A cancer diagnosis brings with it many questions: How advanced is the cancer? Has it spread? How will it be treated? Prostate cancer is no exception, and many men may feel the need to take immediate action after receiving a diagnosis. However, aggressive treatment is not always the best course of action.

“When prostate cancer is found early, there are many effective treatment options available,” says Jonathan Shoag, MD, a urologic oncology specialist at University Hospitals. “However, based on several considerations, one option might be no treatment at all—at least not right away. Instead, we might decide to monitor the cancer’s progression over time. This approach is called active surveillance.”

What is Active Surveillance?

For most types of cancer, immediate treatment is recommended. However, many prostate cancers are slow-growing and less aggressive than other forms of the disease. Often diagnosed at older ages, many men can live with a slow-growing prostate cancer that never causes any symptoms, harm, or lifestyle limitations.

Active surveillance may be an option for men with non-aggressive prostate cancer that hasn’t spread. Instead of treatment, the tumor is regularly monitored for signs of change or growth through blood tests measuring prostate-specific antigen (PSA) levels, MRI scans, and biopsies.

Developing a Personalized Treatment Plan

If diagnostic tests indicate that the cancer is changing, your doctor may start discussing a treatment plan. “At University Hospitals, we refer to these conversations as shared decision-making,” says Dr. Shoag. “It provides a one-on-one opportunity to discuss the available treatment options, their potential side effects, and what to expect throughout treatment and recovery. Most importantly, each patient is encouraged to share their goals and lifestyle expectations as they consider moving forward with treatment.”

“It’s all very personalized,” adds Dr. Shoag. “Every cancer, and every patient, is different. Our primary goal is always to preserve quality of life and minimize treatment side effects, which may include sexual and urinary dysfunction, hair loss, nausea, and fatigue, depending on the type of treatment received.”

Prostate Cancer Treatments

Recommended treatments may include one or more of the following:

Medical Therapy: The most common type of medical therapy is hormone therapy, which reduces testosterone that prostate cancers need to survive. This can be administered orally or as an injection and is often combined with radiotherapy for certain cancers.

Radiation Therapy: High doses of radiation help to slow tumor growth and eventually kill cancer cells. The number of treatments varies for each patient. “At UH, most of our patients undergo stereotactic body radiation therapy (SBRT), a precisely targeted therapy that requires just five treatments,” notes Dr. Shoag.

Surgery: Surgical removal of the prostate gland may be an option if the cancer has not spread beyond the prostate. The procedure, called a radical prostatectomy, removes the entire prostate gland and some surrounding tissues, including the seminal vesicles. Nearby lymph nodes may also be removed during surgery to confirm the cancer has not spread. This surgery is typically done robotically through small abdominal incisions, with minimal post-operative pain, and can be performed as an outpatient procedure or with an overnight hospital stay. “Recent technical modifications, such as the hood technique or pelvic-fascia sparing, have significantly minimized the side effects of prostatectomy,” says Dr. Shoag.

Beware of Experimental Treatments

New ways to prevent and treat prostate cancer are continually being studied. Patients are encouraged to ask their doctors if participation in a clinical trial might be an option. However, Dr. Shoag cautions patients against experimental treatments that are not part of clinical trials. One example is focal therapy. “Unfortunately, this modality is being offered at other institutions outside of clinical trials, which goes against national guidelines and poses significant risks to patients,” warns Dr. Shoag. “The vast majority of patients who receive experimental treatments will experience side effects and may still have cancer afterwards. Many of these men will need additional treatment that wouldn’t have been necessary otherwise.”