Treatment overview for early prostate cancer

Your treatment will depend on different things including the stage and risk group of the cancer, your age, and general health and your preferences.

The main treatments for early prostate cancer include:

  • Active surveillance – the cancer is monitored with regular tests, such as MRI scans or biopsies. If the cancer starts to grow, you can have treatment to cure it straightaway.
  • Watchful waiting – the cancer is also monitored but you will not have scans unless it starts to grow and you have symptoms. Your doctor will usually then advise hormonal therapy to control the cancer.
  • Surgery – this is major surgery to remove the whole prostate.
  • Radiotherapy – you may have external or internal radiotherapy. Some men have both.
  • Hormonal therapy – given by injection or tablet can reduce the amount of testosterone, which prostate cancer depends on to grow, in your body. It can be given with radiotherapy or sometimes on its own.

Other treatments, such as cryotherapy or high-intensity focused ultrasound (HIFU), may be used in clinical trials.

Your doctor will talk to you about your treatment options and their advantages and disadvantages.

Treatment overview for early prostate cancer

There are different treatments for early prostate cancer that can successfully treat 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.


Treatments


Delaying treatment

In some situations, doctors may ask you to think about not having treatment straight away. It means you can avoid treatment and its side effects until you need it. Some men may never need to have treatment.

There are different ways of delaying treatment:

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)

With watchful waiting, your doctors also monitor the cancer. But it does not involve regular scans or a biopsy unless the cancer grows and causes symptoms. It means you avoid treatment and its side effects for as long as possible.

Your doctor might advise this 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 you to start hormonal therapy to control the cancer. But some older men may never need treatment for the cancer in their lifetime.


Surgery

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.


Radiotherapy

This uses high-energy x-rays to destroy the cancer cells. The aim is to cure the cancer. 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.


Hormonal therapy

Prostate cancer needs testosterone to grow. Hormonal therapies reduce 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 difficult.


Other treatments

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.

Watch our video, which gives an overview of treatment for early prostate cancer here.

Treatment for early (localised) prostate cancer explained

A urologist explains the treatment options for early prostate cancer, and a patient shares his experience.

About our cancer information videos

Treatment for early (localised) prostate cancer explained

A urologist explains the treatment options for early prostate cancer, and a patient shares his experience.

About our cancer information videos


Talking about your treatment

After the MDT meeting, your specialist doctor and nurse will talk to you about your treatment options. Before this, you might find it useful to write down a list of your questions. It is a good idea to have a partner, family member, or friend with you at the appointment. They can help you remember what was said and talk to you about it afterwards.

Your doctor will explain your treatment options and the aims. This should include:

  • the benefits and disadvantages (risks and side effects) of different treatments
  • other treatments that may be available
  • what is likely to happen without the treatment.

They will explain different side effects and how they can be managed. They will help you make decisions about your treatment. If there is anything you do not understand, ask your doctor or nurse to explain it again. Cancer treatments can be complicated. It is also hard to take things in when you are feeling anxious. You may need to have more than one meeting with your doctor about your treatment.

My care team have been very open and good at communicating with me. It felt like they had taken the time to look at my case before offering me options.

Simon


Second opinion

Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion.

Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. 

If you do go for a second opinion, it may be a good idea to take a relative or friend with you. You may also find it helpful to have a list of questions ready so that you can make sure your concerns are covered during the discussion.

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