Treatment for early prostate cancer

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:

• your general health
• the grade of the prostate cancer
• the size and position of the cancer within the prostate gland
• 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 side effects for the possible 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 (MDT) and includes a surgeon (urologist) and doctors who are specialists in radiotherapy, hormonal therapy and chemotherapy treatments (clinical oncologists).

The team may also include specialist nurses, social workers and physiotherapists. It’s common to see a surgeon, an oncologist and a specialist nurse to help you to make the decision.

Second opinion Back to top

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 it would be helpful.

Treatment or not? Back to top

You may be advised not to have treatment immediately but to be monitored – this is known as ‘watchful waiting’| or ‘active surveillance|’. 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. Many prostate cancers grow extremely slowly and a small, early-stage prostate cancer may never cause any problems within 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 the sort that can cause problems, rather than giving treatment straight away.

Treatment choices for early prostate cancer Back to top

If the cancer is likely to develop very slowly and you are elderly and not fit 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, fitter men with low-grade, early prostate cancer may be offered active surveillance|. If the cancer begins to progress 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 a moderate to high-grade cancer are more likely to be offered surgical removal of 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 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 directly into the prostate gland as brachytherapy|.

Hormonal therapy may be used for some men who are having radiotherapy|. Cryotherapy| (also known as cryosurgery) or high-intensity focused ultrasound (HIFU) treatment may be offered to some men. You may be offered a choice of treatment. 

Benefits and disadvantages of treatments Back to top

It’s important that you’re fully aware of the benefits and possible disadvantages and side effects of the treatments before you have any treatment. Your doctor will explain these to you. You can then decide which is best for your situation.

The benefits and disadvantages of the treatments for early prostate cancer are outlined in the sections about the different treatments. 

It isn’t possible for doctors to predict accurately who is going to be affected by the side effects of each treatment.

Consent to treatment Back to top

Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other treatments that may be available
• any significant risks or side effects of the treatment.
   

If you don’t understand what you’ve been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need repeated explanations.

It’s often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

You may feel that the hospital staff are too busy to answer your questions, but it’s important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions. You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it’s first explained to you.

You’re also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It’s essential to tell a doctor or the nurse in charge what your decision is, so that they can record it in your medical notes. You don’t have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.