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.

Hormone therapy

Hormone therapy is often used in combination with radiotherapy. For example, you may receive hormone therapy before undergoing radiotherapy to increase the chance of a successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.

Hormone therapy alone should not normally be used to treatlocalised prostate cancer in men who are fit and willing to receive surgery or radiotherapy. This is because it does not cure the cancer on its own.Hormone therapycan be used to slow the progression of advanced prostate cancer and relieve symptoms.

Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow. The purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone.

Hormone therapy can be given as:

  • injections to stop your body making testosterone, called luteinising hormone-releasing hormone (LHRH) agonists
  • tablets to block the effects or reduce the production of testosterone, called anti-androgen treatment
  • combined LHRH and anti-androgen treatment

The main side effects of hormone treatment are caused by their effects on testosterone. They usually go away when treatment stops. They include loss of sex drive and erectile dysfunction (this is more common with LHRH agonists than anti-androgens).

Other possible side effects include:

  • hot flushes
  • sweating
  • weight gain
  • swelling and tenderness of the breasts

An alternative to hormone therapy is to surgically remove the testicles, called orchidectomy. The operation does not cure prostate cancer, but by removing the testosterone, it controls the growth of the cancer and its symptoms. However, many men prefer to have hormone treatment to block the effects of testosterone.

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Treating advanced prostate cancer

If the cancer has reached an advanced stage, it is no longer possible to cure it. However, it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

  • radiotherapy
  • hormone treatment
  • chemotherapy

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.


Steroid tablets are used when hormone therapy no longer works because the cancer is resistant to it. This is called hormone-refractory cancer.

Steroids can be used to try to shrink the tumour and stop it from growing. The most effective steroid treatment is dexamethasone.

Other medical treatments

There are a number of new medications that could be used if hormones and chemotherapy fail. Your medical teamcan tell you if these are suitable and available for you.

NICE has recently issued guidance on medications called abiraterone andenzalutamide. Both abiraterone and enzalutamide may be used to treat men with metastatic prostate cancerthat no longer responds to the chemotherapy drug docetaxel.

Read the NICE guidelines on:

  • enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with docetaxel
  • abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen
Content supplied by the NHS Website

Medically Reviewed by a doctor on 28 Nov 2016