Treatment options for prostate cancer

Treatment for prostate cancer depends on a number of different factors. 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 you. They will discuss the possible side effects and benefits of each treatment. So make sure you tell them about your wishes and concerns.

In 2008, the National Institute for Health and Clinical Excellence (NICE) issued 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. 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.

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

• Treatment for low risk localised prostate cancer
• Treatment for intermediate risk localised prostate cancer
• Treatment for high risk localised prostate cancer
• Treatment for locally advanced prostate cancer
• Treatment for prostate cancer that has spread

Low risk localised prostate cancer

Low risk localised prostate cancer is very unlikely to grow or develop for many years. You are likely to be offered active monitoring (also called active surveillance) to monitor 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 treatment with surgery to remove the prostate gland or radiotherapy to the prostate. You may have hormone therapy before or alongside radiotherapy.

A Cochrane review in 2011 reviewed the research which compared different treatments for localised prostate cancer. This review found that after 5 years follow up internal radiotherapy worked equally as well as surgery to remove the prostate gland. There were differences in side effects. The men who had surgery were more likely to be incontinent and the men who had brachytherapy were more likely to have pain and the need to pass urine often. They say we need more research to find out which treatment is best for men with localised prostate cancer. There are some trials comparing active monitoring with giving surgery or radiotherapy for localised prostate cancer. There are details of the ProtecT and ProSTART trials on our clinical trials database. Both trials have closed and we are waiting for the results.

In younger men, 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.

Cryotherapy or high frequency ultrasound therapy may be offered.

Intermediate risk localised prostate cancer

In men with intermediate risk prostate cancer, the cancer may start to grow or spread within a few years and so you are likely to be offered treatment with surgery to remove the prostate gland or external radiotherapy to the prostate. 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 they are also discussed later in this section. Other treatment options that you may be offered are active monitoring or internal radiotherapy (brachytherapy). If you have radiotherapy you may have hormone therapy before, during or after the treatment.

Cryotherapy or high frequency ultrasound therapy may be offered.

High risk localised prostate cancer

High risk prostate cancer may start to grow or spread within a couple of years and doctors usually offer treatment with surgery to remove the prostate gland or external radiotherapy to the prostate. Internal radiotherapy (brachytherapy) is not often used, because in high risk prostate cancer the cancer cells may have spread slightly away from the prostate gland and internal radiotherapy may not reach all of the cells. Men who have radiotherapy may have hormone therapy before, during or after the treatment. For men who are not fit enough to have radiotherapy or surgery, doctors may recommend watchful waiting as a treatment option or hormone therapy on its own. 

If the cancer comes back

Treatment can cure many men with localise prostate cancer but for some the cancer may come back some time after initial treatment. We have a page about treatment if prostate cancer comes back.

Prostate cancer that has broken through the capsule surrounding the prostate gland is called locally advanced prostate cancer. The usual treatments are surgery to remove the prostate gland or external radiotherapy to the prostate. 

Radiotherapy may be combined 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.

Men who cannot have surgery or radiotherapy because they are not fit enough may have a course of hormone therapy as a treatment on its own.

Cryotherapy and high frequency ultrasound therapy are not standard treatments but may be offered as part of clinical trials.

If your prostate cancer has spread to other parts of the body, it cannot be cured. But it can be controlled by lowering the level of testosterone in the 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. There are a few chemotherapy drugs that work for some men with advanced prostate cancer. 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 the 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.