The types of treatment used for prostate cancer

Choosing treatment

Deciding on the best treatment for cancer of the prostate is not always straightforward and a number of factors have to be taken into account. The most important of these are:

• your general health
• the grade and stage of the prostate cancer
• whether the cancer has already spread beyond the prostate
• your PSA level
• the likely side effects of treatment
• your views about the possible side effects of treatment and how much you are willing to risk the possible side effects because of the benefits in controlling the cancer
• your age.

The possible treatments for your situation are likely to be discussed by a group of doctors working together. This is known as a multidisciplinary team and includes a surgeon (urologist) and doctors who are specialists in radiotherapy, hormonal therapy and chemotherapy treatments (clinical oncologists). The team will also include specialist nurses, social workers, and physiotherapists.

Second opinion

Some people find it helpful to have another medical opinion to help them to decide about their treatment. Doctors can refer you to another specialist for a second opinion if you feel that this would be helpful.

Early prostate cancer

The treatment options for early cancer of the prostate include:

• active surveillance (active monitoring)
• surgery (removal of the prostate gland)
• radiotherapy (external beam or brachytherapy)
• hormonal therapy
• watchful waiting

A combination of treatments may be used to give the best results.

If a prostate cancer is found at an early stage (when it is completely contained within the prostate gland), and is not causing any symptoms, it may not be necessary to have any treatment. This is because prostate cancer often grows very slowly and a small cancer may never cause any problems within a man’s lifetime. The treatments for prostate cancer can cause side effects, such as impotence or incontinence, which for some men may be worse than the effects of the cancer.

If you are advised that treatment is not currently necessary you will be offered active surveillance (active monitoring) or watchful waiting.

Active surveillance is used for young, fit men with early prostate cancer. It means that you will have regular PSA tests (and regular biopsies of the prostate) to see whether the cancer is beginning to grow. The aim is to monitor men to find those whose cancers are growing quickly, so that they can be offered treatment that may cure their cancer. Men whose cancers are not growing or developing can be safely monitored. Active surveillance allows treatment with surgery or radiotherapy to be offered only to men who need it.

Watchful waiting is where PSA tests are used to monitor men who are older, or who have other significant health problems, and are not able to have surgery or radiotherapy. If symptoms develop due to development of the cancer, medicines or other treatments can be given to control the symptoms but would not aim to cure the cancer.

Prostate cancer often grows very slowly and most men with this cancer live their normal life span without it causing them any problems.

Treatment choices

Either surgical removal of the prostate gland (radical prostatectomy) or radiotherapy to the prostate may be used. These treatments aim to get rid of all of the cancer cells and cure the cancer. Younger men or men who have a moderate to high-grade cancer are more likely to be offered surgery or radiotherapy. For some men these treatments will cure the cancer, but for other men some of the cancer cells may be left after the treatment. In some men the treatment may seem to get rid of all the cancer cells for a period of time, but the cancer may come back in the future.

In men with early prostate cancer, surgical removal of the prostate (prostatectomy) or radiotherapy (to the prostate) seem to be equally effective at treating the cancer. The radiotherapy can be given from an external machine or as brachytherapy.

However, each of the treatments has different benefits and side effects. So, you may be offered a choice of treatment. Prostatectomy is discussed on the Surgery page, external beam radiotherapy and brachytherapy on the Radiotherapy page. Hormonal therapy may be given before or after surgery or radiotherapy. It may also be the only treatment given. Hormonal therapy is discussed on the Hormonal therapy page.

Your doctor will explain the benefits and possible disadvantages and side effects of the treatments to you. You can then decide which is best for your particular situation and circumstances. The benefits and disadvantages of the treatments for early prostate cancer are outlined in the following table.

Benefits and disadvantages of treatments for early prostate cancer

Locally advanced prostate cancer

Most locally-advanced prostate cancers can be controlled for many years using hormonal therapy, radiotherapy to the prostate and surrounding area, or a combination of both. Surgery is not used for this stage of prostate cancer. Some locally advanced prostate cancers can be got rid of completely or cured.

In elderly men who have no symptoms from the cancer, or who have other medical problems, it may be best to give no treatment (but continue regular monitoring with PSA tests) and control any symptoms that occur. This is known as watchful waiting and is a common way of dealing with locally-advanced prostate cancer. It is used because the growth of the cancer may be so slow that it is not worth risking the side effects that may be caused by treatment.

Metastatic prostate cancer

If the cancer has spread to other parts of the body (most commonly the bones), hormonal therapy can be effective for many months or years. It can often shrink down tumours to reduce symptoms such as tiredness, problems in passing urine and discomfort or pain. A range of hormonal therapies is available.

Chemotherapy may occasionally be given if hormonal therapy is no longer able to control the cancer. Although the chemotherapy cannot get rid of all the cancer cells it can shrink the tumour and reduce symptoms. It may improve quality of life and prolong life, but can cause side effects. The doctors will look carefully at the possible advantages and disadvantages of chemotherapy treatment for an individual man.

Surgery such as a radical prostatectomy is not helpful for men with secondary prostate cancer, but sometimes a TURP can be useful to relieve problems with passing urine.

Radiotherapy can be given to relieve pain if cancer of the prostate has spread to the bones. The treatment is given to the affected bone or area and is known as palliative radiotherapy.

CancerBACUP has a section on secondary cancer in the bone, which gives more detail about the possible treatments.

If the bones in the spine are affected this can sometimes lead to weakness and tingling or numbness in the legs (due to pressure on the spinal nerves). If this is not treated the nerves may be permanently damaged. Treatment can often prevent damage, so if you develop any feelings of weakness, numbness or pins and needles in the legs, it is important to contact your cancer specialist immediately. Cancer in the spinal bones causing pressure on the spinal cord is known as spinal cord compression.