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Choices of treatment for prostate cancer

Your doctor will discuss the possible side effects and benefits of each treatment with you.

Low risk localised prostate cancer
This is very unlikely to grow or develop for many years. It may grow so slowly that you never have any symptoms from it.  Your doctor is likely to suggest monitoring the cancer to see whether it begins to develop. This is also called active surveillance. If the cancer starts to develop, your doctor will offer treatment such as surgery to remove the prostate gland or radiotherapy. You may have radiotherapy with hormone therapy.

Intermediate risk localised prostate cancer
Your doctor is likely to suggest treatment with surgery to remove the prostate gland or radiotherapy to the prostate. You have radiotherapy with hormone therapy. If you don't want to have surgery straight away your doctor may suggest monitoring the cancer.

High risk localised prostate cancer
Your doctor is likely to suggest treatment with surgery to remove the prostate gland or external radiotherapy to the prostate. You have radiotherapy with hormone therapy.

Locally advanced prostate cancer
This means that the cancer has broken through the capsule surrounding your prostate gland. The usual treatments are surgery to remove the prostate gland or radiotherapy. You have radiotherapy with a course of hormone treatment.

If your prostate cancer has spread 
If the cancer has spread to another part of your body, it can't be cured. But it can be controlled by lowering the level of testosterone in the body with hormone therapy. Bisphosphonate treatment or radiotherapy can help to reduce pain and fractures if the cancer has spread into the bone.
 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating prostate cancer section.

 

 

The main treatments

The main treatments for prostate cancer are surgery, radiotherapy and hormone therapy. Doctors also sometimes use chemotherapy.

Your doctor will have to take into account a number of different factors when deciding on your treatment. The most important of these are how fast the cancer is likely to grow and how far it has already grown.

 

Deciding on treatment

Medical organisations in Europe and the USA recommend that treatment is considered individually for every man with prostate cancer. Your doctors will look at all the different factors and discuss with you which treatments may help. They will discuss the possible side effects and benefits of each treatment. So make sure you tell them about your wishes and concerns.

In January 2014, the National Institute for Health and Care Excellence (NICE) issued updated guidance about treatment options for prostate cancer. You can see the guidelines on the NICE website.

You may come across other men with prostate cancer who are having different treatment to you. This is because they have a different stage or grade of cancer. Or their particular needs may be different. Also, sometimes doctors have different views about treatment. If you have any questions about your own treatment, don't be afraid to ask your doctor or nurse.

Discover your options for prostate cancer treatment.

Prostate Cancer Flowchart

 

Treatments for prostate cancer that hasn't spread

Prostate cancer that is contained within the prostate gland is called localised prostate cancer. Doctors look at different factors to divide men into different groups according to whether the cancer is likely to grow quickly or slowly, or whether it is likely to spread. They use this information to work out which treatments are best for each man. You can find information about low risk, intermediate risk and high risk localised prostate cancer in this section. 

This page tells you about

Low risk localised prostate cancer

Low risk localised prostate cancer is very unlikely to grow or develop for many years. Your doctor is likely to suggest monitoring your cancer (also called active surveillance) to keep an eye on the cancer for a time and see whether it begins to develop. This is because your prostate cancer may grow so slowly that it never causes any symptoms. 

Treatments for prostate cancer can cause long term side effects, so doctors try to avoid giving treatments if they can safely do that. If the cancer starts to develop while you are having active monitoring, your doctor will offer you surgery to remove the prostate gland or radiotherapy to the prostate. You may have hormone therapy as well as radiotherapy.

A Cochrane review in 2011 looked at research comparing different treatments for localised prostate cancer. This review found that after 5 years of follow up internal radiotherapy (brachytherapy) worked as well as surgery to remove the prostate gland. You can see the prostate cancer treatment review on the Cochrane Library website. There is a plain English summary at the bottom of the review.

Although the treatments worked equally well in curing the cancer there were differences in side effects. Men who had surgery were more likely to have urine leakage (incontinence of urine). Men who had brachytherapy were more likely to have bladder pain and the need to pass urine often. The researchers say that we need more research to find out which treatment is best for men with localised prostate cancer. There are some trials comparing active surveillance with giving surgery or radiotherapy for localised prostate cancer. There are details about the ProtecT trial on our clinical trials database. This trial has closed and we are waiting for the results.

In men younger than 65, the risk of the cancer growing within their lifetime is higher. So doctors may offer treatment with surgery to remove the prostate gland or radiotherapy to the prostate at an earlier stage than in older men. 

Your doctor may suggest cryotherapy or high frequency ultrasound therapy as part of a clinical trial.

Intermediate risk localised prostate cancer

In men with intermediate risk prostate cancer, the cancer may start to grow or spread within a few years. Your doctor is likely to suggest surgery to remove the prostate gland or radiotherapy. This may be external radiotherapy to the prostate or internal radiotherapy (brachytherapy). If you have radiotherapy you also have hormone therapy before, during or after the treatment.

Surgery and radiotherapy work equally well in curing the cancer but they have different risks, benefits and side effects. Your doctor can explain these to you and there is more information about this later in this section. If you don't want to have surgery or radiotherapy straight away, your doctor may offer active monitoring of the cancer (active surveillance)

Your doctor may offer you cryotherapy or high frequency ultrasound therapy as part of a clinical trial.

High risk localised prostate cancer

High risk prostate cancer may start to grow or spread within a couple of years. Doctors usually suggest surgery to remove the prostate gland or external radiotherapy to the prostate. They don't often use internal radiotherapy (brachytherapy) for high risk prostate cancer. The cancer cells may have spread slightly away from the prostate gland and internal radiotherapy may not reach them all. Men who have radiotherapy also have hormone therapy before, during or after the treatment. 

For men who are not well enough to have radiotherapy or surgery, doctors may recommend monitoring the cancer or hormone therapy on its own. 

If the cancer comes back

Treatment can cure many men with localised prostate cancer. But for some men the cancer may come back some time later. We have a page about treatment if prostate cancer comes back.

 

Locally advanced prostate cancer

If your prostate cancer has broken through the capsule surrounding your prostate gland, it is called locally advanced prostate cancer. The usual  treatments are external radiotherapy to the prostate gland or surgery to remove the prostate gland. These treatments have different risks and benefits and your doctor will discuss these with you.

You have radiotherapy to the prostate gland with a course of hormone therapy. You may have hormone therapy before radiotherapy and alongside it for 3 to 6 months. Men with a Gleason score higher than 8 usually take hormone therapy for at least 2 years after the end of the radiotherapy.

If you are not well enough to have surgery or radiotherapy, you may have a course of hormone therapy on its own.

Cryotherapy and high frequency ultrasound therapy are not standard treatments but your doctor may offer them as part of a clinical trial.

 

Treatment choices for prostate cancer that has spread

If your prostate cancer has spread to other parts of your body, it cannot be cured. But it can be controlled by lowering the level of testosterone in your body with hormone therapy. You can have hormone therapy as

  • Tablets you take each day
  • Injections each month or every 3 months
  • Tablets for a few months, then a break, followed by more tablets, and so on

Another way of reducing testosterone levels is removing the testicles. This is called surgical castration or orchidectomy. It quickly lowers the testosterone levels and can control the cancer very well. There is detailed information about orchidectomy in this section.

Orchidectomy or hormone therapy can control the cancer for a few years in many men. When the cancer starts to develop again, your doctors may suggest treatment with chemotherapy or steroids. These can control or shrink the cancer for some time. Chemotherapy can work well at controlling advanced prostate cancer in some men. There is more about chemotherapy for prostate cancer in this section, and some information about chemotherapy research on our prostate cancer research page.

If your cancer has spread to your bones and is causing you pain, your specialist may suggest radiotherapy to the affected areas of bone. Radiotherapy for bone pain can work very well to strengthen the bone and relieve pain. The damaged bone begins to repair itself after radiotherapy treatment. Bisphosphonate treatment can also reduce bone pain and help to reduce the risk of bone fracture.

 

More information about prostate cancer treatments

We have detailed information about the treatments for prostate cancer and their possible side effects. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. They will be happy to answer any questions. 

Our prostate cancer organisations page gives details of other people who can give information about prostate cancer treatments. Some organisations can put you in touch with a cancer support group.

Our prostate cancer reading list has information about books, leaflets and other resources discussing treatments.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 21 February 2014