Few conditions create as much controversy as prostate cancer, so it's no surprise doctors have different theories on how best to treat it. Patients who shop around can easily find a doctor willing to try something new or experimental. But some treatments are so new, it's impossible to judge long-term effectiveness, says Dr. Patrick C. Walsh, chief urologist at Johns Hopkins Hospital. Here are the most widely accepted ones:
Surgery. Radical prostatectomy is still considered the standard cure. Overall, about 70 percent of patients are free of cancer 10 years later. The prognosis is even more favorable for men with cancer that appears confined to the prostate. However, this isn't an easy cure.
Recovery takes four to six weeks. Impotence is a common side effect, although sexual function is sometimes preserved with newer surgical techniques. A small group of patients experience ongoing problems with bladder control.
A new study paints a more positive picture of life after surgery. It found 90 percent of patients were happy with their decision. It also found that men who chose surgery had only a slightly higher incidence of impotence and incontinence than prostate cancer patients who had a different kind of treatment.
"For men in their 40s and 50s, surgery is the best form of treatment because it has the best track record so far in terms of curing the cancer," says Dr. Walsh.
Radiation. External beam radiation is often recommended for men over 70, or for patients with cancer that has spread. Many experts argue that it doesn't have the same potential to cure as surgery, but it can control most localized cancers for long periods.
Watchful waiting. Managing the prostate with semiannual checkups is an option for older patients, as well as for men with tiny, nonaggressive cancers. Some men with advanced tumors may choose to just attack symptoms and not the underlying disease.
Watchful waiting may allow men to avoid the side effects of some treatments, but they should be aware that there's no way to predict -- with total certainty -- which cancers will spread.