Treatment options for early prostate cancer

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 examination of the prostate and repeat biopsies.

Benefits: Many men who choose active surveillance will avoid the complications of surgery, radiotherapy, or hormonal therapy.

Disadvantages: Some men find it difficult just to wait to see if their cancer progresses before starting any treatment. Some men will need surgery|, radiotherapy| or hormonal therapy| if their cancer shows signs of developing.

A major surgical 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: For every 1000 men who have a radical prostatectomy: one or two will die from problems caused by surgery; up to 200 will develop slight leaking of urine; around 50 will have incontinence of urine; and about 700 will have problems getting an erection.

High-energy rays are used 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 hormone therapy before and during the radiotherapy may improve the results.

Disadvantages: For every 1000 men who have external beam radiotherapy: up to 300 will develop occasional bleeding from the rectum (back passage); about 100 may have bleeding, a change in bowel habit and some discomfort; and up to 700 will develop erection problems (though this depends on age). Rarely, some men may have leakage of urine or incontinence of urine.

A newer type of radiotherapy, which uses radioactive seeds inserted into the prostate.

Benefits: Same as for external beam therapy. 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 external beam radiotherapy, but bowel problems (diarrhoea) and impotence are expected to be less common. Scar tissue may cause gradual narrowing of the urethra which may need to be treated.

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: Can slow or stop the growth of cancer cells for many years. Does not involve surgery or radiation so there is little risk of bowel or bladder problems.

Disadvantages: It will not get rid of all the cancer cells if it is the only treatment given, and can cause a range of side effects that include breast-swelling and hot flushes, impotence and lowered sex drive.