Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

ii. Psychological Factors

It’s important to remember that the decision about how to treat your prostate cancer can’t be made in a vacuum. So many aspects of this disease can affect the way you view yourself, the way you interact with others, and the way others interact with you. The final decision on whether to choose surgery or radiation therapy might therefore be more tied to a weighing of the psychological, rather than the clinical, factors that are tied up with your prostate cancer.

The first issue to consider is your attitude toward your disease. Although all men see their prostate cancer as something that they want to eradicate, there are generally two ways of looking at how that should be done: cut it out with surgery or kill it with radiation therapy. Your viewpoint on this issue can play an important role in determining how you want to approach your treatment choice. On the other hand, if you have less aggressive prostate cancer but have other medical concerns that need your attention now, active surveillance might be the right choice.

The second issue to consider is the potential side effects of the treatment. (For some men, this issue will be the only one that matters.) In the hands of a skilled surgeon, men who undergo a nervesparing prostatectomy will likely regain erectile and urinary function within a few months; in the hands of a skilled radiation oncologist, men who undergo radiation therapy will see few bladder or bowel problems.But if your tumor is not as well confined as we would hope, complications can arise. Only you can know which set of potential side effects are more important, and which set will make you decide on one or another course of therapy.

Remember: If, due to illness or other reasons, you already have difficulty achieving an erection or maintaining bladder or bowel control, the best that you can expect to see after treatment is a return to where you started.