Prostate cancer - Choosing treatments

This page offers an overview of all the proven treatments available for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. Further detail is on the Choosing treatments sub-pages that have now appeared on the menu to the left.


David, Rawle and Ray talk about the prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. treatments they opted for

Prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. can be treated in a number of ways. The treatment that is best for you depends on a number of factors.

Your treatment choice will take into account the stage and grade of your cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., your PSA level, and other factors such as your age and general health, and whether you have had previous treatments. If you have other health problems, this could affect the course and timing of treatment .

You need to be well informed when it comes to deciding on the best treatment for you.

Help yourself:

  • Read more about the different treatment options, including the advantages and disadvantages of each
  • Talk to your family and friends if you would like their support. It can also help them to cope if you keep them informed about what is going on
  • It can help to read about how other men came to decisions about their treatment
  • Join support groups or online communities. 

Different types of treatment

In some cases, where prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is small and slow-growing and you are not bothered by symptoms, your doctor may recommend that you do not need treatment. This is because the treatment can cause more problems than the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. You may, however, be checked regularly in case anything changes. This type of treatment is called active surveillance.


David, Rawle and Ray talk about side-effects of treatment

When the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is larger, aggressive or has spread outside the prostate, some form of treatment is recommended. It is not unusual to combine two or more methods to give the best chance of success.

In this section, we describe and discuss the most common treatments for each stage (localised, locally-advanced and metastatic) and risk group (low, intermediate and high risk) of prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

It is difficult to say which will be the best treatment for you, because this will depend on a number of factors, including:

  • Your age
  • Your general health
  • The stage of your cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • The grade of your cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Your PSA levels
  • If you have had treatment for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. before
  • The possible unwanted side effects of the treatment.

Other considerations could include your doctor's preferred choice of treatment and the availability of treatment in your area.

Watchful waiting

Watchful waiting means not having any treatment unless symptoms develop that show the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is getting worse.  Learn more

Active surveillance

The aim of active surveillance is to monitor the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. rather than treat it. You will have regular check-ups with your doctor. Learn more

Surgery

There are several surgical treatments for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. The surgical removal of all or part of the prostate glandAn organ with the ability to make and secrete certain fluids. is called prostatectomy and the aim is to remove the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. if it is only in the prostate glandAn organ with the ability to make and secrete certain fluids. and to stop it spreading. Surgical treatment options include radical prostatectomyThe surgical removal of the entire prostate gland., laparoscopic prostatectomy Surgical removal of the prostate, a gland that surrounds the urethra near the bladder.(including robotic prostatectomy) and transurethral resection of the prostate A procedure to shave away some of an enlarged prostate, which eases pressure from the prostate on the urethra, the tube that carries urine from the bladder.(TURP). Learn more


Brief animation showing you what happens during the TURP operation

Radiotherapy

Radiotherapy uses radiation to destroy cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells and stop the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. spreading. Although normal cells in the path of the beam will also be damaged, they can recover better than the cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. cells. Radiotherapy treatment options include external beam radiotherapy The treatment of disease using radiation.(EBRT), conformal radiotherapy and brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour.. Learn more

High intensity focused ultrasound (HIFU)


See a brief animation showing how the ultrasound probe targets the prostate from the rectum

This is a new treatment for localised cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. The aim of this treatment is to use ultrasound energy (high frequency sound waves) to heat and destroy prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells. Learn more (where you will also be able to see a brief animation showing how HIFUAn abbreviation for high intensity focused ultrasound, a relatively new method for treating cancer using focused ultrasound waves. works).

Cryotherapy

This is a new treatment that has been used to treat localised cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. The aim of this treatment is to freeze and destroy cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells, and it is mainly used to treat cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. that has returned following radiotherapy. Learn more

Hormone therapy

The aim of hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy is to reduce the amount of testosterone in the body, so that cellThe basic unit of all living organisms. growth in the prostate slows down. This can slow or shrink cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. growth. Learn more

Chemotherapy

Using drugs to kill cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells or make them less active is known as chemotherapyThe use of chemical substances to treat disease, particularly cancer.. The aim of this treatment is to relieve symptoms and prolong quality of life. Learn more

Bone-targeted therapies

Drugs may be used to delay or prevent symptoms arising from the spread of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. to the bones. They are also used to treat osteoporosis when hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. has resulted in bone thinning. Learn more

Your treatment options will vary based on your particular case, and some of these treatments may not be appropriate for you. It is important that you and your doctors talk through all the choices and that you understand why one type of treatment is better for you than another.

There is a lot of research into prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and new treatments are always On the horizon.

Multidisciplinary team

During your treatment, you may be looked after by a number of doctors, specialists and other healthcare workers. These people will work together in a multidisciplinaryRelating to a group of healthcare professionals with different areas of specialisation. team (MDT) at the hospital.

Depending on your hospital, the likely members of the MDT treating you will include:

  • Urologist
  • Oncologist
  • Radiologist
  • Pathologist
  • Specialist nurse.

The MDT can also liaise closely with other professionals who can provide support as needed, including counsellors and pain management specialists.

There are many factors to consider when it comes to deciding on your treatment for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. Medical practitioners and specialists can advise you, but the final decision is yours. Ask questions, and seek a second opinion if you want reassurance that you have reached the right decision.

Treatment of symptoms

While the doctors are treating the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. they will also be working with you to alleviate the symptoms that may come with the disease or its treatment. These can include pain, nausea, bone problems and general tiredness.

Further treatment

Cancer can return, sometimes many years later, even following successful treatment. Your GleasonA system used to assess the extent of abnormality of prostate cancer cells. score is one of the factors that can help predict recurrence.

After radical treatment, the important things to monitor are:

  • Your GleasonA system used to assess the extent of abnormality of prostate cancer cells. score
  • The timing of a rise in PSA levels after treatment
  • The rate at which PSA levels increase over time, known as PSA velocity.

Doctors will decide if you have had a relapse based on several different factors, including the type of treatment you had. This will also inform their decision about further treatment.

Radical prostatectomy aims to remove all prostate tissue. PSA levels should drop to a very low reading (typically less than 0.01ng/ml) and remain at that level. Radical treatment with radiation also destroys the prostate cells, and so PSA levels should also drop.

A rise in PSA level after radical treatment can show that cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells are present within the prostate or in other parts of the body. However, this does not always mean that the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. has returned.

Taking medications

It is not uncommon for you and your doctor to have to try several different drug combinations before finding the one that suits you best and keeps your cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. in remission without causing unwanted side effects.

It is important to remember to take your medication correctly, and at the right time and intervals. You may have to be in hospital to take your drugs. If you are away from home, you should remember to take your medications with you.

Integrated therapies

Many people with prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. use integrated therapies alongside conventional treatments.

Always tell your doctor if you intend to use or are using any integrated therapies to check that they will not affect any existing treatment you are receiving.

Nutritional therapy

Research has suggested that the growth of prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. can be influenced by the foods that you eat. Foods that provide optimal nutritional benefit include fish, poultry, legumes, fruit and vegetables (especially tomatoes), whole grains and cereals. A physician may recommend various nutrients such as:

  • Beta carotene
  • Vitamin C
  • Eicosapentaenoic acid (EPAAn essential omega-3 fatty acid found in oily fish.)
  • Lycopene.

See the practical help page Prostate-friendly diet.

Pain management

The goal of pain management is not only relief from pain, but also maintaining a good quality of life. By taking medication regularly before the pain breaks through, rather than waiting until it is really bad, you will keep the pain under control, be able to carry out more of your normal activities, and feel better psychologically as well as physically. Of course, you should always follow the advice of your doctor and the medication instructions. Most hospitals have pain management clinics where you can be seen as an outpatient.