Treating prostate cancer

Staging of prostate cancer

Doctors will use the results of your prostate examination, biopsy and scans to identify the "stage" of your prostate cancer (how far the cancer has spread). The stage of the cancer will determine which types of treatments will be necessary.

A widely used method of staging isanumber staging system. The stages are:

• Stage 1 the cancer is very small and completely within the prostate gland
• Stage 2 the cancer is within the prostate gland, but is larger
• Stage 3 the cancer has spread from the prostate and may have grown into the tubes that carry semen
• Stage 4 the cancer has spread into the lymph nodes or another part of the body, including the bladder, rectum or bones; about 20-30% of cases are diagnosed at this stage

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good. About 90% of men diagnosed at stages 1 or 2 will live at least five more years and 65-90% will live for at least 10 more years.

If you are diagnosed with stage 3 prostate cancer, you have a 70-80% of chance of living for at least five more years.

However, if you are diagnosed when your prostate cancer has reached stage 4, there is only a 30% chanceyou will live for at least five more years.

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• Cancer Research UK:

  Watchful waiting

  Watchful waitingis often recommended for older men when it is unlikely that the cancerwill affect your natural life span.

  If the cancer is in its early stages and not causing symptoms, you may decide to delay treatment, and wait to see if any symptoms of progressive cancer develop. If this happens, pain medication and hormone medication (see below) to control prostate cancer are usually used.

  Watchful waiting may also be recommended for people with a higher risk of prostate cancer if:

  • your general health means you are unable to receiveany form of treatment
  • your life expectancy means you will die with the cancer rather than from it

  In this case, hormone treatment may be started if there are symptoms caused by the prostate cancer.

Active surveillance

Active surveillance aims to avoid unnecessary treatment of harmless cancers, while still providing timely treatment for men who need it.

When they are diagnosed, we know that around half to two-thirds of men with low-risk prostate cancer do not needtreatment. Surveillance is a safe strategy that provides a period of observation to gather extra information over time to see whether the disease is changing.

Active surveillance involves you having regular PSA tests andoften severalbiopsies to ensureany signs of progression are found as early as possible. Sometimes, MRI scans may also be carried out. If these tests reveal the cancer is changing or progressing,you can then make a decision about further treatment.

Aboutone inthree menwho undergo surveillance will later have treatment. This does not mean they made the wrong initial decision. Good evidence showsthat active surveillance is safe over an average of six years. Men undergoing active surveillancewill have delayed any treatment-related side effects, and those who eventually need treatmentwill be reassuredthat it was necessary.

Radical prostatectomy

A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer.

Like any operation, this surgery carries some risks, and there may be some side effects. These are outlined below.

• Some men have problems with urinary incontinence . This can range from leaking small drips of urine, to leaking larger amounts. However, for most men, this usually clears up within three to six months of the operation. Abouttwo in every 10 men have long-term problems requiring the use of pads.
• Some men have problems getting an erection ( in vitro fertilisation (IVF) .

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  • Macmillan:

    Radiotherapy

    Radiotherapy involves using radiation to kill cancerous cells. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer. Radiotherapy can also be used to slow the progression of metastatic prostate cancer and relieve symptoms.

    Radiotherapy is normally given as an outpatient at a hospital near you. It is done in short sessions for five days a week, for four to eight weeks. There are short-term and long-term side effects associated with radiotherapy.

    You may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.

    Short-term effects of radiotherapy can include:

    • discomfort around the rectum and anus (the opening through which stools pass out of your body)
    • Traveller's diarrhoea
    • loss of pubic hair
    • tiredness

    • Brachytherapy

      Brachytherapy is a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It is also known as internal or interstitial radiotherapy.

      The radiation can be delivered using a number of tiny radioactive seeds that are surgically implanted into the tumour. This is called low dose-rate brachytherapy.

      The radiation can also be delivered through hollow, thin needles placed inside the prostate. This is calld high dose-rate brachytherapy.

      This method has the advantage of delivering a high dose of radiation to the prostate, while minimising damage to other tissues. However, the risk of sexual dysfunction and urinary problems is the same as with radiotherapy, although the risk of bowel problems is slightly lower.

      Want to know more?

      • Cancer Research UK: internal radiotherapy (brachytherapy) for prostate cancer

• Cancer Research UK:

  Trans-urethral resection of the prostate (TURP)

  DuringTURP, athin metal wire with a loop at the end is inserted into your urethra (the tube that carries urine from your bladder to your penis) and pieces of the prostate are removed.

  This is carried out under general anaesthetic or a spinal anaesthetic ( epidural ).

  This is done to relieve pressure from the urethra to treat any problematic symptoms you may have with urination. It does not cure the cancer.

  An ultrasound probeinserted into the rectum releases high-frequency sound waves through the wall of the rectum. These sound waves kill cancer cells in the prostate gland by heating them to a high temperature.

  The risk of side effectsfrom HIFUisusually lower than other treatments.

  However, possible effects can include impotence (in five to 10 in every 100 men) or urinary incontinence (in less than one in every 100 men). Back passage problems are rare.

  Fistulas (an abnormal channel between the urinary system and rectum) are also rare, affecting less than one in every 500 men. This is because the treatment targets the cancer area only and not the whole prostate.

  However, HIFU treatment is still going through clinical trials for prostate cancer.In some cases, doctors can carry out HIFU treatment outside of clinical trials. HIFU is not widely available and its long-term effectiveness has not yet been conclusively proven.

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  • Cancer Research UK:

    Cryotherapy

    Cryotherapy is a method of killing cancer cells by freezing them. It is sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate gland.

    Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum. They freeze the prostate gland and kill the cancer cells, but some normal cells also die.

    The aim is to kill cancer cells while causing as little damage as possible to healthy cells. The side effects of cryotherapy can include:

    • erectile dysfunction this can affect between two and nine in every 10 men
    • incontinence this affects less than one in 20 men

    It is rare for cryotherapy to causerectal problems or fistulas.

    Cryotherapyis still undergoing clinical trials for prostate cancer. In some cases, doctors can carry out cryotherapy treatment outside of clinical trials.Itis not widely availableand its long-term effectiveness has not yet been conclusively proven.

Chemotherapy is mainly used to treat prostate cancer that has spread to other parts of the body (metastatic prostate cancer) and which is not responding to hormone therapy.

• End of life care