Treatment for locally advanced / late prostate cancer
With locally advanced and late prostate cancer, the aim of treatment is to control the spread of the cancer rather than cure it.
Hormone therapy
Hormone therapy is the main form of treatment. It may be used on its own or in combination with other treatments such as radiotherapy and chemotherapy.
Hormones are natural substances produced by glands in the body. They travel around the body in the bloodstream and affect how certain organs and systems work. The male hormone, testosterone, affects the growth of prostate cancer.
Hormone therapy slows the growth of prostate cancer by reducing the amount of testosterone available in the body or by blocking its effect. The cancer, wherever it is in the body, may also shrink in size, and if you are experiencing symptoms they may disappear.
Testosterone is produced mainly by the testicles although small amounts are made in other parts of the body. The effects of testosterone may be stopped in four ways:
Orchidectomy
An orchidectomy is an operation to remove both testicles. As the testicles produce most of the body’s testosterone, this is the simplest way of stopping its production. Prosthetic testicles made of silicone can be placed in the scrotum to maintain appearance and shape if you wish. This operation cannot be reversed.
Luteinising hormone-releasing hormone (LMRH) analogue
These injections are given on a monthly or three-monthly basis. Initially these drugs will cause your body to increase the production of testosterone before it is switched off. This is called a ‘flare’. When you stop having these injections, your body will slowly start to produce testosterone again, although it may take a few months before the level of testosterone in your body is back to normal.
Anti-androgen tablets
Anti-androgen tablets block testosterone receptor sites. These drugs can cause stomach upsets, diarrhoea and can, with long-term use, cause changes in liver function. You will need regular blood tests to check on how well your liver is working. Anti-androgens are given for one week before and two weeks after LHRH analogue injections to counteract the effects of flare.
Oestrogen
Oestrogen works by blocking the production of testosterone. It is used when prostate cancer does not respond or stops responding to LHRH analogues and anti-androgens.
Side effects
Different types of hormone therapy used to treat prostate cancer have different side effects and these will vary depending on which hormone is used.
The most common side effects are:
- loss of interest in sex
- difficulty getting and/or keeping an erection that is sufficient for penetrative intercourse
- hot flushes and night sweats; usually these are mild and may improve over time
- breast swelling and tenderness (gynaecomastia)
- weight gain, particularly with thickening around the waist
- tiredness
- blood clots.
Other treatment
Prostate cancer may spread to the bones and can cause pain. Radiotherapy is very good for relieving bone pain and you may be offered treatment, as needed. One single treatment or a course of a few days will be given. It doesn't usually have any side effects.
Radiotherapy may also be given as an injection of an isotope (radioactive substance) called strontium. This is injected into a vein, usually in your arm, and travels around your body in the bloodstream. Strontium is taken up by the areas of bone which contain cancer and the radiation kills the cancer cells.
If you are advised to have this treatment it will be explained to you. Please ask any questions you may have.
You may be offered chemotherapy treatment. Chemotherapy means treatment with anti-cancer drugs. It is used in the treatment of late prostate cancer and when prostate cancer is no longer controlled by hormone treatments. Most chemotherapy treatments are given as part of research trials.