By: RS Abdi Waluyo

After a prostate cancer diagnosis, one of the first questions is whether surgery is needed straight away. The answer depends on the individual. Some cancers can be monitored on a planned schedule, while others need treatment to prevent or control progression.

Prostate cancer develops when cells in the prostate gland grow uncontrollably. The speed of growth varies from person to person. Your doctor therefore considers the stage, the cancer’s characteristics, your overall health, and your priorities when planning care.

Active surveillance for low risk cancer

For selected patients with low-risk cancer, a doctor may recommend active surveillance. This means monitoring the cancer on a clear schedule without starting surgery or radiotherapy immediately. It can delay or avoid treatment side effects while treatment is not yet needed.

Monitoring may include PSA blood tests, medical examinations, MRI scans, and repeat biopsies according to the care plan. If reassessment shows that the cancer has become higher risk, treatment intended to cure it may be recommended. Active surveillance requires regular follow-up and does not mean leaving the cancer unchecked. [2]

How active surveillance differs from watchful waiting

Watchful waiting is an observation approach focused on managing symptoms if the disease progresses. It may be appropriate when treatment intended to cure the cancer is unlikely to offer enough benefit, for example because of other health conditions or limited life expectancy.

The difference lies in the goal of care. With active surveillance, surgery or radiotherapy may still be offered with the aim of a cure if needed. With watchful waiting, the priority is symptom relief and comfort. This is an individual decision, rather than one based on age alone. [2]

Focal therapy targets the cancer area

Focal therapy is an evolving approach that destroys a mapped area of cancer while preserving the rest of the prostate. Examples include HIFU, which uses focused ultrasound waves to heat tissue, and cryotherapy, which destroys tissue by freezing it. [4]

It may be considered for selected patients whose cancer is still confined to the prostate. However, an early stage alone does not establish suitability. Doctors assess the location and extent of cancer using MRI and biopsy, its aggressiveness, and the possibility of cancer elsewhere in the gland. Active surveillance remains an important option for low-risk disease. [2, 4]

The aim is to control cancer while limiting damage to healthy tissue, potentially reducing effects on bladder control and erections. Side effects can still occur, and some patients need repeat procedures or other treatment. Follow-up, including PSA, MRI, and biopsy according to the care plan, remains necessary. [2, 4]

Long-term evidence for cancer control is less established than for surgery or radiotherapy. European guidelines place focal HIFU and cryotherapy within programmes that prospectively record and evaluate outcomes or clinical research. Benefits, limitations, and alternatives should therefore be discussed with an experienced team. [2]

Surgery to remove the prostate

Surgery to remove the whole prostate is called a radical prostatectomy. It may be an option when cancer is confined to the prostate and the patient is well enough for surgery. The prostate and related tissues are removed; nearby lymph nodes may also be removed in selected patients.

Surgery aims to remove the cancer, but it can affect bladder control and erectile function. The level of risk varies between patients. Before choosing surgery, discuss its benefits, possible side effects, and the recovery support available. [1]

Radiotherapy to target cancer cells

Radiotherapy uses radiation to damage cancer cells. It can be delivered by a machine outside the body or through a radiation source placed inside the prostate, known as brachytherapy. The choice depends on the cancer’s characteristics and the patient’s condition.

Radiotherapy may be given with the aim of a cure for cancer confined to the prostate and for some cancers that have extended into nearby tissues. For certain risk groups, it is combined with hormone therapy. Side effects can include urinary problems, changes in bowel habits, and erectile difficulties. [1, 2]

Hormone therapy to slow cancer growth

Many prostate cancer cells use hormones called androgens, including testosterone, to grow. Hormone therapy lowers these hormones or blocks their effects on cancer cells. One approach is androgen deprivation therapy, or ADT, which lowers androgen levels.

Hormone therapy may accompany radiotherapy or form a central part of treatment for cancer that has spread. For many patients with metastatic disease, ADT is combined with additional hormonal medication and, in selected patients, chemotherapy, depending on their health and the disease characteristics. [2, 3]

Side effects can include hot flashes, reduced sexual desire, erectile difficulties, weight and metabolic changes, and loss of bone density. Discuss how your bone health and general health will be monitored during treatment. [3]

When cancer has spread

Care usually involves medicines that work throughout the body. Alongside hormone therapy, options may include chemotherapy or targeted therapy for patients whose cancers have particular characteristics. Radiotherapy can also relieve symptoms, such as pain caused by cancer that has spread to the bones. The goals and combination of treatments are tailored to the patient’s needs. [1, 2]

Early detection can offer more options

When cancer is found before it spreads, care options may be broader, including active surveillance, surgery, radiotherapy, or focal therapy for selected patients. This is one reason to discuss early detection with your doctor, especially if you have risk factors. Early detection does not guarantee suitability for focal therapy or a cure. [1, 2]

Early prostate cancer often has no symptoms, so discuss testing in the context of your age, family history, and overall health. Screening still requires weighing benefits against risks, including finding very slow-growing cancers that might never cause problems. [5]

Making the decision with your doctor

Before deciding, ask about the goal of treatment, the expected benefits, possible side effects, and the impact on daily activities, bladder control, and sexual health. If monitoring is recommended, make sure you understand the follow-up schedule and what might lead to a change in the care plan.

Consult a doctor at RS Abdi Waluyo to discuss your prostate cancer treatment options. An appropriate plan considers cancer control alongside your quality of life and what matters most to you.

Referensi

Prostate Cancer Does Not Always Require Surgery Understanding Your Treatment Options