How to choose the best treatment if you have prostate cancer

A Vanderbilt University study is helping men make more informed decisions about how to treat their prostate cancer. The study provides evidence about side effects of each of three methods to treat prostate cancer.

Prostate cancer affects three million men in the United States. The Centers for Disease Control and Prevention (CDC) tracks prostate cancer statistics. In 2017, the most recent year for which data is available, 207,430 new cases of prostate cancer were reported and 30,486 men died of the disease, the CDC says. Another way to look at it is that, for every 100,000 men, 107 new prostate cancer cases were reported, and 19 men died.

Prostate cancer afflicts Black men at higher rates than white, Hispanic, American Indian/Alaska Native or Asian/Pacific Islander men, the CDC says. Nearly 164 Black men per 100,000 have been diagnosed, compared with 96.7 white men; Hispanic men have a rate of 80.9 cases per 100,000; Asian and Pacific Islander men have a rate of 54.9 per one hundred thousand, and American Indian/Alaska Native men have a rate of 52 per one hundred thousand.

While any cancer diagnosis is terrifying, with early diagnosis and early treatment if needed, prostate cancer has a 97.5 percent survival rate, the CDC says. While some prostate cancer cases can be very aggressive and progress quickly, many cases grow more slowly and, once diagnosed, they can be monitored over time to help determine what the best treatment may be. However, the first step is for men to get a prostate evaluation based on their individual needs. There are clear guidelines for health care providers and patients to use in helping to decide when to start screening, how often to do repeat screenings and what options for management are.  But the first — and one of the most important steps — is to Get It Checked. It’s one of the slowest growing types of cancer, so in many cases, men can consider which treatment is best for them, including the side effects.

The Vanderbilt University study considered the health records of 2,550 men diagnosed in 2011 and 2012 in Utah, New Jersey, Louisiana, Atlanta and rural Georgia, and Los Angeles, Calif. It followed the men for three years after they chose treatment.

The men chose one of three treatments:

  • Surgery
  • Radiation
  • Active surveillance

Men who chose surgery reported more instances of sexual dysfunction and urinary incontinence; men who chose radiation reported fewer problems than those who chose surgery but reported slightly more bowel symptoms than those who selected active surveillance. Men who selected active surveillance had the fewest complications, the study found.

Both surgery and radiation treatments are effective, keeping nearly all men alive for at least five years. Men with low-risk prostate cancer can also consider no immediate treatment, electing to monitor their cancer’s progress through repeated testing or “active surveillance.”

“Our study’s take-home message is patients who can safely do active surveillance should consider that very carefully,” says the study’s principal investigator, David Penson, MD, MPH.

More than half the men in the study had prostate cancer at intermediate or high risk of spreading to other parts of the body, so they had to choose between surgery and radiation. The remaining 45 percent had cancer at low risk of spreading, so they could choose active surveillance in addition to the other treatments.

The Vanderbilt University study was funded by the Patient-Centered Outcomes Research Institute (PCORI). You can read about the original study at and an update at Penson talks about the study in a video at

Penson and his researchers continue to follow the men in the study to see how they’re doing five years after diagnosis and treatment.

Men’s Health Network (MHN) is an international non-profit headquartered in Washington, D.C., that is dedicated to advancing good health for men and boys. has been outspoken about the need for men to participate in prostate cancer screening. Its “Get it Checked!” brochure recommends that men of all ages have an annual rectal exam to check for prostate cancer. (You can download a free copy of the brochure at

Additionally, MHN offers the following resources:

Prostate Health Guide

Prostate Cancer Awareness Month

Men’s Health Resource Center

National Program of Cancer Registries (NPCR): United States Cancer Statistics (USCS)

Surveillance, Epidemiology and End Results (SEER): SEER Stat Fact Sheets: Prostate

State Cancer Profiles

Cancer Intervention and Surveillance Modeling Network

Modeling to guide public health research and priorities

Photo credit: Photo by Brett Sayles from Pexels

Robin Mather

View posts by Robin Mather
Robin Mather is a third-generation journalist with more than 40 years' experience working at major daily newspapers and national magazines. A Michigan native, she now lives in Arizona

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