What is the best prostate cancer care for a male aged 67?

Question

Hello doctor,

My uncle, who is 67 years old, was recently diagnosed with localized prostate cancer following elevated prostate-specific antigen (PSA) levels and a biopsy. The doctors have presented him with several options, including surgery, radiation, or active surveillance, and now the family is uncertain about which is best.

He is otherwise healthy but very anxious about the potential side effects of treatment, particularly concerns about incontinence and sexual function. We are trying to help him weigh the pros and cons, but it feels overwhelming. How do most men in his situation usually decide what to do? Is active surveillance a safe choice, or does it carry too much risk? How aggressive is this type of cancer?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Thank you for reaching out, and I truly appreciate the thoughtful way you are supporting your uncle through this complex and emotional time. It is completely normal for patients and families to feel overwhelmed when faced with a cancer diagnosis and multiple treatment options, each with its own implications.

Localized prostate cancer is often a slow-growing disease, and the prognosis is generally excellent, especially when detected early, as it appears to be in your uncle’s case. The main options include active surveillance, surgery, and radiation therapy, and many men in similar situations decide based on several factors.

Active surveillance involves closely monitoring the cancer through regular PSA tests, digital rectal exams, and occasional biopsies without immediate treatment. It is often recommended for men with low-risk or favorable intermediate-risk cancer or those who want to delay or avoid treatment side effects, especially if the tumor is not aggressive.

For many men, especially older adults with non-aggressive cancer, active surveillance can be a safe and effective approach for years, with treatment started if the cancer progresses. Surgery, or radical prostatectomy, involves removing the entire prostate and offers the advantage of removing the cancer entirely and allowing detailed tumor analysis.

However, it carries risks of urinary incontinence, erectile dysfunction and requires recovery time. Surgery may be preferable if the cancer shows more aggressive features or if your uncle is anxious about leaving the cancer untreated. Radiation therapy, which can be external beam radiation or brachytherapy (internal seeds), is a non-surgical option with cure rates comparable to surgery, but it may also affect bladder and sexual function and cause bowel symptoms.

How men decide often depends on cancer aggressiveness, personal priorities such as avoiding side effects or seeking peace of mind, and emotional comfort with observation versus intervention. Your uncle’s anxiety about side effects is completely valid and should be part of the decision-making process. A thorough discussion with his urologist and possibly a radiation oncologist can help clarify the best path based on his values and risk profile.

In many cases, active surveillance is a very reasonable and safe choice, especially if the cancer is low-risk, as it avoids overtreatment and preserves quality of life. However, if the cancer appears more aggressive, proactive treatment may be more appropriate. Please know that there is no one right answer, and many men live full, healthy lives after choosing any of these options.

If you or your uncle would like, I would be happy to help review his biopsy results and risk classification to offer more specific guidance.

I hope this helps.

Thank you.