If you do get "the call", with the urologist saying that your biopsy results show you have prostate cancer, what do you do next?

• Don’t panic. Most of us will survive our prostate cancer, especially if it's found at a relatively early stage.
• Get educated. In order to pick from the range of treatment options available, you need to know what they are and understand them.
• Ask questions. You also need to know the details of your individual cancer. These include:
• Stage: Is the cancer confined to your prostate? If it has spread, how far has it gone?
  

• Grade: Also known as your Gleason score, this number describes how aggressive your cancer is. Gleason scores run from one to ten, with ten being most aggressive.

Once you have this information in hand, you can make an informed choice about your treatment.

Treatment options
Once we are diagnosed with prostate cancer, we can then begin to consider our treatment options. Listed below are the standard treatments. Talking about each one with your healthcare team will help to put you at ease. Information, after all, is power.

Surgery: Surgery is considered a good choice for those of us whose cancer has not left the prostate. (Once prostate cancer has metastasized, surgery is no longer a curative option.)

A radical prostatectomy--removal of the prostate and surrounding lymph nodes--is the most common choice of treatment for those of us under age 70. Nowadays, many of these surgeries are done via laparoscopy, which requires only tiny incisions in the abdomen.

Research shows that survival rates after surgery are similar to survival after external radiation, although some studies show surgery wins out 15 to 20 years down the road.

External radiation: Radiation aims to stop cancer cells from growing and dividing, while at the same time leaving healthy cells unscathed.

To do this, radiation oncologists now rely on techniques such as 3-D conformal radiation therapy and intensity-modulated radiotherapy, which use computerized X-rays to produce detailed pictures of your prostate and surrounding area, including three-dimensional images of your tumor. Then, the radiation is delivered precisely to the affected area in the prostate.

Internal radiation: With internal radiation, also called “brachytherapy,” doctors insert about 125 permanent radioactive seeds into your prostate. The seeds deliver high doses of radiation to the prostate without damaging surrounding tissues. Doctors say the best candidates for this kind of treatment are those of us whose:

• Cancer is limited to the gland and not very aggressive
• PSA level is less than ten
  
• Gleason score is less than or equal to six
• Digital rectal exam showed little or no abnormalities

Clinical studies have shown that 90% of those who undergo brachytherapy will be disease-free for at least seven years.

Hormone therapy: Because prostate cancer tends to grow when it's exposed to male hormones (androgens) such as testosterone, hormone therapy works to stop the production of androgens. Hormone therapy is given either via injection or in pill form; for some of us, castration (the removal of the testicles) may be recommended.

Hormone therapy is not a cure for prostate cancer; it is used primarily to slow a tumor's growth. In most of us, it will be used as an adjunct to surgery in hopes of achieving better results.

Cryotherapy: This option uses extreme cold to destroy cancer cells in the prostate, especially in the early stages or after unsuccessful surgery and radiation.

In cryotherapy, metal rods are inserted into the prostate, and liquid nitrogen is circulated through them to lower the prostate's temperature to -374° F. As the tissue freezes, ice crystals kill the cancerous cells. A catheter is placed inside the urethra and a warming solution is circulated to prevent damage to the urethra.

Short-term results have been positive, but long-term results aren’t as good as with surgery or radiation.

Chemotherapy: Chemotherapy isn’t very effective in fighting early prostate cancer. These highly toxic chemicals are usually reserved for those of us whose cancer has returned or those who have very advanced prostate cancer.

Watchful waiting
Some doctors will recommend watchful waiting for those of us who are older, and whose cancer is so slow-growing that it is not likely to become fatal. Those of us who choose this option will be monitored, and active treatment will begin if our PSA levels start to rise.

See also

• Prosate cancer - introduction
• Prostate cancer - symptoms
• Prostate cancer - causes and risk factors
• Prostate cancer - detection
• Prostate cancer - diagnosis
• Prostate cancer - coping with the aftermath
• Prostate cancer - finding support