Should I continue active surveillance or pursue treatment for prostate cancer?

My guess is that if you have tested positive for prostate cancer, unless you die quite young from other causes, you will need treatment. And better to have it now, rather than when you get older and more frail. I am 79 and have have two out of the five radiation treatments I will get within a three week period at Memorial Sloan Kettering Cancer Center in NYC.

This decision between continuing active surveillance and pursuing treatment is one many face, and the anxiety about having cancer is completely understandable. Both the physical aspects of your diagnosis and the mental peace aspect are important factors that deserve discussion with your medical team, who can help weigh the benefits and risks of each approach based on your specific situation. Many in this community have navigated similar crossroads, so sharing experiences here might provide valuable perspectives as you work through this decision with your doctors.

Well, Gerard, given my nightmare experience following EBRT and ADT two years ago, I dearly wish I’d elected no treatment and taken my chances with the cancer. I was diagnosed in 2023 at age 74, treated at 75, now 77. During all this period I’ve been a super-fit athlete and world-ranked age-group marathoner. Cancer has never caused me so much as an itch. Cancer treatment has caused an endless cavalcade of urinary, bowel, and sexual debilitations that have me spending half my waking hours in bathrooms and the other half in the offices of specialist physicians who’ve been unable among them to come up with even a single means of alleviating a single adverse impact. If I had it to do over, I wouldn’t be the least bit concerned about the presence of cancer cells that are having no perceptible adverse impacts on my body or my life.

I can understand how frustrating the side-effects of treatment are. And if you only live to 80, it might be that you would have been better off without treatment. But if you live to 90 and you opted out of treatment, it seems likely to me that that cancer would have kept growing and growing, not only causing increasing problems by squeezing your urinary tract, but would have metastasized, creating new tumors through your body. I wonder if you have an adequately expert team of physicians. I felt no symptoms from the prostate cancer, biopsy, surgery to inject the spacer gel, or first dose of radiation. But after the second of the five radiation treatments I will get at Memorial Sloan Kettering Cancer Center in Manhattan, I was finding it uncomfortable to urinate, I was urinating way to often, and my stream was weak and slow. I was told this was from radiation-induced prostatitis, and I should take an over-the counter NSAID to reduce the pain and inflammation and got a scrip for Flo-Max. That worked. But if it hadn’t, I could have taken another drug to relieve the symptoms. Of course the hormone therapy significantly impacts the existence you’re having, but it surprised me to hear that you weren’t given meds (and guidance on diet and supplements) to reduce your symptoms.