The choice of treatment for prostate cancer -- active surveillance (also known as expectant management), surgery, radiation therapy, or hormone therapy -- depends on the clinical stage of the cancer and the age and general health of the individual. With increased use of PSA testing, some men will be diagnosed with small prostate cancers (which cannot be felt during a digital rectal exam but are confirmed by biopsy) that pose no immediate threat and may never need treatment. Here's a question from a reader who has chosen expectant management for his prostate cancer.
Q. I've chosen expectant management for my prostate cancer. Will having transurethral resection of the prostate (TURP) for nighttime urination spread the cancer cells within -- and possibly outside -- the prostate?
A. No strong evidence demonstrates that TURP in a man with prostate cancer leads to dissemination of the cancer. However, before you undergo TURP for nighttime urination (nocturia), your doctor should be sure that it is a result of prostate enlargement, also known as benign prostatic hyperplasia (BPH).
If nocturia is your only symptom, it is unlikely that treatment for BPH will improve the condition because the prostate is probably not the culprit. Increased urination at night has a variety of potential causes. In addition to BPH, these include use of certain medications (such as diuretics, lithium, phenytoin, and propoxyphene), urinary tract infections, diabetes, obstructive sleep apnea and other sleep disorders, and drinking too much fluid before bedtime, especially caffeine-containing beverages and alcohol.
