Prostate cancer - Treatments

What are the current treatments for prostate cancer?

There are a number of treatments for prostate cancer. The treatment for a particular man with prostate cancer will depend upon the grade and stage of the prostate cancer, the prostate specific antigen level, and the preference of the man himself. A brief description of the different treatments that may be suitable for prostate cancer which has not spread outside the prostate are given below.

All current treatments can have side effects. These include problems passing water (not being able to pass water, known as urine retention; or not being able to hold on to your water, known as incontinence); problems with sexual function (not having an erection; having an erection but not producing any ejaculate), and bowel problems (passing stool frequently, or bleeding from the bowel). Doctors and scientists are looking for new ways to treat prostate cancer which will have less side effects than current treatments. Photodynamic therapy is one of these new treatments.

Radical prostatectomy

This is surgery to remove the whole prostate. It can be done via a key hole operation, or through an open operation, where a larger cut is made in the abdomen. It usually needs a hospital stay of 3 to 5 days. After the operation, you will usually go home with a catheter. This will stay in place for 1 –2 weeks.

Radiotherapy

This can be given externally or internally. External radiotherapy is given in a number of doses, or fractions. This will involve a number of hospital visits - for example 5 days a week for 6 weeks. It does not usually require an overnight stay in hospital.

There are two types of internal radiotherapy. These are known as seed brachytherapy and high dose rate brachytherapy. Seed brachytherapy involves the placement of many small radioactive seeds into the prostate. These are left in permanently. It is done in a single session, under anaesthetic.

High dose rate brachytherapy involves putting a number of needles into the prostate, under general anaesthetic. A radioactive wire is then passed along each of these needles. This may be done a few times over a couple of days, before the needles are removed. It may be followed by a course of external radiotherapy.

High intensity focussed ultrasound (HIFU)

This uses ultrasound waves which are focussed on the prostate to heat the prostate tissue and kill it. The probe which delivers the ultrasound waves is placed in the back passage. The treatment is done under general anaesthetic, in a single session.

Cryotherapy

This involves putting needles into the prostate through the perineum. The needles freeze the prostate cells, which kills them. It can be done as a first treatment, or after radiotherapy. The treatment is done under anaesthetic, in a single session.

Active surveillance

Active surveillance is an option for some men with prostate cancer. It means monitoring the cancer regularly with PSA blood tests, examination of the prostate and Biopsies as necessary.

If it seems that a cancer is becoming a problem, or is more likely to become a problem, for example by spreading outside the prostate, then treatment can still be given early enough to cure the cancer. If the cancer does not change, then it can be left without treatment. This avoids the side effects of treatments, whilst still allowing for treatment at a later date, if it becomes necessary.

This is particularly suitable for older men with prostate cancer, those with a Gleason score of 6 or less, and those who have other health problems that would put them at greater risk of side effects from early treatment. However, younger men also choose active surveillance, as it does not mean ignoring the cancer, but monitoring it carefully.

Hormone therapy

Hormone therapy is used to control prostate cancer, but it cannot cure it. It is used before some treatments such as radiotherapy, to reduce the size of the prostate which needs to be treated. It is also used to slow the rate of growth of prostate cancer which has spread outside the prostate gland. It can be given continuously or intermittently.

Testosterone is the male sex hormone. About 95% of it is produced by the testicles. The other 5% is produced by the adrenal glands, which are found on top of the kidneys. Testosterone makes prostate cancer grow. Hormone treatment aims to stop the effect of the testosterone, either by stopping the production of testosterone (one way to do this is to remove the testicles), or by stopping the testosterone from having an effect on the prostate cancer. There are different types of hormone treatment. Different types of hormone treatment will be suitable for different men with prostate cancer, depending on the nature of the cancer and whether the treatment is being given with any of the other treatments.