The NCCN guidelines are updated as new significant data becomes available. The stage of a cancer is one of the most important factors in selecting treatment options. Older men and those with other serious health problems often find it useful to think of prostate cancer as a chronic disease, one which will probably not kill them but may cause symptoms they will wish to avoid. In this view, the goal is to relieve symptoms and avoid or minimize side effects of treatment. This view might lead some men to choose watchful waiting or hormonal therapy.
Radiation therapy is another good option for some patients.
It provides a 5-year survival rate equal to radical prostatectomy. Postponing or relieving symptoms may not be their main goal. Instead, many younger, healthy men are more interested in a cure or at least in surviving beyond 10 - 20 years. Views regarding side effects are another very important factor. Some men cannot imagine living with side effects such as incontinence or impotence.