Treatment for early / localised prostate cancer
There are several ways of treating prostate cancer. Don't be concerned if you talk to other men who are receiving similar, but different, treatments. Your treatment will be planned individually for you.
There are several different treatment options for treating early / localised prostate cancer:
Active surveillance or monitoring
If you have active surveillance or monitoring, you will see your doctor regularly for checkups instead of having treatment straight away.
Watchful waiting
The aim of watchful waiting is to put off treatment until men develop symptoms from progressive prostate cancer. Some prostate cancers are slow growing and men may experience very few symptoms. As all treatments for prostate cancer have side effects, your doctors may suggest that you wait for symptoms to develop before starting treatment.
Hormone therapy is usually the treatment offered. This may control your disease for many years but it won’t be curative treatment.
Surgery
The aim of surgery is to remove all of the prostate and prostate cancer. How much tissue is removed during the operation will depend upon the results of the investigations that you will have before surgery. Your doctor will discuss the options with you, and no procedure will be undertaken without your consent. A radical prostatectomy is the removal of the prostate gland, seminal vesicles and nearby lymph nodes.
After surgery, some men (approximately 30%) will experience mild urinary incontinence. This may mean that you could leak a small amount of urine when you cough, sneeze, stand up from a chair or lift a heavy weight. This may be temporary and you will be taught pelvic floor exercises that will help stop or prevent this from happening. A few men (2% to 5%) may experience continuous leakage of urine.
If you have difficulty in obtaining or maintaining an erection, there are a number of different treatments available.
All men undergoing a radical prostatectomy will be infertile. You will not produce any fluid when you ejaculate, although you will have the sensation of ejaculating.
Radiotherapy
Radiation therapy can be given in one of two ways: external or internal (brachytherapy).
Hormone treatment may also be given for three to six months before radiotherapy to help shrink the prostate. This means the target area for radiotherapy is reduced and so are the side effects. Sometimes, longer courses of hormones will be given after radiotherapy.
Radiotherapy uses high-energy X-rays to kill cancer cells. It is a localised treatment which means that it kills cells only in the part of the body which it is pointed at and nowhere else. Treatment is given using a machine similar to an X-ray machine, but slightly larger. The treatment will be planned specifically for you to make sure that the cancer cells are destroyed with the least amount of damage to normal tissues.
You may be offered conformal radiotherapy in which the beam of radiation is shaped around the treatment area. This allows higher and more effective doses of radiotherapy to be given. The likelihood of side effects, particularly proctitis (inflammation of the rectum), may be reduced.
The treatment area will include some of your rectum (the lower part of the bowel). This may cause diarrhoea and possibly bleeding from your rectum. If this happens, please tell your doctor, radiographer or nurse. You will be given advice on diet, and medicine can be prescribed to help you. Make sure you drink plenty of fluids.
Your bladder will also be within the treatment area. You may experience some discomfort when passing urine. You may also want to pass urine more often notice the stream of urine is weaker, or sometimes have to wait before passing urine. Make sure you drink plenty of fluids and tell your doctor about this problem. It may or may not be possible to treat your problem but specialist advice may be available. Occasionally, bowel and bladder problems may persist. Talk to your doctor about these as help can be offered.
Having pain or discomfort when you ejaculate may also occur because your prostate gland becomes inflamed during the radiotherapy treatment. Once treatment has finished, the inflammation will settle and the pain will go away.
Some men experience difficulties getting or maintaining their erections after radiotherapy. These problems tend to come on gradually.
Internal radiotherapy is treatment in which solid radioactive sources are placed inside a body cavity or needles are placed in the tumour.
Brachytherapy is only suitable for men who have early-stage and well-localised cancer with small size prostates. There are two ways of giving brachytherapy: seed brachytherapy and high-dose brachytherapy
Seed brachytherapy involves the implanting of approximately 80 to 100 radioactive seeds into the prostate gland. You will need an ultrasound of your prostate to allow the doctors to plan your treatment. Both procedures will require a general anaesthetic. A few weeks later you will attend hospital to have your seeds implanted. You may need to stay overnight. The seeds will stay in your prostate permanently and will slowly emit radiation to the surrounding tissue. After a year 95% of the radiation has gone.
High-dose brachytherapy is currently only being given as part of a research trial in some hospitals. It involves the insertion of radioactive rods into the prostate which only stay in place for a short time.
The side effects from brachytherapy are very similar to those for external beam radiotherapy.