A better question might be, “Which treatment is right for me?” There are several important considerations here: Your age and overall health, the stage of cancer, the side effects associated with different treatments, and finally—most importantly—your own wishes.

When prostate cancer is localized in men with a life expectancy of 1o years or more, the goal for treatment is cure. This sounds obvious, until we remember that when prostate cancer is advanced, cure is no longer an option. In other words, if we don’t remove the disease or treat it effectively when it’s localized —if the cancer gets outside the prostate—we can’t stop it.

The big advantage of radical prostatectomy is that there is no better way to completely eliminate cancer that is curable (see above). The disadvantages are the side effects—namely, the risks of impotence and incontinence. And radical prostatectomy is not “a walk in the park.” It is major surgery, and the body must be in strong enough shape to handle it.

Radiation therapy’s great advantage is that it isn’t surgery. But its major disadvantage, especially for the younger patient, is that its ability to control the cancer may not last forever. Many studies have suggested that with standard radiation treatment—external-beam therapy—there is a strong likelihood that a prostate biopsy a few years later will be positive. These studies have also suggested that the likelihood that PSA will be in the undetectable range ten years after radiation is only 10 percent. In contrast, a large study at Johns Hopkins showed that the likelihood of PSA remaining in the undetectable range ten years after surgery was 70 percent.

In choosing the treatment that’s best for you, it’s important to try for a balance between effectiveness and side effects. More information on each of these choices follows in this chapter, and the next chapters cover these treatments in significantly greater detail.


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