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Decisions about your treatment

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will talk to you about your treatment, its benefits and the possible side effects.

Treatment overview

You might not have treatment straight away. Instead your doctors monitor your cancer closely. Depending on your situation, they call this:

  • active surveillance
  • watchful waiting

The main treatments are:

  • surgery
  • external radiotherapy
  • internal radiotherapy (brachytherapy)
  • hormone therapy
  • high frequency ultrasound therapy (HIFU) (as part of a clinical trial)
  • cryotherapy (as part of a clinical trial)
  • chemotherapy
  • symptom control treatment

You have one or more of these treatments depending on the stage of your cancer.

Surgery or radiotherapy work equally well at curing early prostate cancer. Each treatment has benefits and side effects. Your doctors and nurses will tell you what your options are and help you make the decision about your treatment.

If you don't have treatment straight away

Active surveillance means you don’t start treatment straight away. The doctors monitor your cancer closely and you have treatment if the cancer starts to grow. The aim is to avoid unnecessary treatment and to offer radical treatment to the men who need it. Radical treatment is treatment that aims to cure your cancer.

You have active surveillance for​:

  • low risk localised prostate cancer that can be cured by treatment in the future
  • medium (intermediate) risk localised prostate cancer if you don’t want treatment straight away

For watchful waiting, you have fewer tests than with active surveillance. The doctors monitor your cancer and you start treatment if you develop symptoms. The treatment aims to control your cancer.

You have watchful waiting if:

  • you have no symptoms from localised prostate cancer, and you have health problems which mean you cannot have radical treatment to cure your cancer in the future
  • you have no symptoms from locally advanced or advanced prostate cancer
  • you have localised prostate cancer and do not want active surveillance

Treatment by stage

Localised prostate cancer

Localised prostate cancer is cancer that is completely inside the prostate gland. It hasn’t spread outside of the prostate gland or to any other parts of the body.  Doctors divide localised prostate cancer into 3 risk groups depending on how likely it is that the cancer will grow quickly or spread. Treatment depends on whether you have:

  •   low risk
  •   medium risk
  •   high risk

Low risk localised prostate cancer

Your doctor should offer you:

  •        active surveillance
  •        surgery to remove your prostate (radical prostatectomy)
  •        radiotherapy – either internal or external beam

Your doctor should explain the risk and benefits of each treatment with you. And the table below shows that the difference in survival between active surveillance, chemotherapy and radiotherapy are only slightly different.

If you have other health problems, you might have watchful waiting instead of active surveillance

Radiotherapy and surgery work equally well at curing prostate cancer but have different side effects. Your doctor can explain these to you.

Intermediate risk localised prostate cancer

You usually have treatment straight away. You might have:

  • surgery
  • external radiotherapy, usually with hormone therapy
  • internal radiotherapy, usually with hormone therapy
  • cryotherapy or high frequency ultrasound therapy (HIFU), as part of a clinical trial

You might have active surveillance if you don’t want treatment straight away. This is an option if surgery or radiotherapy would be suitable treatments for you in the future. If they wouldn’t be possible for you, you might have watchful waiting instead.

High risk localised prostate cancer

You might have:

  • surgery
  • external radiotherapy with hormone therapy
  • internal radiotherapy with external radiotherapy and hormone therapy

If you can’t have treatment, your doctor might monitor the cancer with watchful waiting.

Locally advanced prostate cancer

Locally advanced prostate cancer means the cancer has broken through the outer covering of the prostate gland into nearby tissues.

Your doctor might monitor your prostate cancer if you don’t have any symptoms. This is called watchful waiting. You can start treatment if you get symptoms.

Treatment options include:

  • external radiotherapy with hormone therapy
  • hormone therapy on its own
  • cryotherapy as part of a clinical trial
  • high frequency ultrasound therapy (HIFU) as part of a clinical trial
  • surgery 

A small number of men might have surgery to remove the prostate gland. But doctors don't often use it as a treatment for locally advanced cancer.

Advanced prostate cancer

Advanced prostate cancer is cancer that started in the prostate and has spread to other parts of the body, such as the bones. 

Things to consider

If you are asked to choose your treatment you might want to consider the following factors:

  • How likely is it that the cancer will cause problems in your lifetime
  • How do you feel about living with the cancer in your body and not having treatment
  • What are your options and what do they involve
  • What are the side effects
  • How do you feel about the different treatments
  • Are there some side effects that would bother you more than others
  • How the treatment side effects might affect your sex life
  • How you feel about what is involved practically – for example, spending time in hospital or recovery time
  • How quickly do you want to know how well the treatment is working
  • What are your treatment options if the cancer comes back in the future

It can be hard to make a complex decision by yourself. Your doctor can help. You could write down questions to ask at your next appointment. You might want to take someone with you to your appointment. There may also be a specialist nurse you can talk things through with.

You might find it helpful to discuss things with your friends and family. Or you can talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9 to 5, Monday to Friday.

It can help to speak with other men who have made similar decisions. Your specialist might be able to put you in touch with other men with prostate cancer. Or you can talk to men on the Cancer Research UK forum, Cancer chat.

You might also want to get a second opinion from a different doctor. There are different types of doctors who treat prostate cancer. These include surgeons (urologists) and radiotherapy specialists (clinical oncologists). Talking to each type of doctor can help you understand your options fully.

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Tools to help you decide

For men whose cancer hasn't spread there is a tool to help you decide between monitoring (conservative treatment) and more radical treatment such as surgery or radiotherapy.  It can't tell you as an individual exactly what is going to happen to you in the future but it will provide you with a realistic idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.  

To be able to use the tool you need to know the following about your cancer:

  • PSA level
  • stage of cancer (T stage)
  • grade of cancer
  • the Gleason score

Ask your cancer doctor or nurse specialist if you don't know this information.

The tool is called Predict Prostate. 

Last reviewed: 
04 Jul 2016
  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence, January 2014

  • EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013
    A Heidenreich and others for the European Association of Urology
    European Urology. 2014 Jan;65(1):124-37

  • GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: An update
    Peter J. Hoskina and others
    Radiotherapy and Oncology, June 2013, Volume 107, Issue 3, Pages 325–332

  • Multi-disciplinary Team (MDT) Guidance for Managing Prostate Cancer 
    British Uro-oncology Group (BUG) and the British Association of Urological Surgeons (BAUS) Section of Oncology, September 2013

  • Cancer: Principles and practice of oncology (10th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015   

  • TNM Classification of Malignant Tumours (7th edition)
    International Union Against Cancer   
    L.H. Sobin, M.K. Gospodarowicz, Ch. Wittekind
    John Wiley & Sons, Hoboken, New Jersey, 2009

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