“Which is the best treatment?” That is one of the most common questions that I hear from men during counseling for localized prostate cancer. My patients carefully listen to the risks and benefits of the various treatment options including radical prostatectomy, external beam radiation therapy, and brachytherapy. They then always turn to me to see which is the best treatment for them. For men with moderately aggressive, localized prostate cancer, there is no right answer. Studies have shown that for most men with a PSA less than 10 and Gleason 6 prostate cancer that is not palpable (or minimally palpable) on rectal exam, no single treatment option has been definitively demonstrated to cure prostate cancer better than the others. This information usually confuses many of my patients. After all, how can you choose between therapies when they all treat the cancer about the same?
The answer is side effects.
While the ability to cure cancer is fairly similar for the three mainstream treatment options, their side effect profiles tend to be very different. As I tell my patients, there is no free lunch in medicine. Any treatment you choose will result in some unpleasant outcomes. The key is determining which side effects you think you will best be able to tolerate. The treatment that you think will least impact your quality of life is probably going to be the best treatment option for you. In this post, I will review the different ways that radical prostatectomy, external beam radiation therapy, and brachytherapy affect quality of life.
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