Treatment for locally-advanced prostate cancer

 

Choosing treatment Back to top

Deciding on the best treatment is not 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 of the cancer
• 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
• whether you have had treatment before
• 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 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 to make the decision.

Treatment choices Back to top

Many men with locally-advanced prostate cancer are offered radiotherapy| to the prostate. Hormonal therapy is often given with radiotherapy and can be started before the radiotherapy begins and continued after it is finished.

Some men are offered hormonal therapy| as a treatment on its own. It is also used to treat men who aren’t able to have radiotherapy, or those who can’t have surgery because they aren’t able to have a general anaesthetic, or because of other medical problems they may have.

In elderly men who have no symptoms from the cancer, or who have other medical problems, it may be best to give no treatment (but continue regular monitoring with PSA tests) 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 is 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. Hormonal therapy may be given before or after surgery. Sometimes radiotherapy is given after surgery. Surgery to relieve problems with passing urine, known as a TURP, may be suitable for some men.

You may be offered a choice of treatment. Each of the treatments has different benefits and side effects|.

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 that this would be helpful

Treatment or not? Back to top

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.

Consent to treatment Back to top

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:

• 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 do not 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 is not unusual for people to need repeated explanations.

It is 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 is 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 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 do not have it. It is essential to tell a doctor or the nurse in charge, so that they can record your decision in your medical notes. You do not 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.