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A cancer diagnosis is, understandably, often a source of uncertainty and fear. One of the first questions people who receive this diagnosis ask is “What’s the best treatment option?”
For an early-stage prostate cancer diagnosis, the truth is that there is no universal “best” or most effective treatment. A plan for treating prostate cancer in its early stages needs to be personalized to the individual patient. A consultation with your physician about treatment is crucial in these situations.
However, a diagnosis that identifies early-stage prostate cancer can mean more treatment options are potentially appropriate, offering more choices for moving forward.
Let’s take a closer look at early-stage prostate cancer. We’ll review what early-stage prostate cancer is, discuss prostate cancer screening, and explore potential treatment options.
What is Early-stage Prostate Cancer?
The prostate gland is part of the male reproductive system. Its major function is to produce fluid for semen. The prostate also serves as a switch between ejaculation and urination.
Prostate cancer refers to the formation and uncontrolled growth of cells within the prostate gland. Prostate cancer often develops slowly, as the National Cancer Institute explains.
Although the prostate naturally grows with age, prostate cancer is distinct from this natural growth and represents a potentially serious health risk.
Prostate cancer and many other types of cancer are divided into stages. Johns Hopkins Medicine describes the four stages of prostate cancer and the substages of each in detail.
The Urology Care Foundation explains that stage I and stage II prostate cancer are frequently grouped together under the broader label of early-stage prostate cancer. The defining trait of early-stage prostate cancer is that it has not spread beyond the gland itself.
If left untreated, early-stage prostate cancer can progress. It may spread outside the prostate locally (stage III) or to other areas of the body (stage IV).
Stage 1 and Stage 2 Prostate Cancer: Symptoms and Screening
Prostate cancer often presents no symptoms until it has progressed in the body. Early-stage prostate cancer is often identified through screening as opposed to noticing symptoms.
Traditional screening for prostate cancer includes the following tests and procedures:
Prostate-specific antigen (PSA) testing, is a first-line test which checks the PSA level in the blood. PSA is a protein secreted by the prostate.
Higher PSA levels and an increased level over time can indicate prostate cancer. However, other medical conditions can also cause a rise in PSA and a normal (non-elevated) result is not conclusive proof that someone is free of prostate cancer. Regular screening can establish baseline levels that give physicians valuable context, making it possible to recognize significant changes in PSA level.
A digital rectal exam (DRE) is another first-line test in which a physician checks the prostate using their finger. The reach of this test is limited — it can’t check the entire prostate gland. It can detect some abnormalities but can’t conclusively diagnose prostate cancer.
Transrectal ultrasound-guided (TRUS) biopsy is used when these two initial tests indicate the possibility of prostate cancer. Ultrasound guides the selection of 12 tissue samples from across the prostate.
However, TRUS biopsies ultimately take random samples. Research findings shared in The Lancet, a medical journal, found this procedure identifies clinically significant prostate cancers in slightly less than half (48%) of men with clinically significant prostate cancer, whereas a high quality prostate MRI picks it up in about 94% of men. TRUS biopsies are also invasive, with the potential for side effects like urinary retention and sepsis.
Emerging and Effective Screening Procedures for Prostate Cancer
While not traditional screening procedures, effective, non-invasive screening procedures used between first-line tests and TRUS biopsies have emerged. Multiparametric MRI (mpMRI) results
and Select mdx, a urine test, can help physicians better assess and categorize the risks patients face before undergoing a TRUS biopsy.
An MRI-guided biopsy, while an invasive procedure, is a more targeted alternative to a TRUS biopsy. Imaging helps guide the selection of biopsy sites toward areas where cancer may be present.
Our Position on Prostate Cancer Screening
Prostate Laser Center takes a proactive view on prostate cancer screening. We believe that men aged 45 and older who are otherwise healthy should consider regular PSA testing.
Why should you consider routine screening for prostate cancer? “Because if you do it well, you can often catch the cancer early and have more options for treatment,” says Dr. Ara Karamanian, the founder of the Prostate Laser Center.
Prostate Cancer Early-stage Treatment
The “best” treatment for prostate cancer, even in its early stages, depends on each patient as an individual. It’s vital to avoid both undertreatment and overtreatment, deciding on a treatment plan that truly addresses individual circumstances and needs. Oftentimes, there is no single “best” treatment, and it comes down to an informed decision-making process taking the patients personal concerns and values under consideration along with the best available medical information.
Screening and testing results, the potential for side effects, the overall health of the patient, prior prostate treatment, spread of cancer within (and for more advanced cancer, outside of) the prostate gland, and other factors are involved in determining the “best” approach to treatment.
That determination is usually only possible through consultation with clinicians.
All prostate cancer treatments, including observational “treatments,” present some risk of side effects. However, those risks vary depending on the specific type of treatment.
Learning about prostate cancer treatment options can help you make a more informed decision about your health in concert with your physician. Let’s review some common treatments for early-stage prostate cancer.
Active Surveillance
Active surveillance is an observational approach to treatment that includes both invasive and non-invasive testing. This process centers on regular testing, such as PSA tests and biopsies, to track the development and possible progression of prostate cancer.
The Urology Care Foundation explains that some men, especially those with small, slowly growing prostate cancer, may not need treatment beyond this observational approach. Without any cancer progression, active surveillance may be enough.
However, if significant cancer growth is found through elevated PSA levels and biopsy results, other treatments are needed.
Watchful Waiting
Watchful waiting is also an observational treatment. However, it only involves a patient observing their own symptoms. It is used when patients are of an advanced age or have other serious health issues that make other treatments too risky as compared to their benefits.
Radiation for Prostate Cancer
The American Cancer Society explains that radiation therapy options for early-stage prostate cancer include external beam radiation therapy (EBRT) and brachytherapy, which is a form of internal radiation therapy.
The methods of delivering these therapies differ significantly. However, both types of treatment center on causing targeted damage to cancer cells and stopping their spread while minimizing damage to healthy cells in the body.
EBRT and brachytherapy are effective, but also invasive treatments that cause side effects:
- Research published in the medical journal Urologia Internationalis found that, among a group of 226 patients who received radiation therapy exclusively, 17.8% experienced urinary incontinence.
- A review of existing research published in The Journal of Sexual Medicine estimated that, 5.5 years after radiation treatment, the rate of erectile dysfunction among patients was 57%.
Other side effects include bowel complications and fatigue.
Radical Prostatectomy
Radical prostatectomy is a surgical procedure that involves the complete removal of the prostate gland and some surrounding tissue. There are several methods used to complete this procedure, such as open surgery and less-invasive robot-assisted surgery, The Mayo Clinic explains.
Radical prostatectomy is a proven and effective treatment for prostate cancer. However, the side effects can be significant. Additionally, the recovery timeline can take several weeks.
Surgical complications are not exceptionally high but are always a risk. Additionally, urinary incontinence and erectile dysfunction are important to consider:
- A review of existing research published in the medical journal European Urology found that, 12 months after surgery, 16% of patients had urinary incontinence.
- Rates of erectile dysfunction vary based on the specific type of procedure and the surgeon’s experience. The Journal of Medicine and Life explains that the rate ranges between 14%-90%.
Laser Focal Therapy
Laser focal therapy (LFT), also known as focal laser ablation (FLA), uses MRI guidance to precisely target localized areas of cancer in the prostate gland and uses laser light to treat those areas. It is a minimally invasive outpatient procedure.
LFT is best suited for patients with localized disease (i.e. cancer that has not spread beyond the prostate). It is generally used to treat cancer that is less aggressive and less likely to quickly spread. That makes it well-suited for treating some instances of prostate cancer in its early stages.
A risk of side effects is present with LFT, but they occur with less frequency compared to radical prostatectomy and radiation therapy:
- 10-year interim results from LFT Phase II clinical trials found a urinary incontinence rate of less than 3%.
- The same results noted that the erectile dysfunction rate was less than 10%.
TULSA-PRO
Transurethral ultrasound ablation (TULSA-PRO) is also an MRI-guided, minimally invasive outpatient treatment for prostate cancer. However, it uses therapeutic ultrasound to carefully target cancerous cells.
TULSA-PRO can be well-suited for treating larger and more diffuse prostate cancer within the gland. It can target a specific area or nearly all of the prostate. It is intended for patients with low- or intermediate-risk prostate cancer.
This treatment option also compares favorably to radical prostatectomy and radiation therapy in terms of side effects:
- 12-month FDA trial data for TULSA-PRO indicates a urinary incontinence risk of 7%.
- That same dataset shows a 25% risk of erectile dysfunction.
Moving Forward with Early-stage Prostate Cancer
Consulting with a physician is the only way to effectively determine how to treat early-stage prostate cancer. However, learning about the disease itself, screening options, and treatments can lead to a more informed decision.
Prostate Laser Center offers proven, minimally invasive treatments — FLA and TULSA-PRO — that compare favorably to traditional treatments in terms of side effect risks. Seeking treatment for early-stage prostate cancer? Request a consultation today.
NOTE: The information provided on this website is general medical information and does not establish a physician-patient relationship. Please discuss your particular situation with a qualified medical professional.
