Treatments for localised prostate cancer are intended to completely eradicate or cure the cancer. The options include surgery to remove the prostate or radiotherapy to kill the cancerous cells.
It is often felt that the side effects of treatment are worse than the prostate cancer itself. So, if there is a low-risk prostate cancer (i.e. localised prostate cancer and a low biopsy Gleason score), the following management options may be offered:
- Watchful waiting: For some men, particularly older men with major health issues, treatment might not be appropriate. They will be regularly monitored and if symptoms develop (e.g. bone pain), treatment will be offered to manage these symptoms. The intent is to treat symptoms as they arise.
- Active surveillance: For men who have low-risk prostate cancer, active surveillance is an option. Men are regularly monitored by the Prostate Specific Antigen (PSA) test, digital rectal examination (DRE) and occasional further biopsies. The results from these tests and procedures will show if the cancer has changed. If the disease progresses, they are offered treatment with the intent to cure, usually by surgery or radiotherapy. The thinking behind this strategy is that because treatments have side effects that affect quality of life, it can be better to delay treatment as long as possible. Men on active surveillance might never need treatment.
- Active treatment: treatments with the intention of completely eradicating or curing the cancer.
When the cancer does need to be actively treated, surgery or radiotherapy will most likely be offered.
Surgery – radical prostatectomy
The doctor may suggest surgery in cases of early prostate cancer, for healthy men whose cancer has not spread to other parts of the body. The procedure is called a radical prostatectomy and aims to remove the cancer completely. This involves the removal of the prostate gland, part of the urethra and the seminal vesicles, which store semen. For more aggressive cancer, the adjacent lymph glands may also be removed.
Radical prostatectomy may be performed using different surgery techniques:
Open radical prostatectomy
An open radical prostatectomy is usually done through a small cut in the lower abdomen.
Laparoscopic radical prostatectomy
Sometimes the prostate may be able to be removed via keyhole surgery, called a laparoscopic radical prostatectomy (LRP). The surgeon may control the instruments using a robotic console.
Radiotherapy is one of the treatments offered to men with early prostate cancer who are otherwise in reasonably good general health. It is generally offered as an alternative to surgery. Sometimes radiotherapy is used after a prostatectomy for locally advanced or more aggressive cancers, or if there are indications that not all of the cancer has been removed by surgery.
External beam radiotherapy (EBRT)
External beam radiotherapy (EBRT) is a conventional form of radiotherapy that uses high-energy x-rays to kill cancer cells or injure them so they cannot multiply.
Brachytherapy is a type of targeted internal radiotherapy where the radiation source is placed directly within the prostate gland. This allows higher doses of radiation to be given, while the effects on nearby tissues such as the rectum and bladder are minimised.
Treatment for advanced prostate cancer
Androgen deprivation therapy (ADT)
ADT is the main form of treatment for advanced prostate cancer, when disease has spread beyond the prostate. In this case, the treatment will not cure the cancer but can keep it under control for months and even years. Radiotherapy and chemotherapy are also standard treatment options in combination with ADT, which is also known as hormone therapy.
Chemotherapy involves the use of drugs to kill or slow the growth of cancer cells. If the prostate cancer continues to advance and spread to other parts of the body despite using hormone therapy, chemotherapy may be suitable. Chemotherapy may also be offered as a first-line treatment in combination with Androgen Deprivation Therapy (ADT).
You can find further information on these treatments and their possible side effects on the Prostate Cancer Foundation of Australia website. This material is also available as a free set of printed booklets that you can pick up at one of our regular monthly meetings.