Treatment for locally-advanced prostate cancer
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:
your general health
the stage and grade of the prostate cancer
your PSA level
the likely side effects of treatment
your views about the possible side effects of treatment and whether you are willing to risk getting them for the possible benefits of controlling the cancer
whether you’ve had treatment before.
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, clinical oncologist and a specialist nurse to help them make decisions about treatment.
Not having treatment straight away
You may be advised not to have treatment immediately but to be monitored instead. This is known as watchful waiting.
Many locally advanced prostate cancers grow very slowly and may cause very few problems in a man’s lifetime. The grade of the cancer (Gleason score) can give doctors more information, but will not be able to predict the exact outcome. It’s impossible for doctors to tell from blood tests and biopsies what will happen with your cancer in the future.
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 locally advanced 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.
Common treatment choices for men with locally-advanced prostate cancer
Most men with locally advanced prostate cancer will need a combination of several treatments. Many men are offered radiotherapy to the prostate. Hormonal therapy is often given with radiotherapy . It can be given before radiotherapy starts and continued after it finishes.
Some men are offered hormonal therapy on its own. It’s often used to treat men who aren’t able to have radiotherapy. It can also be used to treat men who can’t have surgery because they’re unable to have a general anaesthetic, or men 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. Instead, PSA levels will continue to be monitored and treatment can be given to control any symptoms that do occur. This is called watchful waiting .
Surgery to remove the prostate gland ( prostatectomy ) may be possible for a small number of men with locally advanced prostate cancer. Sometimes radiotherapy is given after surgery as well.
Advantages and disadvantages of treatments
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 locally advanced prostate cancer are highlighted in green boxes in the pages for each individual treatment.
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.