Deciding on Treatment
 

if you ask which treatment is best? The results of surgery, seeds or external are all about the same (see here, here and here). The NCCN guidelines for patients are a good place to start (go here).

 In 2007 the American Urological Association published new guidelines which basically said that the results with external beam or seeds or surgery were the same (go here).

In 2012 the PIVOT trial showed that a radical prostatectomy only improves survival by 2 to 3% over no treatment at all, again raising the option of 'watchful waiting' (page 1, page 2, page 3)

The technology with IMRT has become so good that IMRT may be the best treatment (go here). For a recent review on modern radiation and prostate cancer go here.

• Decide on therapy
• Understand the stage and risk category
• No initial therapy (watchful waiting)

• Surgery
• Relapse after surgery
• Comparisons surgery with radiation
• Survival comparisons
• Postoperative Radiation (immediatley after surgery)
• 'Salvage' radiation (for rising PSA after previous surgery)
• Cryosurgery
• Radiation to prevent breast enlargement

• External beam (IMRT, IGRT, Tomotherapy)
• Seed implants (brachytherapy)
• Cyberknife
• Hormone therapy combined with radiation
• PSA starts to rise after radiation.
• Proton beam therapy has not been found to be superior to modern IMRT (go here and here)

• Hormone therapy or Abiraterone or Provenge
• Chemotherapy  
• Herbal therapy
• Lymph node spread
• Bone metastases.