Low-Risk Prostate Cancer

Don’t rush to get treatment

If you are diagnosed with prostate cancer, you should discuss treatments and quality-of-life issues with your cancer care team.

Your team should include a urologist and a radiation oncologist. You can also get helpful advice from a medical oncologist.

Common treatments are surgery and radiation. However, there is another approach to learn about. It’s called “active surveillance” or “watchful waiting.” It’s for men with low-risk prostate cancer. In active surveillance, your team watches your condition closely. If tests show that it’s getting worse, you will get treatment. Discuss active surveillance with your team. Here’s why:

Treatment isn’t always needed.

Many men with low-risk prostate cancer are treated immediately, with surgery or radiation. Treatment is not necessary for many patients. And it can cause sexual, urinary, and bowel problems.

Often, prostate cancer is low-risk.

Many prostate cancers are found with a PSA blood test. Often these cancers are low-risk. This means:

  • The tumor is small.
  • It is contained within the prostate.
  • It is probably growing so slowly that it will not become life-threatening.

Usually a man with low-risk prostate cancer dies of something else, even if he doesn’t get treatment.

Active surveillance may help your quality of life.

With this approach, you have regular checkups, including a PSA test and rectal exam. You’ll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.

Active surveillance is a good choice for many men with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.

Treatment can have serious side effects.

Side effects from surgery or radiation may include:

  • Impotence—not getting erections that are firm enough for intercourse.
  • Leaking urine. There may be complete loss of bladder control, but this is less common.
  • Frequent, urgent, bloody, or painful bowel movements.

Treatment can be expensive.

Medicare costs for prostate cancer surgery are about $13,000, according to www.HealthcareBlueBook.com. Radiation treatments cost $10,000 to $17,000. These treatments are covered by most insurance plans. You usually pay a part of the cost. Complications and side effects can cost more.

When should you get immediate treatment for prostate cancer?

If your cancer is advanced or higher-risk, you will probably need treatment right away. Signs of higher-risk cancer include:

  •  PSA value that is high or rapidly rising.
  • Test results show that the tumor is outside the prostate gland. Or the tumor is growing rapidly and is likely to spread outside the gland.
  • Gleason score is high-risk.

Ask your team if your cancer shows any of these signs. If so, active surveillance may not be a good choice.

Talk to your cancer (oncology) care team.

Your team is an important source of advice. Some men may benefit from having a low-risk tumor treated right away, even if they might have side effects. Discuss your treatment options and quality-of-life issues with your team.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2014 Consumer Reports. Developed in cooperation with the American Society for Radiation Oncology.