Treatment of prostate cancer will depend mostly on the stage of the disease. For each stage, there are different options and choices to be made. In the advanced stages, the choices are limited, though men may live many years thanks to the available treatments. On the other hand, there are a large number of options for localized (early-stage) prostate cancer. That means both good and bad news for patients. The good news is that we can obtain excellent results with more than one type of treatment. The bad news is that patients will have difficult decisions to make, based on the pros and cons of the various options and their own priorities.
Why can’t we doctors simply tell our patients what to do? The reasons are multiple: first, patients need to understand the risks of treatment and what we can expect in terms of cancer control. Second, predicting how localized prostate cancer will evolve if left untreated is difficult, but the question needs to be addressed and considered by patients. Third, since early-stage prostate cancer can have a long natural history, we have to look at patients’ life expectancy (influenced by age and other health problems) before deciding on treatment. This isn’t always easy and can sometimes involve an uncomfortable — but necessary — discussion.
In some cases, we may require additional expertise from other specialists to properly evaluate a patient’s health status and life expectancy. The hope is that, through research, we’ll eventually be able to predict more precisely what treatment (if any) would be best for an individual patient. When we get to that point, we may eventually be able to narrow down the choices. While this may help men in the decision-making process, I don’t believe there will ever be a time when physicians will make all the decisions.
