Prostate cancer treatment

Your doctor will explain the different treatment options for early or locally advanced prostate cancer. Together you can decide on the best treatment for you. Treatments may cure the cancer or keep it under control for many years.

About treatment options for prostate cancer

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.

Multidisciplinary team (MDT) for prostate cancer

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.

Treatments for prostate cancer

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.

High-intensity focused ultrasound (HIFU) or cryotherapy are treatments that use heat or cold to destroy prostate cancer cells. These are less common treatments for early prostate cancer.

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.

  • Radiotherapy

    Radiotherapy is often the main treatment. You may have internal radiotherapy (brachytherapy) as well. You usually have hormonal therapy with radiotherapy.

  • Hormonal therapy

    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.

  • Surgery

    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.

  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is sometimes used to treat locally advanced prostate cancer that is harder to treat.

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.

Making treatment decisions

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.

Treatment effects on your sex life

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.

Fertility

Prostate cancer treatments can affect your fertility. If this is a concern for you, talk to your doctor or nurse. You may be able to store sperm before treatment starts.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following:

  • Call the Macmillan Support Line on 0808 808 00 00.
  • Chat to our specialists online
  • Visit our cancer treatment forum to talk to people who have been affected by cancer, share your experience, and ask an expert your questions.

About our information

  • Reviewers

    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.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.

You can read more about how we produce our information here.