Treatment of early prostate cancer

Active Surveillance

Do not be surprised if the Consultant recommends having no treatment at this moment. This is called 'Active Surveillance' and is suitable for men with small, less
aggressive cancers. Active surveillance aims to individualise patient care by monitoring early prostate cancer and by then selecting curative treatments for those at risk of disease progression. It is therefore important that the prostate has been accurately and extensively assessed before you undertake this option. Patients under surveillance are closely monitored using serum PSA levels and repeat prostate biopsies. The decision to continue surveillance or recommend curative treatment depends on whether the disease progresses or not.

Watchful Waiting

This will involve attending the patient's clinic at regular intervals for regular PSA tests and clinic review. Hormone treatment will begin, if the PSA rises significantly or symptoms develop. It may also include changes in diet, or introducing an exercise regime, which may help to slow or even reduce the growth of the cancer cells.

Radical Surgery

This involves the total removal of the prostate gland in an operation called a Radical Prostatectomy. It is done in the hope that all of the cancer is contained within the gland and therefore can be completely removed. This may involve conventional surgery but an increasing number of surgeons are now using, when suitable, Laparoscopic (Keyhole) or Robotic surgery (using the Da Vinci Robot) to remove the prostate and the cancer completely. Recovery from keyhole surgery is much faster and less time is therefore spent in hospital and for convalescence.


Brachytherapy

This is a one-stage treatment for early prostate cancer in which tiny radioactive seeds are implanted directly into the cancerous prostate gland. It may be performed as a day case or overnight stay. Seeds the size of a grain of rice are implanted into the prostate gland under a general anaesthetic. A trans-rectal ultrasound allow the seeds to be precisely positioned within the prostate. A "real time" planning computer monitors the procedure to ensure that the desired radiation dose is given to the gland whilst the surrounding structures are spared. By delivering radiation directly into the prostate, the side effects can be minimised and patients rapidly return to their normal activities.

External beam therapy

It involves directing high-energy radiation at the tumour. Modern technology (Conformal and IMRT) use a computer to 'shape' the radiotherapy beams to a more exact shape of the prostate. This minimises the amount of healthy tissue that receives radiation. Radiotherapy may also be used if cancer has spread outside the gland.

Experimental treatments

Novel treatments are available only as part of clinical studies, as their benefits have not yet been clearly demonstrated. They allow focused treatment of the prostate and could reduce side effects. An example is Targeted (or Focal) Cryosurgery, a minimally invasive treatment currently under investigation for localised and recurrent prostate cancer post radiotherapy. It utilises argon gas to freeze the cancer to -40 degrees Centigrade. It is only available at a small number of academic institutions in the UK. Another is HIFU ( High Intensity Frequency Ultrasound). Focused microwaves are used to generate heat in the prostate to destroy cancerous tissue. It is again minimally invasive and uses ultrasound to monitor treatment. The patient is under anaesthetic for the procedure and can be discharged within 24 hours. It is more commonly used in Europe. And finally, the Interstitial Laser procedure, which presently is undergoing pilot trials to assess whether indeed it will be of use.

Side Effects

All radical/curative treatments carry the risk of side effects. These include impotence (loss of erections), incontinence (leakage of urine) and bothersome urinary symptoms. Some of these will wear off but some may be long term. It is important that you discuss the relative risks of these with your urologist and also with members of the multi-disciplinary team looking after you, (which will include a clinical nurse specialist, oncologist, etc) and also your family and sometimes other patients. It is very important not to rush into any form of treatment (seek a second opinion if need be) and it is vital to discuss the pros and cons of each procedure.

Although your Consultant(s) may recommend a course of treatment, the final decision remains YOURS, with help and support from spouse or partner and those closest to you. It is important to thoroughly understand all available treatment options so you can make an informed decision based on the benefits and risks associated with each.

Recurrence

Recurrence after radiotherapy may be treated by cryotherapy and recurrence after surgery can be treated by external beam radiotherapy. These treatments can only be used if the recurrence is localised to the pelvis and not due to metastases.