The Treatment of Prostate Cancer

Treatment of Prostate Cancer

The methods most commonly used to treat prostate cancer can vary between countries. When deciding what treatment to provide, specialists must balance the potential benefits that may be derived from treatment, with the likelihood and severity of potential side effects. The type of treatment prescribed will depend on several factors:

• How aggressive the cancer is (i.e. how quickly the cancer is growing) and whether it has spread outside the prostate. • The age and health of the patient.

The main types of treatment are:

1. ‘Active Surveillance’. This treatment is prescribed for men thought to have small, slow-growing tumours which may not reduce their lifespan. Men are seen regularly to monitor their health, receive regular PSA tests, and possibly undergo further biopsies. If the cancer starts to grow more quickly than expected, curative treatment such as Prostatectomy or Radiotherapy will be considered. 2. ‘Watchful Waiting’. This treatment is most commonly prescribed for elderly men with slow growing cancers which are not expected to affect their life-span or adversely affect their quality of life. Men are seen regularly to monitor their health, and ensure the prostate cancer is not affecting their quality of life. 3. Prostatectomy, an operation to remove the prostate. This treatment is usually prescribed for men with an aggressive form of the disease which has not yet spread outside of the prostate. There can be serious side-effects which are often associated with this operation; a large proportion of men will suffer problems getting or maintaining an erection (impotence), and some will suffer a loss of ability to control urination (urinary incontinence). 4. Radiotherapy, X-rays are used to kill the cancer cells. These can either be delivered through the skin (external beam radiotherapy) or through the careful placement of small radioactive implants within the prostate (brachytherapy). Like Prostatectomy, this treatment is suitable for men with an aggressive form of the disease which has not yet spread outside of the prostate. Following radiotherapy the risk of impotence and urinary incontinence is similar, but bowel problems can be additional side-effects. Long-term outcomes of both prostatectomy and radiotherapy are usually good, but after undergoing treatment men will have regular PSA tests to ensure that all the cancer cells were removed or killed, and that the cancer has not returned. 5. Hormone therapy. Prescribed for men with prostate cancer which has spread either to the surrounding tissue or to other parts of the body, and occasionally for men who will undergo radiotherapy with the aim of curing the disease. The male hormone, testosterone, promotes the growth of prostate cancer, and if the amount of testosterone in the body is reduced, it is possible to slow down or even stop the growth of cancer cells. Drugs are usually prescribed to lower testosterone levels, and these can be administered in tablet form, or by injection. Hormone treatment can be effective over a long period of time. A patient’s condition will be monitored carefully, and treatment may be continued for many years. Side-effects of hormone therapy can include loss of sexual desire, impotence, hot flushes, weight gain, tiredness, and breast (chest) swelling/tenderness; but these vary depending on the drugs used, and are often reversed once treatment is stopped.

Before undergoing treatment for prostate cancer, it is important that all treatment options are discussed in detail between a patient and his doctor so that the patient is in a position to make an informed choice. This discussion should cover all the possible side-effects of each treatment, and how likely they are to occur.