment. Men with Intermediate-Risk or High-Risk disease usually do require treatment.
Good news: Even with High-Risk Prostate Cancer, Survival is Excellent
Compared to other cancers, prostate cancer has an excellent 10-year survival rate. With High-Risk prostate cancer, 95 out of 100 men are still alive in 10 years.1 Remarkably, men with Low or Intermediate-Risk disease are not at any increased risk for dying of prostate cancer within the first 10 years after diagnosis.2
Take Time to Make the Best Choice — Don’t Panic
Many men wrongly believe that they have to get treatment fast when they hear they have prostate cancer. Fear makes them leap without looking at their options. They don’t realize that this disease tends to grow much more slowly than other cancers. Also, prostate cancer is usually found very early.
That means you have time to learn about your disease and your treatment options. Then you will be equipped to make the choices that are best for you.
Sexual Performance Can be Affected by Treatment
Treatments for prostate cancer can have serious risks. Treatments can cause problems like difficulty holding urine or trouble getting an erection. One study of over 1200 men showed that two years after surgery 78% of men were impotent and 10% were permanently incontinent.3 These problems can make a big difference in your daily life.
Active Surveillance May Be Your Best Option
Studies now show that if you have Low-Risk disease, you only need regular checkups instead of having immediate surgery or radiation. Following the approach of monitoring rather than immediate treatment, more than half of men with Low-Risk tumors have not required treatment five years later.4
In another study of Low-Risk disease, men who received immediate treatment were compared with men who only got checkups until the cancer became higher risk. The outcome was the same in both groups.5 However, the men who waited were able to avoid treatment for years (and its side effects) until they really needed it.
Waiting is not right for every man with prostate cancer, but it’s a good option for men with Low-Risk disease.
Find Out Your Risk Level — “Your Type”
Before selecting treatment the first thing to learn is your personal “Risk Level”.
The chart below shows the way doctors measure Risk Level. You can compare your own test results to this chart to understand your Risk Level.
- To be “Low-Risk”, all your results must meet the Low-Risk standards in the green row in the table below. Even one result outside the green means you are either Intermediate-Risk (Yellow)
- Not all experts agree on the exact line between Intermediate-Risk and High-Risk.
- Some say that having two or more scores in the Intermediate range raises the risk to High.
- Others believe that you are not High-Risk until you have one or more tests that are clearly in the High-Risk range.
Many Types of Treatment
Systemic therapy (Treatment that affects the whole body including the prostate)
- Testosterone Inactivating Pharmaceuticals (TIP) also called “androgen blockade”. These are drugs that keep the male hormone testosterone from stimulating prostate cancer growth.
Local therapies (Treatment that only affects the area near the prostate)
- External Radiation therapy
- Seed implants
Treatment Selection Based On Risk
Men who are in the Low-Risk Category can forgo immediate treatment and simply monitor their situation in a program called Active Surveillance. This consists of regular PSA testing, prostate exams and periodic repeat biopsies.
Men with Intermediate-Risk disease usually start with one kind of treatment, local or systemic. Doctors call this “monotherapy,” which is Greek for “one treatment.” Men with High-Risk prostate cancer generally get two or more kinds of treatment. For instance, the doctor might use TIP and radiation. Doctors call this “combination therapy.”
Side Effects Matter
Since prostate cancer is not nearly as life-threatening as other cancers it is important to focus on the possible side effects of treatment. All treatments can have side effects. Some of these effects never go away, even after you stop the treatment.
There is no convincing evidence of a difference in survival with the different monotherapies. Therefore, your concern about selecting the best type of treatment should be focused on which side effects you most want to avoid. Combination therapy should be reserved for High-Risk disease because two treatments cause more side effects than one.
Where to Learn More
Talk to your doctors. Visit a support group. Many men in support groups will gladly share their experiences and knowledge. Visit our website at www. pcri.org, or contact the PCRI helpline via email email@example.com or phone 800-641-PCRI.
As you learn more, you can make better choices and feel more confident about them.
1. Mayo Clinic Validation of the D’Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. Journal of Urology Vol. 179 page 1354, April 2008.
2. Long-Term Survival Rates of Patients with Prostate Cancer in the Prostate-Specific Antigen Screening Era: Population-Based Estimates for the Year 2000 by Period Analysis. Journal of Clinical Oncology Vol. 23 page 441, January 2005.
3. 5-Year Urinary and Sexual Outcomes after Radical Prostatectomy: Results from the Prostate Cancer Outcomes Study. Journal of Urology Vol. 173 page 1701, May 2005.
4. Active Surveillance for Prostate Cancer: For Whom? Journal of Clinical Oncology Vol. 23 page 8165, November 2005.
5. Expectant Management of Nonpalpable Prostate Cancer with Curative Intent: Preliminary Results. Journal of Urology Vol. 167 page 1231, March 2002.