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The right prostate cancer treatment isn't the same for every man. ACTIVE VERSUS AGGRESSIVE RECEIVING A DIAGNOSIS of prostate cancer can be upsetting. However, extensive research shows some men are able to take a surveillance approach to treatment, which provides the opportunity to postpone or even avoid the stress and potential side effects often associated with prostate cancer therapy. STANDING BY Doctors use several tests to diagnose and stage cancer of the prostate, a gland that helps produce semen. These tests include a digital rectal physical exam, a blood test that measures levels of a prostate-produced protein called prostate-specific antigen (PSA) and, finally, a biopsy of prostate tissue. Identifying the stage and grade of prostate cancer, as well as men's ages and overall health, helps doctors identify appropriate treatment options. For example, older men with early-stage, low- grade cancers—slow-growing cancers that have not yet spread to other parts of the body and are not expected to spread rapidly—may not need treatment. Instead, these patients and their doctors may choose active surveillance. "Using active surveillance, we monitor men over time to make sure the cancer does not progress," says Ivan Grunberger, M.D., chief of urology at NewYork-Presbyterian Brooklyn Methodist Hospital. "Men commit to twice-a-year office visits, which typically include a follow-up PSA blood test and physical exam, as well as a repeat biopsy six months after they receive their diagnosis. If the cancer remains stable, we can extend the interval between biopsies to one year or longer." WHEN AGGRESSIVE ACTION IS NEEDED Some men do not want to delay prostate cancer treatment and choose to begin right away. Others may be unable to delay treatment because they have later stage or higher grade cancers. In addition, some men who choose active surveillance may need to begin treatment if their PSA levels rise or a follow-up biopsy shows tumor growth. In these cases, doctors may recommend treatments that include: Radical prostatectomy—A surgical procedure in which doctors remove the prostate gland. Advances in surgical technology now allow doctors to offer robot-assisted, nerve-sparing prostatectomy, during which they make several small incisions instead of one large cut in the lower abdomen. The smaller incision sizes mean that men have less pain and shorter recovery times. Because this approach also lowers the risk of nerve damage, it's less likely to impact the patient's sexual function than more invasive surgical procedures of the past. Radiation therapy—Options for radiation therapy include external beam radiation therapy or brachytherapy. "External beam radiation is a noninvasive radiation treatment that treats the prostate five days a week for a period of six to eight weeks," Dr. Grunberger says. "With brachytherapy, radiation oncologists place needles into the prostate and inject radioactive pellets into the gland. These pellets are active for three months and give off high doses of localized radiation." Chemotherapy—These treatments are usually recommended for men with late-stage prostate cancer, where the cancer has migrated to other parts of the body. Chemotherapy can help alleviate prostate cancer symptoms and extend patient lives. High-Intensity Focused Ultrasound—Only approved by the FDA in the last year, this non-invasive treatment uses localized high-intensity ultrasound waves that create high temperatures to kill prostate cancer cells. It's a good option for patients with early cancer who want treatment with minimal side effects. "We have very efficient methods of treating prostate cancer today that allow us to preserve men's quality of life," says Hani Ashamalla, M.D., chairman of NYP Brooklyn Methodist's Department of Radiation Oncology. "Men can find out which option is most suitable for them by talking with their doctor and learning as much as possible about each treatment." W H AT ' S " WAT C HF UL WA I T ING ? " The terms "active surveillance" and "watchful waiting" have at times been used interchangeably when it comes to prostate cancer, but these phrases don't mean the same thing. "Think of active surveillance as putting treatment on standby," Dr. Ashamalla says. "Watchful waiting is much less stringent— there's less follow-up care, and we don't usually recommend repeat biopsies." Many doctors, however, are moving away from watchful waiting in favor of active surveillance because the follow-up process keeps patients in communication with their doctors on a more routine basis, according to Dr. Grunberger. WINTER 2018 W W W.N Y P.O RG / BRO OKLY N 26 26 M E N ' S W E L L N E S S