SALT LAKE CITY — The chances are very good that most men 80 and older have some prostate cancer cells. But decisions on what treatment to choose or even whether to treat depend on the individual and his cancer. That means that some patients who have cancer may find "watchful waiting" is the best option for dealing with it.

And that's what two prostate cancer specialists told a number of the callers to a busy Deseret News Intermountain Heathcare Hotline Saturday.

"That doesn't mean ignore the cancer," said Dr. Steven Lynch, an Intermountain Medical Center urologist, who with radiation oncologist Dr. Jeffrey Lee, of Utah Cancer Specialists and IMC, fielded calls on the topic. Both doctors also work at LDS Hospital.

Prostate cancer can kill, but that occurs when it has spread from the prostate. Of those diagnosed, about one-eighth die. It's a slow-moving cancer, so if it hasn't spread and a patient is elderly, the likelihood is he will die with cancer, not of it. Doctors don't usually recommend treatments that can have some unpleasant side effects in those cases. When patients are younger or have a larger volume of cancer cells or it seems more aggressive, active treatment is recommended, Lee said. "If you have a low score and older age, it's probably worth following."

Typically, the treatment options are some form of radiation or surgery. In some cases, a patient may require both. But in the early stages, the two very different forms of therapy offer similar cure rates. If cancer has spread beyond the prostate, surgery's not going to be adequate.

Both treatments have potential for some unpleasant side effects, although doctors are much better at heading them off than in decades past, Lee said. And technology has improved, with new surgery and radiation techniques, as well as robotics that offer very small incisions and great precision. The placement of radioactive beads, called brachytherapy, is an outpatient procedure that offers lower risk of rectal bleeding than external beam radiation therapy, for example.

What's best for a patient depends. But the good news with slow-moving cancer is there's usually time to consider the options, do some research or get two opinions and really think about the treatment course to choose, said Lee, who noted that Intermountain takes a team approach that provides multiple experts considering a case.

Radiation has potential for some urinary and bowel issues such as frequency, urgency and discomfort. Incontinence is more likely with surgery and so, possibly, is impotence. Older patients may be better suited to radiation, while younger patients may do better with surgery. In all cases, it depends largely on cancer volume and location. Younger patients who have surgery typically experience fewer of the side effects than older patients, Lynch said.

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When prostate cancer spreads, it moves most often into the pelvic lymph nodes and the bones. But it can go elsewhere, including into the brain.

The best way to survive it is to find it before it spreads. And that means screening, the duo agree.

The hotline tackles a different health topic the second Saturday of each month.

e-mail: lois@desnews.com

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