Prostate cancer treatment

The treatment for prostate cancer will depend on how advanced it is, called staging, and a man's individual circumstances.

In some cases, doctors may recommend that no immediate treatment is started but recommend watchful waiting or active surveillance for men with low-risk localised prostate cancer.

Treatment options include surgery, types of radiotherapy, chemotherapy and hormone therapy.

After weighing-up the options with their doctors, some men decide against treatment to avoid the side effects of treatment that can significantly affect their quality of life,

Staging prostate cancer

Doctors will use diagnostic tests to determine the stage prostate cancer has reached.

This will be done using a system of initials or numbers.

One staging system is TNM system: tumour, nodes, metastasised.

• T describes whether a tumour can be felt during rectal examination, how much cancer was found during biopsy, and if the cancer has spread into tissue near to the prostate.
• N describes whether a cancer has spread to the lymph nodes.
• M describes whether the cancer has metastasised or spread to other parts of the body.

Information may be given as numbers:

• Stage 1: The cancer has stayed within the prostate gland
• Stage 2: A larger tumour, but still within the prostate gland
• Stage 3: The cancer has spread beyond the prostate and possibly into tubes carrying semen
• Stage 4: The cancer has spread into the lymph nodes or to another part of the body.

Watchful waiting

Watchful waiting means monitoring prostate cancer in the early stages and only starting treatment if the cancer progresses. This may be recommended for men who are older and are likely to outlive the tumour.

Active surveillance

Active surveillance is a step beyond watchful waiting with regular PSA tests and biopsies carried out to check for signs of progression at an early stage so treatment can begin.

The aim of active surveillance is to avoid unnecessary treatment where possible. Around 1 in 3 men under active surveillance will go on to have treatment.

Radical prostatectomy

Radical prostatectomy is an operation to remove the prostate gland, which may be recommended for localised prostate cancer and locally- advanced prostate cancer.

Radiotherapy

Radiotherapy, or external beam radiotherapy, uses targeted radiation for localised prostate cancer and locally-advanced prostate cancer. Radiotherapy may also be used to slow the progression of more advanced prostate cancer.

Brachytherapy

Brachytherapy is a form of internal radiotherapy where an operation is carried out to implant tiny radioactive seeds into the tumour.

Hormone therapy

Hormone therapy may be used to slow the progression of advanced prostate cancer, or for other stages of cancer in combination with radiotherapy.

High intensity focused ultrasound (HIFU)

High intensity focused ultrasound uses an ultrasound probe inserted into the rectum to use special sound waves to target cancer cells in the prostate gland. HIFU may be recommended for localised prostate cancer.

Cryotherapy

Cryotherapy uses special probes inserted into the prostate to freeze and kill cancer cells. Long-term success for this treatment isn't yet known as it is still being assessed in clinical trials.

Chemotherapy

Chemotherapy drugs may be used to treat prostate cancer that has spread to other parts of the body and isn’t responding to other treatments.

Steroids

Steroids, such as dexamethasone, may be used to help shrink a prostate cancer tumour that is not responding to hormone therapy.