The treatment options for early prostate cancer include watchful waiting, active surveillance, surgery (removal of the prostate gland), external beam radiotherapy and brachytherapy.
Sometimes, hormonal therapy may be given after radiotherapy, or as a treatment on its own to older men or those who are unfit for other treatments.
Deciding on the best treatment isn’t always straightforward and a number of factors have to be taken into account. The most important of these are:
In most hospitals a team of specialists will discuss the possible treatments for your situation. This multidisciplinary team (MDT) will include a surgeon (urologist) and doctors who specialise in radiotherapy, hormonal therapy and chemotherapy treatments (clinical oncologists).
The team may also include specialist nurses, social workers and physiotherapists. It’s common for patients to have appointments with a surgeon, oncologist and a specialist nurse to help them make decisions about treatment.
The MDT uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and to have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
For more information about treatment decisions visit our full site.
Not having treatment straight away
You may be advised not to have treatment immediately but to be monitored instead. There are two approaches to this: active surveillance and watchful waiting. Although blood tests and biopsies can now find prostate cancer at a very early stage, it isn’t possible to tell whether the cancer is going to grow enough to cause any symptoms. The grade of the cancer (Gleason score) can give doctors more information, but will not be able to predict the exact outcome. Many prostate cancers grow very slowly and a small, early-stage prostate cancer may never cause any problems in a man’s lifetime.
The treatments for prostate cancer can cause side effects such as erection problems or incontinence, which for some men may be worse than the effects of the cancer. Your doctors may advise waiting to see whether the cancer is likely to cause problems, rather than giving treatment straight away.
Choosing between two or more treatments
In some situations, men with early prostate cancer are given the choice between two or more types of treatment. This is because sometimes treatments are thought to be equally effective and there is no clear benefit of having one treatment over another. In this situation, doctors offer men a choice of treatments. This is because some men with prostate cancer may have a preference over which treatment they want in terms of what the treatment involves and the possible side effects.
If you’re asked to choose a treatment yourself, it’s important to make sure you have all the information you need about the different types being offered to you. Your doctor or specialist nurse will answer any questions you have. Don’t worry if you need to ask the same questions again – treatments for cancer can be very complex and it’s common to need repeated explanations. You may also want to ask your doctor or specialist nurse for some time to think about your options.
You may find our section about Making treatment decisions helpful.
Common treatment choices for men with early prostate cancer
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If your cancer is likely to develop very slowly and you are elderly and not well enough for treatment such as surgery or radiotherapy , you may be offered watchful waiting. If symptoms begin to develop you may then be offered treatment, such as hormonal therapy , to control the cancer.
Younger men who are well and have low-grade early prostate cancer may be offered active surveillance. If the cancer begins to progress, they will then be offered surgery or radiotherapy to try to cure the cancer. Active surveillance enables the doctors to give treatment to those who will need it rather than to men whose cancer is not going to progress. Men who have cancer that doesn’t progress can then avoid the potentially difficult side effects of treatment.
Men who have a moderate- to high-grade cancer ( Gleason score of 7 or more ) are more likely to be offered surgery to remove the prostate gland (radical prostatectomy) or radiotherapy to the prostate. These treatments aim to get rid of all of the cancer cells and cure the cancer.
For some men these treatments will cure the cancer, but for others some of the cancer cells may be left behind after the treatment. In others, 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 directly into the prostate gland as brachytherapy .
Hormonal therapy may be used for some men who are having radiotherapy. Newer treatments , such as cryotherapy (also known as cryosurgery) or high-intensity focused ultrasound (HIFU) treatment may be offered to some men.
Advantages and disadvantages of treatments
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It’s important that you’re fully aware of the advantages and possible disadvantages and side effects of the treatments before you have them. Your doctor or specialist nurse will explain these to you. You can then decide which treatment is best for you.
The advantages and disadvantages of individual treatments for early prostate cancer are highlighted in green boxes in the relevant treatment sections of our cancer information pages.
It’s important to remember that everyone reacts differently to cancer treatment. It’s impossible for doctors to accurately predict who will and who won’t be affected by the side effects of each treatment.
David Plume explains the benefits and disadvantages of getting a second opinion about your treatment.