Your top questions about prostate cancer treatment, answered

If you’ve received a prostate cancer diagnosis, it’s natural to be worried. But take this to heart: Prostate cancer is highly treatable. The five-year overall survival rate is 97%, according to the American Cancer Society (ACS). That means that 97 out of every 100 men diagnosed with prostate cancer are doing fine five years later.

“The prognosis is quite good,” says Stacy Loeb, M.D. She’s a urologist who specializes in prostate cancer. “There are lots of treatment options available. You and your doctor will work together to choose the best one for you.”

You probably have questions about what lies ahead. Most prostate cancers are slow growing, which means you have time to decide on the right treatment. It’s important to talk with your doctor about the risks and benefits of each treatment option, according to the American Society of Clinical Oncology (ASCO).

Here are some key ones to ask.

What kinds of experts will treat me?

It won’t be just one doctor. You’ll have a group of doctors, nurses, and other medical professionals who will work together throughout your treatment. This is known as your cancer care team. Members might include:

• Urologist: A doctor who treats diseases of the urinary and male reproductive systems (including the prostate).
• Radiation oncologist: A doctor who treats cancer with radiation therapy.
• Medical oncologist: A doctor who treats cancer with medicines such as chemotherapy, hormone therapy, and immunotherapy.
• Nurses: They’ll do physical exams, give you medications, and answer your day-to-day questions.
• Registered dietitian: They’ll help you choose foods to build up your strength and cope with side effects such as nausea or vomiting.
• Mental health professional. Mental health experts help you cope with the stress of cancer. You might see a psychiatrist, an oncology social worker, a psychiatric nurse, or a licensed counselor.

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Why type of prostate cancer do I have? And what should I understand about it?

There are many varieties of prostate cancer. And there are many types of treatment, too.

“Treatment varies according to your individual cancer,” says Dr. Loeb. “It’s really important to learn about the specific features of your case.”

You’ll be hearing lots of numbers connected to your diagnosis. Those numbers help your doctors decide how serious the cancer is and how to treat it:

• Prostate-specific antigen (PSA) level: PSA is a protein produced by prostate cells. It will be your baseline number based on a blood test at diagnosis. The PSA test is initially used as a screening test to help determine if you might have prostate cancer, and whether you need further tests. But it is also useful once you’ve been diagnosed, says the ACS. Your doctor uses your PSA level to track the progress of your treatment and watch for recurrence.
   
• Grade: When you had a biopsy, your doctor removed tissue from your prostate, then examined it under a microscope. The result is your Gleason score, a number from 6 to 10. Some doctors may use the Grade Group instead, which ranges from 1 (lowest) to 5 (highest).
   
• Stage. Doctors use the Gleason score and PSA level, along with results from other tests and scans, to determine what stage the cancer is. Stages range from 0 to 4, according to ASCO. The higher the number, the more advanced the cancer is.

What are my treatment options?

Once your doctor knows your numbers, you can have a conversation about your treatment.

If you’re at low risk: If your cancer is only in the prostate and your Gleason score is low, your doctor may recommend a strategy called “active surveillance.” Even though prostate cancer treatments are effective, the side effects can be tough. So, if your numbers show that you are low risk, your doctor may suggest a wait and see approach.

“Active surveillance means no upfront treatments,” says Dr. Loeb. “We monitor the cancer carefully over time.”

Expect to repeat your PSA test every six months, get a yearly exam, and have a biopsy every one to five years. A new study showed that 97% of those diagnosed with early-stage prostate cancer were still alive 15 years later, whether they’d received treatment or not.

The term “watchful waiting” is sometimes used to describe a less intensive follow-up, with less testing, according to the Cleveland Clinic.

If you’re at medium risk: This is when your cancer hasn’t spread but your Gleason score is higher. In this case, the gold standard for treatment is surgery or radiation therapy, says Dr. Loeb.

• Radiation: A computer will take a three-dimensional image of your prostate. Then your radiation oncologist will use that information to plan your treatment. They’ll send high-energy X-ray beams to your prostate, killing cancer cells but leaving everything else untouched.
  
  You might receive external-beam radiation therapy, which uses a machine aimed at your prostate. Or you may receive brachytherapy, which is internal radiation. A radiation oncologist places radioactive seeds inside your prostate. They stay in there, sending out radiation, until they die off.
   
• Surgery: If your health is pretty good, your doctor may suggest surgery. The surgeon will remove your prostate and surrounding tissues.

If you’re at high risk: You fall into this category if your cancer has spread beyond your prostate into surrounding organs. Dr. Loeb says there are still many effective treatment options. “The prognosis is better than ever,” she points out. “It’s a really hopeful time for men with advanced prostate cancer.” Among your treatment options:

• Hormone therapy: Prostate cancer is supercharged by male hormones called androgens, especially testosterone. Androgen-deprivation therapy slows your cancer’s growth. You’ll receive injections at your doctor’s office or take pills at home.
   
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It can help you live longer, improve your quality of life, and reduce pain.

What are the side effects?

There are advantages (and disadvantages) to every kind of treatment. Talk to your doctor about your concerns — there’s almost always a solution. Here are some common side effects for the different treatments:

Active surveillance: You may feel anxious, which could make you jump into treatments you don’t really need. Finding ways to cope with emotional stress is important.

Radiation: After radiation, you may experience urinary and bowel irritation, plus problems with erections.

Surgery: You may have issues controlling your urine. Normal bladder control usually returns in a few weeks or months, according to ACS. Erection problems are also common.

Hormone therapy: Side effects range from hot flashes and mood swings to weight gain, muscle loss, and erectile dysfunction.

Chemotherapy: Modern drugs often make chemotherapy easier. Side effects may include hair loss, fatigue, and numbness in your fingers and toes. Your doctor can treat most of these issues.

Remember that it’s important to keep the lines of communication open with your cancer care team as you begin treatments. Don’t be afraid to speak up if you’re confused, concerned, or simply have questions. Your care team will be there to support you.

Additional sources:
Prostate cancer statistics: American Cancer Society
Treatment risks and benefits: American Society of Clinical Oncology
PSA test: American Cancer Society
Prostate cancer stages: American Society of Clinical Oncology
Screening for prostate cancer: American Cancer Society
Study on early-stage prostate cancer: New England Journal of Medicine
Watchful waiting: Cleveland Clinic
Surgery side effects: American Cancer Society

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.