Prostate cancer treatment
Your treatment for prostate cancer will depend on:
- your general health
- your age
- the risk group if you have early prostate cancer
- the Gleason score and cancer grade
- the stage of the cancer
- your preferences.
Your doctor and nurse will talk to you about the different things to think about when making treatment decisions. They will explain the benefits and disadvantages of each treatment. How you feel about treatments and your preferences are a personal choice. Making treatment decisions can be difficult, but there is support to help you.
After your test results, you and your doctor start to talk about your treatment. Your doctor usually meets with other specialists to get their opinions too.
A team of specialists meet to talk about the best treatment for you. They are called a multidisciplinary team (MDT).
The MDT look at national treatment guidelines or the latest evidence for the type of cancer you have. If you have any treatment preferences, your doctor will tell them about this.
The MDT will usually include the following professionals:
- Urologist – a doctor who treats problems with the prostate, kidneys, bladder and male reproductive system.
- Surgeon (urologist) – a doctor who specialises in operating on the prostate.
- Oncologist – a doctor who treats people who have cancer.
- Clinical nurse specialist (CNS) – a nurse who gives information about cancer, and support during treatment.
- Radiologist – a doctor who looks at scans and x-rays to diagnose problems.
- Pathologist – a doctor who looks at cells or body tissue under a microscope to diagnose cancer.
The MDT may also include:
- a physiotherapist
- a dietitian
- a counsellor or psychologist.
The main types of treatment for early stage or locally advanced prostate cancer include:
- Surgery to remove the prostate (prostatectomy). This is usually done with keyhole surgery (laporoscopic) or robotic surgery.
- External radiotherapy, which uses high-energy x-rays to destroy the cancer cells. You usually have this over a few weeks as an outpatient.
- Internal radiotherapy (brachytherapy) which gives high doses of radiation directly to the prostate. It is often given as a boost with external radiotherapy. Brachytherapy may be given on its own for some early prostate cancers.
- Active surveillance to monitor early prostate cancer with regular tests. It can help to avoid unnecessary treatment and side effects.
- Hormonal therapy reduce the amount of testosterone in the body. It is often given before and after radiotherapy. Hormonal therapy is sometimes given on its own to control the cancer if you do not want other treatments.
- Watchful waiting is monitoring that does not involve regular tests or biopsies. If the cancer shows signs of changing or symptoms develop you usually start hormonal therapy.
Treating early prostate cancer
In early prostate cancer, doctors offer treatments based on the risk group of the cancer.
Low-risk prostate cancer
This type of prostate cancer is very slow-growing. Sometimes it never causes problems. Surgery or radiotherapy are the main treatments used to cure it. To begin with, you and your doctor may talk about whether you need immediate treatment. This depends on the risk of the cancer progressing and how you feel about the benefits and disadvantages of treatment.Not having treatment may involve a certain amount of risk. To manage this your doctor may advise monitoring the cancer with active surveillance. Your
doctor assesses the risk of the cancer progressing using your biopsy, PSA test and scan results.
- If you are older, a decision to avoid treatment may be easier to make. You may feel low-risk prostate cancer is unlikely to cause you a problem within your lifetime.
- If you are younger and preserving your erectile function is a priority, avoiding treatment may be important for your quality of life.
You may find the online decision aid called Predict helpful. If you do choose active surveillance you can decide to have treatment at any time if you change your mind.
Intermediate-risk prostate cancer
You usually have treatment with either external radiotherapy or prostatectomy straight away. If you have radiotherapy, you may also have brachytherapy. You also usually have hormone therapy before radiotherapy and for a few months after. Active surveillance or a type of monitoring called watchful waiting may also be treatment options.
High-risk prostate cancer
You usually need more treatment to cure the cancer as there is a higher risk of it spreading. You can have treatment with either a prostatectomy or radiotherapy. If you have radiotherapy, you also have brachytherapy and hormonal therapy. You may have hormonal therapy for 3 years after radiotherapy. If you have a prostatectomy and your doctor thinks the cancer may not have been completely removed they may advise radiotherapy afterwards.
Treating locally advanced prostate cancer
You may need a combination of treatments.
Hormonal therapy with radiotherapy helps to make treatment more effective. You may have hormone therapy before, during and for up to 3 years after radiotherapy. It reduces the risk of the cancer coming back.
Watchful waiting (watch and wait)
Instead of having treatment straight away your doctors monitor the cancer with watchful waiting. You do not have regular tests or scans. You will not start treatment unless the cancer is changing, or you get symptoms. If this happens your doctor will usually advise you start hormonal therapy on its own to control the cancer.
A prostatectomy is not commonly done to treat locally advanced prostate cancer. Surgery may not be able to remove all the cancer cells that have spread outside the prostate. If you have a prostatectomy you usually have radiotherapy afterwards. Other types of surgery are sometimes done to relieve symptoms.
Sometimes doctors may advise having hormonal therapy on its own. For example, if you are older, have health problems or do not want other treatments.
You and your doctor decide on the right treatment plan for you. Your doctor is an expert in the best treatments. But you know your preferences and what is important to you.
When you make treatment decisions there are different things you may want to think about:
- What your treatment preferences are and how their advantages and disadvantage will affect you. For example, you may prefer not to have surgery if you have heart problems. Or, if you have a bowel condition you may want to avoid radiotherapy.
- How much side effects, such as erection difficulties, are likely to bother you. If active surveillance is suitable, you can avoid erectile dysfunction (ED). After surgery you are more likely to get ED straight away. With radiotherapy it may be less likely or take longer to develop.
- Whether the cancer is very unlikely to cause you problems over your lifetime. If not, monitoring the cancer with active surveillance or watchful waiting may be more suitable for you.
- What your treatment options would be if the cancer came back. You may be able to have radiotherapy after surgery. But it may not be possible to have surgery if you have already had radiotherapy.
The effects of treatment on your sex life and relationships may be a big concern for you. Your doctor and nurse will explain the likely effects of treatments on your sex life. You may worry about talking about your sex life with your healthcare team. But it is important to ask questions. There are different treatments and support available to improve sexual difficulties.
We have more information about prostate cancer and sex.
Macmillan is here to support you. If you would like to talk, you can do the following:
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from www.esmo.org/guidelines/genitourinary-cancers/prostate-cancer
National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131) Available at www.nice.org.uk/guidance/ng131
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.
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