About treatment for prostate cancer

Treatment of prostate cancer depends on the diagnosis and the stage and grade of the cancer.

Your doctor and nurse will help you understand what these treatments involve and how they may affect your life. If possible, you may want to involve a partner or someone close to you in these talks. Deciding on your treatment can be difficult, but there is support to help you.

Your doctor will talk to you about the different factors you should consider when making treatment decisions. Together, you can decide on the best treatment for you. This will depend on:

Sometimes your doctor may talk to you about having your treatment as part of a clinical trial.

The main treatments for prostate cancer include active surveillance, watchful waiting, surgery to remove the whole prostate, radiotherapy, and hormonal therapy (see below).

Delaying treatment for prostate cancer

Not everyone with prostate cancer needs treatment straight away.

In some situations, doctors may ask you to think about delaying treatment. It means you can avoid treatment and its side effects until you need it. Some men may never need to have treatment.

There are two ways of delaying treatment. They are called active surveillance and watchful waiting. Watchful waiting is also called watch and wait.

Active surveillance

Your specialist doctor monitors the cancer using tests. These tests include MRI scans, biopsies, and measuring your PSA level every 3 to 6 months. Your doctor might advise active surveillance if either:

  • the cancer is low risk
  • you want to avoid immediate treatment.

If the cancer is not changing, you may avoid treatment and its side effects. If the cancer starts growing, you may have treatment to cure it straight away.

Watchful waiting (watch and wait)

In some situations, doctors may want to monitor the cancer without using tests. Doctors call this watchful waiting (watch and wait). You do not have regular scans or start treatment unless the cancer is growing or you get symptoms. It means you avoid treatment and its side effects for as long as possible. For some men, the side effects of treatment may be worse than the effects of the cancer.

Your doctor might advise watchful waiting if either:

  • you are older and do not have symptoms
  • you have another medical condition that makes having treatment difficult.

If the cancer starts growing or you get symptoms, your doctor will usually advise that you start treatment. But some older men may never need treatment for the cancer in their lifetime.

Common treatments for prostate cancer

Surgery for early prostate cancer

This is a major operation to remove the whole prostate, called a prostatectomy. The aim is to cure the cancer. Your specialist might ask you to think about this if the cancer is intermediate-risk or high-risk cancer. You also need to be well enough to have a major operation.

Surgery for locally advanced prostate cancer

Surgery is not commonly done to treat locally advanced prostate cancer. Surgery may not be able to remove all the cancer cells that have spread outside the prostate. But occasionally it may be done to try to prevent the cancer spreading. You usually have radiotherapy afterwards.

Other types of surgery are sometimes done to relieve symptoms or reduce testosterone levels in the body.

Surgery for advanced prostate cancer

Surgery to remove the prostate is not suitable for men with advanced prostate cancer. Some men may have an operation called a transurethral resection of the prostate (TURP) to help relieve problems with passing urine (peeing). Another type of operation removes part of the testicles. This is called a subcapsular orchidectomy. It is done to reduce the amount of testosterone in the body. Surgery may also be used to help control other symptoms or to help stabilise a bone that is at risk of breaking.

There are other treatments available that can relieve and control any symptoms you may have.

We have a video about treating advanced prostate cancer.

Radiotherapy for prostate cancer

This uses high energy x-rays to destroy the cancer cells. Radiotherapy is usually given externally (from outside the body).

Some men have radiotherapy given internally (from inside the body). This is called brachytherapy. It is sometimes given on its own and sometimes given with external radiotherapy. Brachytherapy is not suitable for all prostate cancers. Your cancer doctor can discuss this with you.

You may have radiotherapy to improve symptoms such as pain in the prostate area or the bones. Radiotherapy can also help strengthen a weakened bone.

Radiotherapy can sometimes follow surgery.

We have information on radiotherapy for advanced prostate cancer.

Hormonal therapy

Prostate cancer needs testosterone to grow. Hormonal therapy reduces the amount of testosterone in the body.

You may have hormonal therapy before, during or after radiotherapy, to make the treatment more effective. Or your doctor may advise having hormonal therapy on its own if either:

  • you are older
  • you have health problems that make having radiotherapy or surgery difficult.

Hormonal therapy for advanced prostate cancer

Hormonal therapy is the main treatment for men with advanced prostate cancer. You can have it as injections, implants, tablets or nasal spray. You might have a drug on its own or with another hormonal therapy. Some men have hormonal therapy along with chemotherapy.

Chemotherapy for advanced prostate cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is given to men when they are first diagnosed with advanced prostate cancer, together with hormonal therapy. It may also be used to treat cancer that is no longer being controlled by hormonal therapy.

The aim of chemotherapy for advanced prostate cancer is to control the cancer. This will help to relieve symptoms and improve quality of life.

The most commonly used chemotherapy drug to treat prostate cancer is docetaxel (Taxotere®). Other drugs that may be used are:

Other treatments for prostate cancer

Some men may decide to have other treatments, such as cryotherapy or high-intensity focused ultrasound (HIFU). These treatments are still being researched to see how effective they are, so you usually have them as part of a clinical trial. They are only suitable when the cancer is only on one side of the prostate.

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