Prostate Cancer Treatment

There may be a number of suitable treatments for men with localised disease. These may include:

• Active surveillance
• Radical prostatectomy
• Robotic radical prostatectomy (using the Da Vinci TM robot)
• Radical Radiotherapy Brachytherapy, including focal therapy

For advanced or metastatic disease, the options may include:

• Hormone treatment
• Modern chemotherapy
• Brachytherapy

Brachytherapy involves implanting tiny pellets which release low-level radiation into the prostate in an attempt to kill off cancer cells and spare healthy surrounding tissue.  This technique can also be used as focal therapy.

We carefully counsel our patients and illustrate the benefits and risks of the different approaches. We use up-to-date risk calculators and share information with you to decide the best course of treatment.

Some of these risk calculators are listed below:

Prostate risk indicator:

http://riskcalc.org:3838/PCPTRC/

For patients considering treatment options for confirmed prostate cancer:

https://prostate.predict.nhs.uk

For patients considering treatment for high-risk (confirmed) prostate cancer:

https://www.evidencio.com/models/show/1555

https://www.mskcc.org/nomograms/prostate/pre_op

For patients who have had surgery for their prostate cancer:

https://www.mskcc.org/nomograms/prostate/post_op

Active surveillance?

This is a way of monitoring early prostate cancer which has not spread outside the prostate. The rationale is based on low and low-intermediate risk prostate cancers that are slow growing and may not need treatment or may not need treatment for a very long time. This avoids living with the side effects of prostate cancer treatment for as long as possible and still being able to cure the cancer if required at any time in the future.

Who is it for?

• Patients with low-risk prostate cancer (Cambridge Prognostic Group 1).  This is where patients have a PSA of less than 10 and a grade grouping of 1 (Gleason score 6) and stage T1-2.
• Patients with an intermediate risk of prostate cancer (Cambridge Prognostic Group 2). This is where patients have a PSA of between 10-20 or a grade grouping of 2 (Gleason score 3+4) and stage T1 or 2.

What it involves:

This involves regular reviews with your prostate cancer surgeon. It will involve one or more of the following:

• Review your symptoms, if any.
• Digital rectal examination (DRE)
• Regular PSA blood tests
• Annual mpMRI
• Repeat prostate biopsies
• Other tests may be discussed i.e. biomarkers

What are the advantages?

• Avoid treatment-related side effects
• Less impact on daily life and quality of life
• Can have curable treatment when required

What are the disadvantages?

• Uncertainty about living with cancer which may cause anxiety.
• The need for repeat prostate biopsies.
• Rarely, cancer can grow more quickly than expected resulting in a missed opportunity for a cure.
• General health may deteriorate resulting in not being able to have curable treatment.

What happens after?

Active surveillance relies on the potential of having radical treatment in the future. This will depend on how your cancer behaves during the surveillance period.  In addition, you may decide in the future that you would prefer to have your cancer definitively treated, even if it has not shown any signs of growing.

Prostate Cancer Treatment – Watchful Waiting

What is it

This is a way of monitoring prostate cancer or suspected prostate cancer where the aim is to avoid unnecessary treatment and side effects. This is particularly suitable for men with other often health problems or extremes of age, where curative treatment may not be appropriate.

Who is it for?

• Men unsuitable or unfit for curative treatment
• Men with no cancer-related symptoms
• Men in whom prostate cancer treatment is unlikely to increase their life expectancy

What does it involve?

This involves regular reviews with the prostate cancer surgeon and may involve one or more of the following:

• Review of symptoms if any
• Regular PSA blood test
• Use of scans to check that prostate cancer has not spread

What are the advantages?

• Avoid treatment-related side effects
• Less impact on daily life and quality of life
• Avoid unnecessary prostate biopsies
• Treatment can be started if you develop any symptoms or if the prostate cancer begins to spread

What are the disadvantages?

• Uncertainty about cancer may cause anxiety
• Cancer may grow more quickly than expected

What treatment would be offered if required?

This would involve androgen deprivation therapy so-called ADT (male hormone reduction therapy). This is usually achieved by 3 monthly injections of hormones, usually into the abdomen which decreases the testosterone (male hormone) and therefore shrinks and controls the growth of the prostate cancer. We may sometimes also offer radiotherapy.