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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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The treatment options for locally-advanced prostate cancer include radiotherapy|, hormonal therapy|, watchful waiting| (observation) and surgery|.
Sometimes a combination of treatments will be given.
Deciding on the best treatment isn't always straightforward - a number of factors have to be taken into account. The most important of these are:
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 is common to see a surgeon, an oncologist and a specialist nurse to help you make the decision.
Some people find it helpful to have another medical opinion to help them decide about their treatment. Your specialist or your GP will usually be willing to refer you to another specialist for a second opinion, if you feel it will be helpful.
If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready so that you can make sure your concerns are covered during the discussion.
You may be advised to be monitored instead of having treatment immediately. This is known as watchful waiting|. Many locally-advanced prostate cancers grow extremely slowly and may cause very few problems within a man’s lifetime. However, it’s not possible to tell from blood tests and biopsies how quickly the cancer is going to grow.
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 having treatment straight away.
Many men with locally-advanced prostate cancer are usually offered radiotherapy| to the prostate. Hormonal therapy| is often given with radiotherapy and can be started before the radiotherapy and continued after it ends.
Some men are offered hormonal therapy as a treatment on its own. It’s also used to treat men who aren’t able to have radiotherapy, and those who can’t have surgery because they aren’t able to have a general anaesthetic, or who can’t have surgery because of other medical problems.
In elderly men who have no symptoms from the cancer, or who have medical problems in addition to cancer, it may be best to give no treatment (but continue regular monitoring of PSA levels) and control any symptoms that occur. This is known as watchful waiting| and is a common way of dealing with locally-advanced prostate cancer. It is used because the growth of the cancer may be so slow that it’s not worth risking the side effects that may be caused by treatment.
Surgery| to remove the prostate gland (a prostatectomy) may be possible for a small number of men. Sometimes radiotherapy is given after surgery. An operation to relieve problems with passing urine, known as a TURP, may be suitable for some men.
You may be offered a choice of treatment. The different treatments are discussed in more detail within this treatment section|.
Your doctor will explain the possible advantages, disadvantages and side effects of each treatment. You can then decide which is best for your particular situation. Before you have any treatment it’s important that you are fully aware of them.
It isn’t possible for doctors to predict accurately who is going to be affected by the side effects of each treatment. For this reason you need to be given full information about the risks beforehand and have plenty of opportunity to discuss them. Remember, there are often choices to be made about which treatment you have, or even whether to have treatment. You can take as large or small a part in these choices as you wish.
Before you have any treatment, your doctor will explain its aims to you. 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:
If you don’t understand what you have 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 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 your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It is essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting to have treatment, but it can help to let the staff know your concerns so that they can give you the best advice.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.