What are the best non-surgical treatment options for prostate cancer?

There are several non-surgical options that doctors commonly consider for intermediate prostate cancer, including radiation therapy techniques like external beam radiation and brachytherapy, as well as hormone therapy or active surveillance in some cases. Each treatment approach has different considerations for side effects and quality of life, so discussing your specific priorities and concerns with your medical team on Tuesday will help you understand which options might be most suitable for your particular situation and goals.

Hey Robert. I was diagnosed with unfavorable intermediate PC December 19. I have had biopsy, CT Scan and PET scans done by the end of January and had consults at the Mayo Clinic and Cleveland Clinic. After talking with a few others who have had either the Robotic Prostatectomy or Radiation all have said having a good mental state and support system is key to get through what ever treatment option you decide. With that said, the research I have done and the doctors I have talked to, have indicated surgery is the preferred treatment option. If the cancer should come back in the future, I have more treatment options available. If I did the radiation treatment first, then surgery is off the table in the future and options are limited. I am 58 yrs old, and seeing my youngest daughter get married and my grandchildren grow up also influenced my decision on surgery. I am just waiting on a surgery date now. Another suggestion is to write down questions, so you don’t forget to ask. Hope this helps and good luck with your journey.

Thank you for that. Very thoughtful reply Chris. My oncologist said the one issue with surgery is the potential for not being able to maintain or to erection or get an erection again. Sorry if this is to specific, but I don’t feel ready to give that up and radiation and other protocol may be less risky in that area. What I’m learning is, it seems like there are trade-offs, depending on the type of treatment. I just wanted to bring that up in case for some reason you weren’t aware of some of the complications of surgery. Be well.

Thank you Robert. Yes, that is something I thought about, and the doctors I have seen have mentioned the potential of ED issues. For me, we broke it down to two phases to the recovery (1) Urinary function, aware there will be some leakage in the first 6-8 weeks after surgery. At my 6 week appointment we focus on (2) Erectile Function as that can last as long as 2 years. Of course, each body responds differently. I forgot to mention in my earlier post that when I was diagnosed; I researched pre surgery exercises and consulted with my physical therapist and urologists to identify what I should do before treatment. So I have been losing weight (which has a significant impact)and started doing kegel/pelvic floor exercises which should help shorten my recovery time.

I had PSA of 6.5 then increasing to 10.5 within 5 months. In-between these readings I had biopsy with Gleason 4 + 4. After the 10.5 I changed urologist and got a biopsy of 4 +3. My uncle passed from PC. I choose surgery as stated by others surgery cant be performed after radiation. My after surgery pathology showed positive margin and 1 nodal spread. PSMA was negative. Next was 37 treatments to prostate bed and lymph mode along with 2 years ADT. PSA went from .34 to .54 after surgery and before radiation. Now <.04. So many different possibilities mostly out of oncologists absolute control. Family history was final decision.

Hello, Robert … plus maybe Chris and Timothy; this is Dave Stauffer, Denver, and over the past two years I’ve been navigating, deciding, executing, and experiencing consequences and outcomes of my treatments. We four are a small sample size, yet we demonstrate the complex, even bewildering, range of choices. My PCa is Stage 1, Gleason 4+4, PSA 6.7, and just one tiny speck of cancer (0.83 mm) in one core with no metastasis. I did 42x radiation and 4 months ADT. Results to date are essentially negatory, with numerous and continuing side effects, no hormonal or sexual recovery, such that I just launched TRT with doctors okaying but not approving. I’m guessing the big difference for me versus you three is my age: 77 in 2 weeks (diagnosed at age 74 1/2). I’m gambling with TRT b/c of my fitness (I was a world-ranked marathoner) and my PSAs so far holding at <0.01. Plus, let me get real: Age 77 means highly likely to live 5 years post-diagnosis…highly UNlikely to live 10 yrs. So I die in my early 80s … big deal! So do a healthy share of the world’s men who are cancer-free. All of this is by way of saying (again) how complex and multitudinous are our options and conequences. Robert, I hope you’ll continue to post your own choices and results.

Hi all, I think each of you for your remarkably candid and generous hearing of experience and information. What I’m learning by your responses is how much we are not told about treatments, not with malice, but just I suppose it affects everyone differently. Treatments seem to vary so much. I’m seeing a young urinary oncologist at Northwestern medicine here in Chicago. Yesterday I went and prepared to understand what my treatment options were, and he suggested that my whopping 27 PSA may have been an anomaly and that we should retest it now that it’s six weeks past my biopsy. The retest had it drop to just under eight. This moved me into the favorable intermediate category instead of unfavorable. The pet scan a week ago, showed two tumors, confined to my prostate, no spread. To my surprise, the oncologist recommended that I stay in observation mode. He said all the treatments have side effects and I should play it out as long as I can safely before going down the path of radiation or surgery. I much appreciated this honesty. They will do either radiation or surgery if I want to remove the tumors. But I am opting to wait, and get tested every six months with a biopsy once a year. I do have a bladder biopsy in two weeks, based on a small mass on my bladder lining, to rule that out. Any thoughts on me monitoring waiting this out? I’m still active and in the mindset of what if they say never grow? But actually, I will need treatment but maybe something new will come out if I can hold off. Thoughts? Thanks so so much

Robert—Hooray!! I agree 100%, in light of the new findings. And I’m pleasantly surprised your advisor would dare to state the case for monitoring. You may want to scan my recent post with the headline Key Considerations for the Newly Diagnosed, which gets into the U.S. medical-industrial complex’s extreme bias for over-treatment. — Dave Stauffer, Denver CO

I forgot to add pathology showed a Gleason 5. ( how i forgot to include i don't know ). Goes to show there's no definitive pre surgical determination on which to choose other than as I noted my uncle died of PC and that was my final deciding issue. I would say my prostate went from localized to advanced rather quickly. I believe I made the correct choice.