"In discussing prostate cancer treatments, step one is: determine whether treatment is needed at all. A good number of prostate cancers, when diagnosed, are found to be low grade. They don't have any appearance that's so much different from normal prostate tissue. And under the microscope, that appearance can predict aggressiveness. Secondly, the stage of the cancer is highly important. If the cancer is truly localized to the prostate and needs treatment, at least treatment can be performed with success. Some prostate cancers by the time of diagnosis have already spread beyond the prostate, making treatment much more challenging and much less likely to be successful in curing the disease. So if we begin with cancers that are low grade, low stage and thereby low risk, many of these men can be observed. We call this a process of active surveillance. Active surveillance involves regular testing of, say, the PSA blood test, and occasionally repeating MRI tests, or even repeating biopsies to confirm that the disease is actually stable. And many of these folks can go years and years without intervention. Patients with intermediate risk or high risk prostate cancers that are still confined to the prostate gland can be treated with the intent of curing disease. And these treatment modalities involve a type of radiation, a type of surgery, perhaps freezing the prostate or doing high intensity focused ultrasound. Radiation can be delivered through little seeds, pellets or something similar, but not leaving anything behind, HDR, high dose radiation, also performed directly into the prostate, and then external therapies like external beam or otherwise known as intensity modulated radiation therapy."
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