Treatments | Prostate Cancer Wales & UK

There are several different treatment options for prostate cancer and you will have a choice of how to proceed depending on the stage of your cancer and where it is. For example if your cancer is contained within the prostate gland (localised), has spread just outside of the prostate (locally advanced) or had spread to other parts of the body (advanced).

Localised prostate cancer

Localised prostate cancer usually grows slowly – or might not grow at all – and has a low risk of spreading. So very often, slow-growing localised prostate cancer might not need to be treated at all. You might be able to have your cancer watched with regular check-ups instead. You won’t need treatment unless the cancer starts to grow or you get symptoms.

If you do have treatment there are various options. All treatments have side effects, such as urinary problems, problems getting an erection, and fatigue.

You might want to think about the following things:

how far your cancer has spread (its stage)
your age and general health
the possible side effects of each treatment
practical things like visits to the hospital
do you want to avoid surgery?
how early treatment options might affect your treatment options in the future

The following treatments are available:

Active surveillance
Active surveillance is a way of monitoring slow-growing prostate cancer, rather than treating it straight away. It might not seem right to delay treatment, but prostate cancer is often slow-growing and may never cause any problems in your lifetime. In other words, you might never need any treatment. As many treatments for prostate cancer can cause side effects, such as leaking urine, difficulty getting and keeping an erection, and bowel problems, some men prefer to wait. If you decide to go on active surveillance, you won’t have any treatment unless your tests show that your cancer is growing.

Watchful waiting
Watchful waiting is a way of monitoring prostate cancer that isn’t causing any symptoms or problems. The aim is to keep an eye on the cancer over the long term, and avoid treatment unless you get symptoms. Prostate cancer is often slow growing and may not cause any problems or symptoms in your lifetime. And many treatments for prostate cancer can cause side effects. For some men these side effects may be long-term and may have a big impact on their daily lives.

Surgery: radical prostatectomy
Surgery may be a good option for men with prostate cancer that is contained inside the prostate and who are are otherwise fit and healthy. Radical prostatectomy is an operation to remove the prostate and the cancer contained inside it. The seminal vesicles are also removed. A radical prostatectomy is a major operation though so you have to be fit enough for surgery. It may not be suitable if you have other health problems such as heart disease, you’re over 75 or you’re overweight as you’re more likely to have problems during and after surgery.

Permanent seed brachytherapy
Permanent seed brachytherapy involves implanting tiny radioactive seeds into your prostate gland. This is also called low dose rate brachytherapy. Radiation from the seeds destroys cancer cells in the prostate. You may have this treatment on its own or together with external beam radiotherapy or hormone therapy. You may be suitable for this treatment if your cancer is thought to be contained within the prostate gland (localised prostate cancer) and:

your PSA level is 10ng/ml or less, and
your Gleason score is 6 or less, and
the stage of your cancer is T1 – T2a.

If you have a PSA of between 10 and 20, and a Gleason score of 7, this treatment may still be an option for you as long as tests show that the cancer is unlikely to have spread outside of the prostate.

High-intensity focused ultrasound (HIFU)
High-intensity focused ultrasound (HIFU) uses high frequency ultrasound energy to heat and destroy cancer cells in the prostate. A beam of ultrasound energy travels into the prostate from a probe put into the back passage (rectum).

Cryotherapy
Cryotherapy is a treatment that uses extreme cold to freeze and destroy cancer cells. Thin needles are inserted into the prostate and a gas is passed down them to freeze the prostate and kill the cancer cells. You may be able to have cryotherapy if your cancer is contained inside your prostate (localised prostate cancer). Cryotherapy may also be a treatment option for men whose prostate cancer has come back after treatment with radiotherapy or brachytherapy. But you may also be able to have it as a first treatment. You may not be suitable for cryotherapy if you have severe urinary problems as it can make these worse. Cryotherapy is newer than some of the other treatments for prostate cancer. This means it is only available in specialist centres in the UK, or as part of a clinical trial.

Clinical trials
Clinical trials are types of medical research that test medicines, medical procedures or medical equipment. If you have prostate cancer, you might have the chance to take part in a clinical trial.

Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that has started to spread to areas just outside the prostate. Some treatments for locally advanced prostate cancer aim to get rid of the cancer, while others aim to keep it under control. Again you have a choice of treatments, depending on how far your cancer has spread.

The following treatments are available:

Surgery: radical prostatectomy
Radical prostatectomy is an operation to remove the prostate and the cancer contained inside it. The seminal vesicles are also removed. Surgery is an option for men with cancer that is contained inside the prostate (localised prostate cancer) and who are otherwise fit and healthy but may also be an option for some men with cancer that has spread to the area just outside the prostate (locally advanced prostate cancer). This will depend on how far the cancer has spread. A radical prostatectomy is a major operation. You have to be fit enough for surgery though.

External beam radiotherapy
External beam radiotherapy uses high energy X-ray beams to treat prostate cancer. The X-ray beams are directed at the prostate gland from outside the body. They damage cancer cells and stop them growing. Radiotherapy treats the whole prostate, and sometimes the area around it. The treatment is painless but it can cause side effects. You may be able to have radiotherapy if your cancer is contained inside the prostate (localised prostate cancer). Radiotherapy may also be suitable for you if your cancer has spread to the area just outside the prostate (locally advanced prostate cancer). Radiotherapy can also be used after surgery if your PSA level starts to rise or if tests suggest that not all the cancer was removed with surgery.

Hormone therapy
Hormone therapy works by stopping the hormone testosterone from reaching prostate cancer cells. It treats the cancer, wherever it is in the body. Testosterone controls how the prostate gland grows and develops. It also controls male characteristics, such as erections, muscle strength, and the growth of the penis and testicles. Most of the testosterone in your body is made by the testicles, and a small amount by the adrenal glands which sit above your kidneys. Testosterone doesn’t usually cause problems, but if you have aggressive prostate cancer, it can make the cancer cells grow faster. In other words, testosterone feeds the prostate cancer. If testosterone is taken away, the cancer will usually shrink, wherever it is in the body. Hormone therapy alone won’t cure your prostate cancer but it can keep it under control, sometimes for several years, before you need further treatment. It is also used with other treatments, such as radiotherapy, to make them more effective.

Temporary brachytherapy
Temporary brachytherapy, also known as high dose-rate (HDR) brachytherapy, involves inserting a source of high dose-rate radiation into the prostate gland for a few minutes at a time to destroy cancer cells. It is not available at every treatment centre in the UK. You may be suitable for this treatment if your cancer is ‘medium risk’. Your cancer may be described as medium risk if:

your PSA level is between 10 and 20 ng/ml, or
your Gleason score is 7, or
the stage of your cancer is T2b or T2c.

Some men whose prostate cancer is beginning to spread to the area just outside the prostate (locally advanced prostate cancer), or with higher Gleason scores, may be able to have temporary brachytherapy.

Advanced prostate cancer

Advanced (metastatic) prostate cancer has spread from the prostate to other parts of the body. It develops when prostate cancer cells move from the prostate to other parts of the body through the blood stream or lymphatic system.

Prostate cancer can spread to any part of the body, but most commonly to the bones. More than four out of five men (80 per cent) with advanced prostate cancer will have cancer that has spread to their bones.

Another common place for prostate cancer to spread to is the lymph nodes (sometimes called lymph glands). Lymph nodes are part of your lymphatic system and are found throughout your body. Some of the lymph nodes are in the pelvic area – near the prostate.

Symptoms might be: fatigue (extreme tiredness), bone pain and problems urinating.

It’s not possible to cure advanced prostate cancer, but treatments can keep it under control, sometimes for several years.

The following treatments are available:

Watchful waiting
Watchful waiting is a way of monitoring prostate cancer that isn’t causing any symptoms or problems.

Treatment options after your first hormone therapy
Information about treatment options for men with prostate cancer that is no longer responding so well to their first hormone therapy:

Chemotherapy
Chemotherapy uses anti-cancer drugs to kill prostate cancer cells, wherever they are in the body. It doesn’t get rid of prostate cancer, but it aims to shrink it and slow its growth. Research shows that the chemotherapy drugs docetaxel and cabazitaxel can help some men to live longer. Chemotherapy can also delay or help to improve any symptoms you have, such as pain. You will also take other medicines with your chemotherapy, such as steroids. These help make chemotherapy more effective and lower the risk of side effects.

New treatments
Several new treatments for prostate cancer have been developed recently:

Abiraterone (Zytiga®): A new type of hormone therapy for men whose prostate cancer has spread to other parts of the body (advanced prostate cancer) and has stopped responding to other types of hormone therapy.

Enzalutamide (Xtandi®): A new type of hormone therapy for men with advanced prostate cancer that is no longer responding to hormone therapy.

Cabazitaxel (Jevtana®): A new type of chemotherapy for men with advanced prostate cancer that has stopped responding to hormone therapy and the chemotherapy drug docetaxel (Taxotere®).

Radium-223 (Xofigo®): A new treatment for men with prostate cancer that has stopped responding to hormone therapy, has spread to the bones and is causing symptoms.

Radiotherapy for advanced prostate cancer
Men with advanced prostate cancer may have radiotherapy to help relieve pain and other symptoms. You may hear this called palliative radiotherapy. Radiotherapy for advanced prostate cancer does not aim to get rid of your cancer but it can help to slow down its growth. You might have external beam radiotherapy (EBRT) or a type of internal radiotherapy called radioisotope treatment.

Bisphosphonates
Bisphosphonates are drugs that can be used to treat men whose prostate cancer has spread to the bones and is no longer responding to hormone therapy. They do not treat the cancer itself but they can help to relieve bone pain. Bisphosphonates may also help to prevent and slow down the breakdown of bone.

For more detailed information please visit the Prostate Cancer UK charity website.