An estimated one in eight men will be diagnosed with prostate cancer in their lifetime, often after 65. And as terrifying as that number is, a diagnosis isn’t always quite what it seems. Today, the vast majority of patients will survive the disease — and a growing number of men are living out their lives without ever undergoing treatment.
Since the late 1980s, doctors have been able to detect most prostate cancers using a simple and inexpensive blood test, called P.S.A., that identifies proteins called prostate-specific antigens. The test revolutionized how prostate cancer is diagnosed, allowing doctors to spot it when it is most treatable. By 2021, nearly 98 percent of prostate cancer patients were still alive at least five years after diagnosis.
Traditional treatments for prostate cancer, including radiation therapy and a surgery to remove the entire gland — have long been effective but often come with life-altering costs.
Today, however, new technologies and treatment methods are expanding men’s options. Here’s what you should know about your choices for prostate cancer care.
Surgery and Radiation
For patients with large, fast-growing tumors that have not yet spread beyond the prostate, surgery and radiation remain the best frontline treatments — and both are effective at eradicating the disease.
What these patients choose, then, is “not so much the efficacy of the treatment, but the side effects they are prepared to put up with,” said Dr. Freddie Hamdy, the head of the department of surgical sciences at the University of Oxford.
Most men who have a prostatectomy experience some degree of erectile dysfunction and urinary incontinence, particularly in the immediate aftermath of surgery. (New surgical techniques, however, are helping minimize this.) Men who undergo radiation are somewhat less likely to experience erectile or urinary issues, but slightly more likely to develop bowel problems or other types of cancer.
Younger men, and those without other significant health problems, can recover more easily from a prostatectomy — while older men, or those with certain conditions, like heart disease, may not be suitable candidates.
Active Monitoring
Until about 15 years ago, most men diagnosed with prostate cancer — no matter how aggressive — underwent surgery or radiation. But that’s changed. Research has shown that patients often have similar survival rates with “active monitoring,” where doctors delay treatment and regularly check on slow-growing tumors.
The findings have been “quite a surprise” to many experts, Dr. Hamdy said, the lead researcher on the study. Many men with low-risk cancers — who make up about 43 percent of new diagnoses — can go the rest of their lives without experiencing harm to their health from their tumors, he added.
As a result, today nearly 60 percent of patients with low-risk cancers choose active monitoring instead of treatment — up from 26 percent in 2014. Some experts believe that number should be higher.
Dr. Hamdy said a lot of patients struggle with the idea of “living with cancer for the rest of their lives,” even if it’s low risk. But treatment has risks too, and one 2023 review found nearly 20 percent of men regretted their prostatectomy because of the side effects.
“If I take your prostate out, or you get radiation, I can guarantee that you will have side effects from your treatment,” said Dr. Kristen Scarpato, director of the urology residency program at Vanderbilt University. “But I can’t guarantee that I’m benefiting your life expectancy.”
Focal Therapy
While surgery and radiation therapy focus on the entire prostate, focal therapy is any treatment that targets the part of the gland with cancerous cells, while sparing the rest. Urologists use a variety of techniques, like high-intensity ultrasound waves, cryotherapy (freezing the tumor) and laser treatment.
Focal therapies have shown promise in early trials, Dr. Scarpato said — though she added it’s still considered experimental and lacks data demonstrating its effectiveness. (Several randomized controlled trials are currently underway.)
Dr. Scarpato — who specializes in focal therapy — said it often had fewer side effects than traditional treatments, but cautioned that it wasn’t right for everyone. The “ideal candidate” for focal therapy, she said, would be a man with intermediate-risk tumors confined to a single area clearly identifiable on an M.R.I. scan.
Unlike surgery and radiation, focal therapy often doesn’t remove a patient’s cancer completely, so it does have a higher chance of returning.
Advanced Imaging
Not long ago, P.S.A. tests typically led directly to a biopsy, in which urologists took random samples from across the prostate. This method, however, often risked missing high-risk tumors or flagging lower-risk ones — potentially leading to unnecessary treatment.
An advanced imaging tool, known as a multiparametric M.R.I., has been “transformative” for the field over the last decade, Dr. Scarpato said. Though not yet universally available, the scan helps experts focus on clues associated with aggressive tumors, like certain tissue abnormalities or a lack of blood flow. The American Urological Association recently changed its guidelines to recommend this scan, where available.
Hormone Therapy
A type of hormone therapy, called androgenable deprivation, helps reduce the likelihood that a cancer will reoccur or spread to other parts of the body.
However, the therapy is “really challenging for patients,” Dr. Scarpato said, since it causes testosterone levels to plummet. “When you take away a man’s testosterone, even temporarily, the quality of life implications are really significant,” she added. Low testosterone can lead to depleted energy, sexual dysfunction, brain fog, muscle loss and fat gain, among other issues.
New A.I. tools are helping experts predict which men have the most aggressive forms of the disease, and thus most likely to benefit from hormone therapy and who may be able to avoid it.
The goal today with hormone therapy, as in prostate care more generally, is to spare patients from debilitating side effects, Dr. Hamdy said. And to “target treatments to the patients who need it.”
David Dodge is a freelance writer focusing on health, wellness and L.G.B.T.Q. issues.
The post To Treat Prostate Cancer, There Are More Options Than Ever appeared first on New York Times.
