Chart produced by the Wall Street Journal Health Section, comparing treatment options:
|
TREATMENT |
RECOMMENDED FOR |
PROS |
CONS |
|
Active Surveillance: Also known as watchful waiting; no treatment, but continued monitoring via PSA, biopsies, scanning. |
Gleason score below seven, PSA below 10; small, localized tumors; men with less than 10 years’ life expectancy. |
85% of prostate cancers don’t cause problems; no surgery, no hospitalization, no side effects; new imaging techniques allow close monitoring. |
15% of prostate cancers do spread, requiring more aggressive treatment later; requires regular follow-ups; psychological stress. |
|
Prostatectomy: Removal of the prostate gland by traditional open, laparoscopic or robotic surgery. |
Cancer confined to the prostate, men under 65 and healthy enough for surgery. |
Fast cancer removal; gives best information on disease stage; can be followed by radiation. |
Requires hospitalization, urinary catheter for seven to 10 days; erectile and urinary side effects. |
|
External-Beam Radiation: Prostate is bombarded from outside the body with X-rays or proton beams. |
Cancer outside the prostate; men over 70 and those who can’t have surgery. |
No incisions, hospitalization or anaesthesia; few immediate side effects. |
Up to 40 daily sessions; can cause erectile and urinary problems that worsen over time; can cause rectal soreness. |
|
Brachytherapy: Tiny radioactive seeds are implanted in prostate and kill the cancer cells gradually. |
Low and medium-grade cancers. |
One-time, minimally invasive procedure; no hospital stay. |
Urinary and erectile problems can develop over time. |
|
Focal Ablation: Cancer is destroyed by freezing (cryotherapy) or high-frequency radio waves. |
Small, localized tumours that can be seen clearly via imaging or mapping biopsies. |
Minimally invasive; leaves part of prostate intact; can be repeated as necessary. |
Heat and cold can damage surrounding tissue; little long-term data on the procedure. |
|
Drug Therapies: Hormone medications block androgens that fuel cancers; can be combined with radiation or chemotherapy. |
Advanced, high-grade or recurrent cancers. |
Can help halt spread of cancer, shrink enlarged prostate. |
Loss of libido and erectile function; osteoporosis; decreased muscle mass; hot flashes; breast enlargement; diminished mental acuity. |
