Problems and Treatments

There is no ‘one size fits all’ treatment for prostate cancer. Treatment depends on the extent of the cancer, whether it has spread to other organs, the patient’s medical history, and, of course, what the patient wants.

This section gives information on traditional as well as newer, alternative treatments available at the British Prostate Centre.

Active Surveillance

Some prostate cancers that are diagnosed by biopsy may be so slow growing that they may never cause any harm to the patient. In these men it may be sensible to follow an Active Surveillance policy. This would just mean keeping a close eye on the disease to ensure that it is not progressing. This is best done with regular PSA blood tests. At the BPC we appreciate that having a blood test done one day and waiting for the results then needing a second appointment to discuss them is an unnecessary and unwanted inconvenience. We are pleased to offer a 10 minute test that can be performed in clinic with a finger prick sample, allowing instant results and therefore further treatment options to be discussed straight away.

Surgery (Prostatectomy)

During surgery, the entire prostate is removed along with the seminal vesicles (small sacks behind the prostate) and a short part of the Vas Deferens, which carries sperm from the testes to the prostate. The bladder is then rejoined to the urethra and the two are helped to heal together by a catheter (a tube through the penis into the bladder). The catheter is left for 2 weeks or so to help the healing process.

This treatment usually involves a 4-5 day stay in hospital.

Surgery is effective if the cancer hasn’t spread from the prostate and if the patient is under 70 years old. However, unfortunately, there is a risk of impotence even with nerve sparing procedures. Incontinence is uncommon but may be a complication in a minority of patients.

HIFU

Localised prostate cancer can be treated with high intensity focused ultrasound (HIFU) from an ‘Ablatherm®’ computer-guided medical device. Available in the UK since 2005 and heralded as a ground-breaking new treatment, HIFU kills off cancerous cells without even breaking the skin. Less invasive and with high success rates and low side effects, the treatment and its results are described more fully on our dedicated HIFU website. www.hifu.org.uk

External radiotherapy

This treatment involves the use of very high energy rays directed at the prostate gland. These rays destroy the cancer cells.

Radiotherapy does not require anaesthetic and treatment is generally given during regular hospital visits - usually daily for seven weeks. Hormone therapy is commonly used for several months prior to radiotherapy, to shrink the prostate as much as possible.

Side effects include impotence and, less commonly, incontinence. There is also a risk of radiation damage to surrounding organs such as the bladder and rectum. If the cancer returns, radiotherapy can’t be performed again, but maybe treatable with HIFU. usually radiotherapy is reserved for patients unfit or unsuitable for surgery.

Alternative treatments

Brachytherapy

This involves implanting tiny radioactive seeds directly into the prostate gland to irradiate and destroy cancer cells. It’s not suitable for patients with more aggressive cancers or those who’ve had, or need to have, prostate surgery. Also, if the cancer comes back, the patient won’t be able to have further treatment or radiotherapy because of the radiation dose involved in the treatment.

Cryotherapy

During cryotherapy, the cancerous cells in the prostate are frozen under ultrasound guidance. The procedure is done under anaesthesia and requires at least an overnight stay in hospital. Side effects include high impotence rates and numbness in the penis.