Urinary PSA test
Doctors will use the results of your prostate examination, biopsy and scans to identify the "stage" of your prostate cancer (how far the cancer has spread). The stage of the cancer will determine which types of treatments will be necessary.
A widely used method of staging isanumber staging system. The stages are:
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good. About 90% of men diagnosed at stages 1 or 2 will live at least five more years and 65-90% will live for at least 10 more years.
If you are diagnosed with stage 3 prostate cancer, you have a 70-80% of chance of living for at least five more years.
However, if you are diagnosed when your prostate cancer has reached stage 4, there is only a 30% chanceyou will live for at least five more years.
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Watchful waitingis often recommended for older men when it is unlikely that the cancerwill affect your natural life span.
If the cancer is in its early stages and not causing symptoms, you may decide to delay treatment, and wait to see if any symptoms of progressive cancer develop. If this happens, pain medication and hormone medication (see below) to control prostate cancer are usually used.
Watchful waiting may also be recommended for people with a higher risk of prostate cancer if:
In this case, hormone treatment may be started if there are symptoms caused by the prostate cancer.
Active surveillance aims to avoid unnecessary treatment of harmless cancers, while still providing timely treatment for men who need it.
When they are diagnosed, we know that around half to two-thirds of men with low-risk prostate cancer do not needtreatment. Surveillance is a safe strategy that provides a period of observation to gather extra information over time to see whether the disease is changing.
Active surveillance involves you having regular PSA tests andoften severalbiopsies to ensureany signs of progression are found as early as possible. Sometimes, MRI scans may also be carried out. If these tests reveal the cancer is changing or progressing,you can then make a decision about further treatment.
Aboutone inthree menwho undergo surveillance will later have treatment. This does not mean they made the wrong initial decision. Good evidence showsthat active surveillance is safe over an average of six years. Men undergoing active surveillancewill have delayed any treatment-related side effects, and those who eventually need treatmentwill be reassuredthat it was necessary.
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer.
Like any operation, this surgery carries some risks, and there may be some side effects. These are outlined below.
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Radiotherapy involves using radiation to kill cancerous cells. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer. Radiotherapy can also be used to slow the progression of metastatic prostate cancer and relieve symptoms.
Radiotherapy is normally given as an outpatient at a hospital near you. It is done in short sessions for five days a week, for four to eight weeks. There are short-term and long-term side effects associated with radiotherapy.
You may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.
Short-term effects of radiotherapy can include:
Brachytherapy is a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It is also known as internal or interstitial radiotherapy.
The radiation can be delivered using a number of tiny radioactive seeds that are surgically implanted into the tumour. This is called low dose-rate brachytherapy.
The radiation can also be delivered through hollow, thin needles placed inside the prostate. This is calld high dose-rate brachytherapy.
This method has the advantage of delivering a high dose of radiation to the prostate, while minimising damage to other tissues. However, the risk of sexual dysfunction and urinary problems is the same as with radiotherapy, although the risk of bowel problems is slightly lower.
Hormone therapy is often used in combination with radiotherapy. For example, you may receive hormone therapy before undergoing radiotherapy to increase the chance of a successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.
Hormone therapy alone should not normally be used to treatlocalised prostate cancer in men who are fit and willing to receive surgery or radiotherapy. This is because it does not cure the cancer on its own.Hormone therapycan be used to slow the progression of advanced prostate cancer and relieve symptoms.
Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow. The purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone.
Hormone therapy can be given as:
The main side effects of hormone treatment are caused by their effects on testosterone. They usually go away when treatment stops. They include loss of sex drive and erectile dysfunction (this is more common with LHRH agonists than anti-androgens).
Other possible side effects include:
An alternative to hormone therapy is to surgically remove the testicles, called orchidectomy. The operation does not cure prostate cancer, but by removing the testosterone, it controls the growth of the cancer and its symptoms. However, many men prefer to have hormone treatment to block the effects of testosterone.
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DuringTURP, athin metal wire with a loop at the end is inserted into your urethra (the tube that carries urine from your bladder to your penis) and pieces of the prostate are removed.
This is carried out under general anaesthetic or a spinal anaesthetic ( epidural ).
This is done to relieve pressure from the urethra to treat any problematic symptoms you may have with urination. It does not cure the cancer.
An ultrasound probeinserted into the rectum releases high-frequency sound waves through the wall of the rectum. These sound waves kill cancer cells in the prostate gland by heating them to a high temperature.
The risk of side effectsfrom HIFUisusually lower than other treatments.
However, possible effects can include impotence (in five to 10 in every 100 men) or urinary incontinence (in less than one in every 100 men). Back passage problems are rare.
Fistulas (an abnormal channel between the urinary system and rectum) are also rare, affecting less than one in every 500 men. This is because the treatment targets the cancer area only and not the whole prostate.
However, HIFU treatment is still going through clinical trials for prostate cancer.In some cases, doctors can carry out HIFU treatment outside of clinical trials. HIFU is not widely available and its long-term effectiveness has not yet been conclusively proven.
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Cryotherapy is a method of killing cancer cells by freezing them. It is sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate gland.
Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum. They freeze the prostate gland and kill the cancer cells, but some normal cells also die.
The aim is to kill cancer cells while causing as little damage as possible to healthy cells. The side effects of cryotherapy can include:
It is rare for cryotherapy to causerectal problems or fistulas.
Cryotherapyis still undergoing clinical trials for prostate cancer. In some cases, doctors can carry out cryotherapy treatment outside of clinical trials.Itis not widely availableand its long-term effectiveness has not yet been conclusively proven.
If the cancer has reached an advanced stage, it is no longer possible to cure it. However, it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
Chemotherapy destroys cancer cells by interfering with the way they multiply. Chemotherapy does not cure prostate cancer, but can keep it under control and reduce symptoms (such as pain) so everyday life is less affected.
The main side effects of chemotherapy are caused by their effects on healthy cells, such as immune cells. They include infections, tiredness, hair loss, sore mouth, loss of appetite, nausea and vomiting. Many of these side effects can be prevented or controlled with other medicines, which your doctor can prescribe for you.
Steroid tablets are used when hormone therapy no longer works because the cancer is resistant to it. This is called hormone-refractory cancer.
Steroids can be used to try to shrink the tumour and stop it from growing. The most effective steroid treatment is dexamethasone.
There are a number of new medications that could be used if hormones and chemotherapy fail. Your medical teamcan tell you if these are suitable and available for you.
NICE has recently issued guidance on medications called abiraterone andenzalutamide. Both abiraterone and enzalutamide may be used to treat men with metastatic prostate cancerthat no longer responds to the chemotherapy drug docetaxel.
Read the NICE guidelines on:
As many of the treatments above have unpleasant side effects that can affect your quality of life, you may decide against treatment. This make be especially true if you are at an age when you feel that treating the cancer is unlikely to significantly extend your life expectancy.
This is entirely your decision, and your MDT will respect it.
If you decide not to have treatment, your GP and hospital team will still give you support and pain relief. This is called palliative care . Support is also available for your family and friends.
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Prostate cancer is the most common cancer in men in the UK, with over 40,000 new cases diagnosed every year.
Prostate cancer normally causes no symptoms until the cancer has grown large enough to put pressure on the urethra.
It is not known exactly what causes prostate cancer, although there are some things that can increase your risk of developing the condition.
If you have symptoms that could be caused by prostate cancer, you should visit your GP.
There is currently no screening programme for prostate cancer in the UK. This is because it is has not been proved that the benefits would outweigh the risks.
The treatment you receive for prostate cancer will depend on your individual circumstances.