Treatment options for early prostate cancer

Active surveillance (active monitoring) Back to top

Most early-stage prostate cancers are very slow-growing and may never cause any symptoms. For this reason, some men and their specialists decide to wait to see whether the cancer is getting bigger (progressing) before starting any treatment. The ‘active surveillance|' approach involves regular check-ups with PSA tests|, rectal examinations| of the prostate and repeat biopsies|.

Benefits Many men who choose active surveillance will avoid the complications of surgery, radiotherapy or hormonal therapy, which are discussed on the following pages.

Disadvantages Some men find it difficult to just wait and see if their cancer progresses before starting any treatment.

Radical prostatectomy Back to top

This is a major operation| to remove the whole prostate gland.

Benefits Removing the whole prostate gland may stop an early cancer from spreading and may result in a cure. Radical prostatectomy appears to prolong life for some men with a faster growing cancer, but for men with small, slow-growing cancers, the benefits are unclear and probably only apply to younger men. In two out of five men, the cancer cells are not fully removed, and therefore the operation may not result in a cure.

Disadvantages 1 in 200 men over 65 and 1 in 1,000 men under 65 who have a radical prostatectomy may die from problems caused by the surgery. For every 100 men who have a radical prostatectomy, up to 20 will develop slight leaking of urine. Around five men will have incontinence of urine, and about 50 will have problems getting an erection.

External beam radiotherapy Back to top

External beam radiotherapy| uses high-energy rays to destroy cancer cells.

Benefits Radiotherapy may lead to a cure in early prostate cancer, but as with prostatectomy, the benefits in small, slow-growing cancers are uncertain. A complete course takes up to seven weeks. Giving hormonal therapy before and during the radiotherapy may improve the results.

Disadvantages For a small number of men, external beam radiotherapy to the prostate can cause long-term bowel problems, such as occasional bleeding from the rectum (back passage). Bowel motions may become looser and more frequent. Approximately 1 in 3 men will develop erection problems - this depends on your age and whether you are also being treated with hormonal therapy. Rarely, some men have leakage or incontinence of urine. Radiotherapy to the prostate will also cause infertility.

Brachytherapy Back to top

This is a type of radiotherapy that uses radioactive seeds inserted into the prostate. Brachytherapy| is only available in some hospitals in the UK.

Benefits These are the same as for external beam radiotherapy. It's a simpler procedure than external beam radiotherapy, as it usually involves only one planning session and one treatment session (under general anaesthetic) during a stay in hospital of one or two days. 

Disadvantages Side effects to the bladder, such as inflammation (cystitis) may be more severe than with external beam radiotherapy, but bowel problems (diarrhoea) and impotence are less common. Scar tissue may cause gradual narrowing of the urethra, which may need to be treated.

Hormonal therapy Back to top

This treatment lowers the levels of testosterone in the body using tablets or injections, or by surgery to remove the testes. Hormonal therapy| may be used on its own or given with radiotherapy treatment.

Benefits Hormonal therapy can slow or stop the growth of cancer cells for many years. It doesn't involve surgery or radiation so there's little risk of bowel or bladder problems.

Disadvantages It won't get rid of all the cancer cells if it's the only treatment given. It can also cause a range of side effects including breast-swelling and hot flushes, erection problems (impotence) and a lowered sex drive.