Prostate Cancer Management

Surgery – Robot-assisted Radical Prostatectomy (RALP) is a minimally invasive treatment to remove the entire prostate, usually performed with a Robot using a number of small incisions in the abdomen (“keyhole”). The surgery aims to be curative in many cases. The disadvantages of surgery include a risk of erectile problems, loss of ejaculation and urinary leakage (incontinence).

Radiotherapy is a treatment that aims to kill cancer cells using radiation. It is is often combined with hormone treatment. It can be given to the whole prostate gland and lymph nodes nearby if necessary. Many men continue with their normal daily lives during radiotherapy treatment. However, the side effects can include difficulties with erections, bowel problems and urinary problems.

Brachytherapy is a type of radiotherapy treatment that is given internally to the prostate. This can be done by placing permanent radioactive seeds (Low Dose Rate Brachytherapy) or small needles (High Dose Rate Brachytherapy) into the prostate. In higher risk cancers, these treatments can sometimes be combined with conventional radiotherapy. Brachytherapy has a similar side-effect profile to radiotherapy, but it is not suitable for all men.

Focal therapy includes Cryotherapy and HIFU (High intensity focused Ultrasound) treatments. These are newer, less invasive treatments than Surgery or Radiotherapy, however they can still cause urinary or erectile problems. Because these treatments are newer, there is less information about their effectiveness in the longer-term.

Hormone therapy is used to block testosterone from being produced, or from reaching cancer cells. Testosterone can stimulate prostate cancer cells, so reducing the level of testosterone can be an effective treatment. Tablet or injection hormone therapy can be used for cancers that are contained within the prostate to help with radiotherapy, or for cancers that have spread outside the prostate to other parts of the body.  Hormone therapy can cause some side effects including tiredness, hot flushes and erection problems.

Other drug treatments, including Chemotherapy, Abiraterone and Enzalutamide may be offered if the cancer is advanced. As with all prostate cancer treatments, patients will have a discussion of the pros and cons of each option with their Urologist and Oncologist as appropriate.

Watchful waiting is a way of monitoring prostate cancer that isn't causing any symptoms. Many prostate cancers are slow growing and may never cause an issue. In watchful waiting, your GP or Urologist can monitor the cancer and treat if symptoms develop. This approach is often used in frail or elderly men for whom the side-effects of treatment might outweigh the benefits.