September 22, 2026
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Provided Courtesy/Fox Chase Cancer Center
William Coren received high dose-rate brachytherapy at Fox Chase Cancer Center in 2023. His PSA level has remained very low, and at 76, he continues to coach cross-country and spring track.
Two patients can have prostate cancers that look similar on paper and still reasonably choose different treatments. The right choice depends on the cancer itself, as well as the patient's overall health, lifestyle, and personal priorities.
For Mark A. Hallman, MD, PhD, a specialist in genitourinary radiation oncology at Temple Health's Fox Chase Cancer Center, that makes it important for patients to understand their options before making a decision.
Mark A. Hallman, MD, PhD"It's always good to get a different perspective and I welcome patients to do that," Hallman said. "It's very important to me that patients get the opportunity to do their due diligence and look at the different treatment options."
William Coren, 76, saw that approach firsthand. He had undergone two bowel surgeries related to Crohn's disease earlier in his life, so when another health system recommended surgery for his prostate cancer, he was concerned about how another operation could affect him.
At Fox Chase, urologic oncologist Alexander Kutikov, MD, FACS—who also serves as Co-Executive Director of the Fox Chase–Temple Health Urologic Institute, which provides advanced treatment options and highly specialized care for patients with both cancerous and noncancerous urological conditions—consulted Hallman about Coren’s case. They considered surgery and different forms of radiation before recommending high dose-rate brachytherapy, a form of internal radiation treatment.
Coren's case required the team to consider how established treatment options could best be applied when there wasn't one clearly defined approach.
“There wasn’t one clearly established pathway for a patient with his combination of prostate cancer and prior surgeries,” Hallman said. “We drew on the evidence behind established treatments and our experience with each to determine which option could treat the cancer effectively while minimizing the risks.”
Coren underwent two treatments in 2023. His PSA level dropped significantly afterward and has remained very low.
"It gave me a new lease on life," Coren said. At 76, Coren still coaches cross-country and spring track, an important part of the active life he wanted to preserve.
Before recommending treatment, doctors first need to understand the cancer itself.
A patient's prostate-specific antigen, or PSA, level provides one piece of the picture. An elevated PSA can be a sign of prostate cancer, although other conditions can also cause it to rise.
A biopsy provides more information. The results are used to calculate a Gleason score, which reflects how abnormal the cancer cells look and helps doctors determine whether the cancer is low, intermediate, or high risk.
Imaging can show whether the cancer appears confined to the prostate or has spread elsewhere in the body. Genetic and molecular testing may provide additional information about the cancer and how it could respond to different treatments.
Together, those findings help narrow the treatment options.
For some men with low-risk prostate cancer, immediate treatment may not be necessary. Instead, doctors may recommend active surveillance to closely monitor the cancer and begin treatment if it shows signs of changing.
Test results aren't the only consideration. Doctors also look at a patient's age, overall health, lifestyle, and existing urinary, bowel, and sexual function.
Fox Chase uses questionnaires and conversations with patients to gather that information and better understand how different treatments could affect their daily lives.
Treatment logistics can matter, too. Some options require more visits than others, which can be an important consideration for someone who lives farther from the treatment center.
Often, Hallman said, the information points to one or two options. In other cases, patients may have several choices with meaningful differences in side effects, effectiveness, and treatment schedules.
Treatment guidelines provide a framework for care, but Hallman said they still need to be applied to each patient's individual circumstances and priorities.
"Some patients want the most aggressive treatment and don't care so much about side effects," Hallman said. "Other patients' priority is their quality of life. If a treatment is more effective but causes more side effects and reduces their quality of life, they may not want it, even if it helps them live longer."
Prostate cancer treatment decisions can also involve doctors from different specialties.
Coren's experience showed how that collaboration can shape treatment decisions. Kutikov consulted Hallman about Coren's case, and together they considered surgery and different forms of radiation. Coren was particularly impressed that Kutikov, a surgeon, was willing to recommend a nonsurgical approach when the doctors determined it was a better fit given his medical history, concerns, and goals.
That multidisciplinary approach gives patients the benefit of more than one perspective, particularly when several treatments may be medically appropriate.
It also helps shift the conversation from simply asking which treatments can work to deciding which one makes the most sense for a particular patient.
Advances in prostate cancer treatment are giving doctors more ways to tailor care, but more options don't necessarily make treatment decisions easier. New approaches still need to be studied to determine which patients are most likely to benefit from them.
Radiation therapy, for example, has become more precise. Imaging can help doctors target the prostate while limiting radiation exposure to nearby healthy tissue. For some patients, that precision can allow radiation to be delivered in higher doses over fewer treatment sessions.
Brachytherapy is another option for certain patients. The high dose-rate treatment Coren received temporarily places a radioactive source inside the prostate before removing it after treatment.
Clinical trials are also helping shape the next generation of prostate cancer care. At Fox Chase, researchers are studying new treatment combinations, radiation approaches, and how the genetic and molecular characteristics of prostate cancers can help guide treatment decisions. The research can help doctors determine not only whether a new approach works, but when it should be used and which patients are most likely to benefit.
There isn't a single factor that determines what should happen after a prostate cancer diagnosis. PSA levels, biopsy findings, Gleason score, imaging, and risk group help doctors understand the cancer, while a patient's health, lifestyle, concerns about side effects, and personal priorities can help determine which treatment makes the most sense.
A second opinion can also be valuable when weighing those factors. It isn't necessarily about finding a doctor who disagrees with the first recommendation. Instead, it gives patients another opportunity to consider their options and make sure the treatment plan fits both the cancer and their individual needs.
Understanding those options and discussing them with specialists can help patients feel more informed about the decisions ahead. If you or a loved one has been diagnosed with prostate cancer, learn more about prostate cancer care and treatment options at Fox Chase Cancer Center.
