Which treatment is best for my prostate cancer at 65?

Question

Hello doctor,

I am a 65-year-old man who was recently diagnosed with early-stage prostate cancer. My PSA was 8.5, and the biopsy showed a Gleason score of 6. My doctor said I could choose between surgery, radiation, or active surveillance.

I am concerned about side effects, such as urinary incontinence and sexual problems. How can I decide which option is best for me? Can lifestyle changes or diet make a difference?

Also, how often should I have checkups to monitor for cancer recurrence?

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing your concern.

A diagnosis of early-stage, low-risk prostate cancer (Gleason 6) presents you with several safe and effective options. Your concern about side effects is very common and should be a key factor in your decision.

Active surveillance is often the recommended starting point for Gleason 6 cancer. It involves regular PSA (prostate-specific antigen) tests, exams, and occasional repeat biopsies to monitor the cancer. It avoids immediate treatment side effects while ensuring intervention if the cancer shows signs of progressing. Whereas, surgery (prostatectomy) aims to remove the cancer entirely but carries risks of urinary incontinence and erectile dysfunction (though techniques to preserve function are used).

Lastly, radiation therapy destroys cancer cells with radiation. It has different side effect profiles (potential bowel or urinary irritation, fatigue). The choice depends on your life expectancy, overall health, personal anxiety about living with cancer, and your priority on avoiding specific side effects. Discuss your values and concerns in detail with a urologist and radiation oncologist.

Yes, lifestyle and diet can help. While not a cure, a healthy lifestyle supports overall health and may influence cancer progression. Focus on:

A heart-healthy diet (rich in fruits, vegetables, and tomatoes; limited red and processed meats).
Regular exercise.
Maintaining a healthy weight.

The frequency of your checkups is tailored to your chosen path, like:

Active surveillance: PSA every three to six months, exam every six to 12 months, repeat biopsy every one to three years.
After surgery or radiation: Regular PSA monitoring (typically every six to 12 months initially) to ensure the cancer has not returned.

Your diagnosis is highly treatable. Taking time to understand each option is the best next step.

I hope this was helpful.

Thank you.