Managing Treatments

Early Stage Prostate Cancer: To Treat or Not?

Early stage prostate cancer has an excellent prognosis, with nearly all men diagnosed living more than five years. If you have early stage prostate cancer, talk to your doctor about treatment options and whether monitoring your disease is appropriate.

It’s been said that if men live long enough, they’ll get prostate cancer. According to the American Cancer Society, by age 80, more than half of all men in the U.S. will have detectable cancer in their prostate. While that may be a scary statistic, it’s also true that few men with early stage prostate cancer (that which is contained within the prostate, typically before symptoms arise) will die of their disease. In fact, less than one percent of them will die from prostate cancer within five years of their diagnosis.

Fortunately, prostate cancer is a slow-growing cancer, often taking 10 to 30 years to develop large enough for a tumor to be detected, according to the National Cancer Institute. In fact, it’s so slow-growing that oftentimes you may not even require immediate treatment. This can be due to a shortened life expectancy, older age or poor health, and/or the detection of low-risk disease. Disease risk is determined by evaluating a series of factors, including tumor size, characteristics of the tumor viewed under a microscope and results of a prostate cancer-specific blood test. Low-risk disease is likely to take years to grow or spread. Whatever the reason, you generally have options before more intense treatment is needed.

Active Surveillance

If you have early stage prostate cancer but don’t need treatment right away, you’ll still undergo active surveillance. Basically, you’ll be closely monitored for signs of disease progression. Most men who choose this approach can successfully delay treatment for many years, thus postponing or even avoiding the costs and side effects of therapy without harming their chances of long-term survival. It’s important to note, however, that even active surveillance can have disadvantages, as you may experience psychological distress at the thought of taking no action to fight cancer.

Treatment Options

If your doctor suggests that treatment is the best course of action, there are a number of effective therapies to choose. Each approach has a distinct safety profile.


You could have surgery, called a prostatectomy, to remove your prostate. The major drawbacks are the risks of urinary incontinence (inability to control urine), according to the American Cancer Society, and erectile dysfunction, according to AARP. You also need to be healthy enough to withstand the surgical procedure.


In some cases, radiation therapy may be the best course of treatment. External beam radiation therapy is when a machine outside your body aims radiation at your prostate. Brachytherapy is when radioactive material is implanted inside your body for more targeted treatment. While urinary incontinence is rarely a problem with radiation treatment, erectile dysfunction is a relatively common side effect according to the Prostate Cancer Foundation (PCF), as is difficulty passing urine. Gastrointestinal side effects occur, too, as a result of radiation extending beyond the prostate to part of the rectum. This can cause such issues as burning when defecating and bleeding from the rectum.

UVA Cancer Center offers a novel approach to radiation for prostate cancer that protects the rectum. SpaceOAR is an FDA-approved device that moves the rectum away from the field of radiation. This spacer can significantly reduce harm to the rectum as a result of radiation therapy for prostate cancer. Listen to UVA radiologist Timothy Showalter, MD as he discusses the benefits of the spacer.

Hormone Therapy

Hormone therapy, given via injection or pills, is another option if you have an early stage disease, particularly if you have a limited lifespan or serious health concerns. It has a rather long list of potential side effects, however, including loss of sex drive, erectile dysfunction, loss of bone density, hot flashes and loss of muscle mass, says the PCF.

Thus, if you have early stage prostate cancer, it’s important to thoroughly discuss all your options with your doctor in order to make the best treatment decision for your situation. Take into account the details of your disease, the advantages and disadvantages of each approach, as well as your opinion on how proactive you should be in response to your cancer diagnosis. Keep in mind that, whichever avenue you choose, your prostate cancer is unlikely to affect your life expectancy.

Listen to a Podcast

UVA radiation oncologist Timothy Showalter, MD discusses a new approach to radiation therapy for prostate cancer patients.

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Jennifer Klem, PhD