Prostate Cancer

Treatments for Prostate Cancer

Treatment of the prostate cancer depends on whether it is localised or advanced.

Localised: This includes all cancers that are found to be confined within the prostate gland. Radical interventions with curative intent may be offered, including surgery (radical prostatectomy) or radiotherapy, the latter often used in combination with hormone therapy. Proper trials of these treatments have a last begun to be reported and suggest there are some men who do receive benefit from these interventions. Most prostate cancers grow slowly and require no treatment. Up to 90% of men with early cancer survive for more than 10 years.

Some men may benefit from monitoring alone. This is often termed ‘active surveillance’ or ‘watchful waiting’ to determine whether the tumour is staying stable, growing only slowly or presents a real risk.

Advanced: Once the cancer has spread outside the prostate, some form of hormone therapy is recommended. This blocks the male sex hormones that cause the prostate gland to grow and function. Such treatments are usually given indefinitely but because of the side-effects of this treatment, there is debate about the best time to start therapy and it is occasionally given intermittently or delayed until symptoms develop.

All these treatments are available in the UK.

Some of the newer treatments including brachytherapy, high intensity focussed ultrasound (HIFU) and cryosurgery are available in specialised UK centres. There effectiveness remains to be demonstrated but they may offer fewer side-effects.

Side-effects of treatment

Although neither radiation nor surgery is completely free of local side effects, most patients lead an entirely normal life. Each treatment might result in different side-effects. With radical surgery or radiotherapy, the commonest include impotence, urinary incontinence and scars (strictures) within the urethra (the tube through which urine passes). Bowel and bladder problems can also occur with radiotherapy although newer techniques may enable a higher dose (and possibly better chances of cure) with less side-effects.

Hormone therapy can result in osteoporosis (bone thinning), hot flushes with sweats, fatigue, a lower sex drive with impotence, reduced mental state and feelings of weakness. This is called the andropause or castration syndrome.