Low-Risk Prostate Cancer

If you are diagnosed with low-risk prostate cancer, you should discuss treatments and quality-of-life issues with your cancer care team.

Prostate cancer is often treated by urologists and/or radiation oncologists.

Common treatments are surgery and radiation. However, there is another approach to learn about. It’s called “active surveillance.” It’s for those with low-risk prostate cancer.

In active surveillance, your team watches your condition closely. If tests show that it’s getting worse, you will get treatment. Discuss active surveillance with your team.

Treatment isn’t always needed.

Many with low-risk prostate cancer are treated immediately, with surgery or radiation. Treatment is not necessary for many patients and it can cause sexual, urinary, and bowel problems.

Often, prostate cancer is low-risk.

Many prostate cancers are found with a prostate-specific antigen (PSA) blood test. Often these cancers are low-risk. This means:

• The tumour is small.
• It is contained within the prostate.
• The PSA blood test is not very high (less than 10).

For most with low-risk prostate cancer, the tumour is probably growing so slowly that it will not become life-threatening. Usually a man with low-risk prostate cancer passes away of something else, even if he doesn’t get treatment for prostate cancer.

Active surveillance may help your quality of life.

With this approach, you have regular checkups, including a PSA test and rectal exam. You’ll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.

Active surveillance is a good choice for many with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.

Treatment can have side effects.

Side effects from surgery or radiation may include:

• Impotence—not getting erections that are firm enough for intercourse.
• Leaking urine. There may be complete loss of bladder control, but this is less common.
• Frequent, urgent, bloody, or painful bowel movements.

If your cancer is advanced or higher-risk, you will probably need treatment right away. Signs of higher-risk cancer include:

• PSA value that is quite high or rapidly rising.
• Test results show that the tumour is outside the prostate gland. Or the tumour is growing rapidly and is likely to spread outside the gland.
• Gleason score is high-risk.

Ask your team if your cancer shows any of these signs. If so, active surveillance may not be a good choice.

Talk to your cancer (oncology) care team.

Your team is an important source of advice. Some may benefit from having a low-risk tumour treated right away, even if they might have side effects. Discuss your treatment options and quality-of-life issues with your team.

Choosing a treatment for prostate cancer:

Most with low-risk prostate cancer have time to think about their choices. These tips may help you reach a decision.

Review your health history. Give your cancer care team your full personal and family medical histories. Ask how your age and general health could affect treatment. Ask if you have any condition that might increase the risks of treatment, for example, conditions such as diabetes, heart problems, or bowel disease might increase your risk of sexual, urinary, or bowel problems.

Think about your values. Discuss these questions with your spouse or partner:

• Do I want to get rid of my cancer, even if I might have sexual or urinary problems?
• Which side effects would upset me most?
• Would I be okay with active surveillance, even if I am worried and have to see a health care provider more often?

Find out all of your treatment options. Ask your health care providers about each choice, including benefits and side effects. Some health care provider only suggest the option they know best. Typically:

• A radiation oncologist can discuss active surveillance and radiation treatment.
• A urologist can discuss active surveillance and surgery.

Talk about your choices with your health care provider.