There are many different treatments for prostate cancer and deciding what is right is not always straight forward, as there is a balance between treatment and side effects. Urologists often discuss individual cases with other doctors called Oncologists (specialists in treating cancer) as there are many issues to consider. The type of treatment offered depends on the grade and stage of the cancer (how aggressive it is and whether it has spread outside the prostate), the age and general health of the man affected. There are four main types of treatment:

‘Watchful Waiting’ – men are seen regularly and have PSA blood tests, but no treatment is given unless they deteriorate. Useful for small, slow growing non-aggressive cancers in elderly men where the cancer does not affect their life expectancy.

Radical Surgery (prostatectomy) – an operation in which the whole prostate is removed. Men are followed up afterwards with regular PSA blood tests to make sure the cancer does not come back. It is only effective in younger men who have aggressive small cancers that have not spread outside of the prostate. It is a major operation with serious side effects. Many men afterwards are impotent (unable to get an erection) and a minority will be incontinent. Despite this, some men prefer this treatment as the long-term outcome is good.

Radiotherapy – X-rays are delivered to the prostate either through the skin from the outside (external beam) or by placing small radioactive seeds directly in the prostate (brachytherapy) to kill cancer cells. It is effective on the same group of men as surgery and often a decision between the two has to be made as the long-term results are similar. The risk of impotence and incontinence after radiotherapy is less than surgery, and radiotherapy has it’s own side effects including skin damage and bowel problems.

Hormone Therapy – Prostate cancer cells are very sensitive to the male hormone testosterone. By removing this hormone the cancer cells shrink and don’t grow, remaining static. Testosterone levels can be lowered by castration (surgical removal of both testicles - this is rare nowadays) or more commonly, by tablets or monthly injections. Men with metastatic prostate cancer i.e. cancer that has spread either locally (around the area of the prostate) or to distant areas (usually the bones) are most suitable for hormone therapy. It is sometimes used before radiotherapy to shrink the cancer down. It can be very effective in controlling the pain associated with cancer which has spread to the bones, and in many men controls their cancer sufficiently for them to live a normal life. Side effects can include lowered libido, possible impotence, hot sweats and breast enlargement, but generally it is tolerated well.

In some circumstances combinations of different treatments are used. It is important for men with prostate cancer to be informed of all the benefits and risks when deciding what treatment is best for them.

In some circumstances combinations of different treatments are used. It is important for men with prostate cancer to be informed of all the benefits and risks when deciding what treatment is best for them.