The first decision to be made in managing prostate cancer is whether any treatment at all is needed. Prostate cancer, especially the most common, low-grade forms found in the typical elderly patient, often grows so slowly that no treatment is required at all. Donald Gleason, the inventor of the Gleason score, advocated for renaming the very common 3+3 prostate "cancer" to prostate adenosis, because he believed it so unlikely to harm the patient. Treatment may also be inappropriate or impossible if the patient has other serious health problems or is not expected to live long enough for symptoms to appear.
Which option is best depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors are age, general health, and patient views about potential treatments and their possible side effects. Because all treatments can have significant side effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations. A combination of the treatment options is often recommended for managing prostate cancer.
The National Comprehensive Cancer Network (NCCN) offers evidence-based guidelines for prostate cancer that can guide treatment choices for specific clinical situations. This requires a good estimation of the patient's long-term health-adjusted life expectancy, because this factor is the most important determinant of survival in newly diagnosed patients. A simplified approach shows how to estimate health-adjusted life expectancy and apply the NCCN guidelines so that patients can have a roadmap to reach the decision recommended for their clinical situation, which they can alter according to their personal values, including fear of cancer and fear of side effects.
Patients can also use a newly developed 18-item questionnaire to learn whether they have good knowledge and understanding about their treatment options before they choose an option. Most newly diagnosed patients who have already made a treatment choice can not correctly answer over half of the questions.
The selection of treatment options involves many factors. For example, if radiation therapy is done first, and fails, then radical prostatectomy is a very technically challenging surgery and may not be feasible. On the other hand, radiation therapy done after surgical failure may have many complications. The desire to maximize subsequent options in case of failure may affect the treatment decision.
Patients can also use a newly developed 18-item questionnaire to learn whether they have good knowledge and understanding about their treatment options before they choose an option. Most newly diagnosed patients who have already made a treatment choice can not correctly answer over half of the questions.
