The American Cancer Society reports that about one in eight men will be diagnosed with prostate cancer in their lifetime. The average age of men who get diagnosed is 67.
Today, less than 1% of the 3.5 million men living with prostate cancer are expected to die from it.
“The big question is, which are the types that can be ignored, and which are the types that need action?” asks Dr. David Schuster, director of the division of nuclear medicine and molecular imaging at Emory University School of Medicine.
A 2023 study discovered that men who didn’t do any treatment, called active monitoring, lived just as long as men who did, and today, 60% of patients choose to forgo treatment without any life-changing side effects.
“What we do in our field is try to determine which types need action and to help guide the action by finding the areas of cancer,” explained Schuster.
Fast-growing localized prostate cancer can be eradicated with surgery and radiation, but:
“Men traditionally have severe urinary incontinence and erection issues after radiation when we’ve taken their prostate out,” said Dr. Zeyad Schwen, a urologic oncologist at Cleveland Clinic.
For patients whose cancer returns, hormone therapy can reduce the risk of death by over 40%.
“The hormonal therapies have a lot of side effects. They have fatigue, low libido, bone mineral density loss, there are cardiovascular side effects,” Schwen told Ivanhoe.
And for patients who want to avoid both hormonal therapy and surgery, salvage HIFU kills the cancer with ultrasound ablation.
“The recovery time is much quicker. There’s almost no pain. Also, the urine control and the sexual function usually is minimally changed,” said Schwen.
How fast a cancer is growing can greatly change options. Focal therapies, which don’t target the entire prostate, are best used in localized cancers that have an intermediate risk. And while surgery and radiation have intense side effects, younger men and men without significant health problems have an easier recovery.
Active surveillance and watchful waiting are other options to ask your doctor about.