Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.

Treatment for prostate cancer depends on:

• the stage of the disease
• the location of the cancer
• the severity of symptoms
• your general health and wishes.

Treatment may involve the following:

Management options

For some people with prostate cancer, treatment may not be recommended straight away.

Watchful waiting

You might be monitored in case symptoms develop or change – this is called ‘watchful waiting’.

If symptoms develop, such as bone pain, you will be offered treatment to manage these symptoms.

Active surveillance

If you have low-risk, localised prostate cancer, you might have ‘active surveillance’. This is because prostate cancer often grows slowly and, for some people, the side effects of treatment can outweigh the potential benefits.

You will likely have regular blood tests to check your PSA level, regular digital rectal examinations, and possibly ultrasounds or biopsies. If the cancer starts to grow or there are signs that it is getting worse, you might start treatment.

Surgery

If the tumour has not spread outside the prostate, you might have surgery to remove the prostate and some of the surrounding tissue, including the seminal vesicles. This is called a radical prostatectomy.

There are 2 main types of radical prostatectomy:

• Retropubic prostatectomy – where an incision (cut) is made in your belly, and the prostate (and possibly nearby lymph nodes) is removed through the cut.
• Perineal prostatectomy – where an incision (cut) is made in the skin between the anus and the scrotum, and the prostate is removed through the cut.

Prostatectomy can be either open (where a large cut is made) or laparoscopic (also called ‘keyhole surgery’, where several small cuts are made). Robotic surgery is a type of laparoscopic surgery where the surgeon is assisted by a special machine (robot).

After surgery, a catheter will be inserted into your penis to help drain your bladder while you heal. This will stay in place for about 1 to 2 weeks, and you will be able to urinate normally after it is removed.

Another type of surgery, called transurethral resection of the prostate (TURP), uses a piece of equipment called a resectoscope to remove some of the tissue in the prostate. The resectoscope is inserted in the penis and uses heat or a laser to remove tissue from the prostate. This type of surgery is not often used as the primary treatment for prostate cancer, but can be used to relieve symptoms, or for people who can’t have a radical prostatectomy.

Possible side effects of surgery for prostate cancer include:

• urinary incontinence (where urine leaks out or you can’t control your urination)
• erectile dysfunction or impotence
• orgasms that are less intense
• dry orgasms (where semen is no longer produced because the prostate and seminal vesicles have been removed)
• shortening of the penis
• lymphoedema.

Some side effects get better over time, but others may be lifelong.

Surgery for prostate cancer also leads to infertility because of erectile dysfunction or because the sperm can no longer travel out of the penis, although other parts of semen might still be produced.

Radiotherapy

Radiotherapy can be used to treat prostate cancer. This can be either:

• external beam radiation therapy – where a machine outside the body directs radiation towards the prostate gland
• internal radiation therapy (brachytherapy) – where small radioactive ‘seeds’ are placed inside the prostate. Some seeds give off low doses off radiation and are left in place permanently (i.e. not removed after the radiation has been used up). Others are held in place temporarily using catheters, and give off higher doses of radiation for a shorter time.

Cryosurgery

Prostate cancer can sometimes be treated with cryosurgery, which involves inserting long needles through the perineum into the prostate. Very cold gases are then passed through the needles, which freezes the prostate and destroys cancer cells. Warm liquid is also passed through a catheter in the penis to stop the urethra from freezing.

Cryosurgery is not often used as the main treatment for prostate cancer, but it may be used after radiotherapy, or if the cancer has come back after other treatments.

Side effects of cryotherapy can include:

• urinary incontinence (where urine leaks out or you can’t control your urination)
• erectile dysfunction
• fistula (abnormal connection) between the bladder and the rectum.

Hormone therapy

Some types of cancer, including prostate cancer, need certain hormones to grow. By reducing the levels of these hormones in the body, the cancer can slow its growth or even shrink.

Prostate cancer cells use hormones called androgens – an example of an androgen hormone is testosterone. Hormone therapy for prostate cancer is also called androgen deprivation therapy (ADT), and there are several types:

• surgical removal of 1 or both testicles (orchiectomy). Because the testicles make androgens, this surgery is a type of hormone therapy because it results in reduced androgen levels
• drugs that stop the testicles from making testosterone (called luteinising hormon-releasing hormone analogs)
• drugs that stop androgen production at different body sites (called androgen synthesis inhibitors)
• drugs that block the androgen receptors on cancer cells so they can’t receive hormones (called anti-androgens).

Some of the common side effects of hormone therapy can include:

• erectile dysfunction
• loss of sexual desire
• hot flushes
• growth of breast tissue
• osteoporosis or weakened bones.

Chemotherapy

Chemotherapy can be used to treat prostate cancer.

Immunotherapy

Sipuleucel-T is a drug that uses your own white blood cells to destroy prostate cancer cells. It is used to treat advanced cancer or cancer that has spread.

Follow-up

After treatment, you might need regular visits to the doctor for digital rectal examinations (if your prostate wasn’t removed) and PSA tests to check whether the cancer has come back (recurred).

Advanced and recurrent cancer

If prostate cancer spreads beyond the prostate, it usually spreads to the bones. This is called secondary cancer or metastasis. Cancer in the bones can be painful and might lead to bone fractures or other complications.

Treatment to prevent prostate cancer from spreading to the bones, or to relieve symptoms associated with secondary cancer in the bones may include:

• bisphosphonates, which can help strengthen bones, and is also used in men who have had hormone therapy
• external beam radiotherapy, which can help relieve bone pain
• monoclonal antibodies such as denosumab injected under the skin to help protect bones
• corticosteroids, which can relieve pain and lower PSA levels
• radiopharmaceuticals (medicines that contain radioactivity), which are injected into the body and settle in areas of damaged bone, where they can destroy cancer cells
• pain medications.

Prostate cancer may recur (come back) after treatment. The cancer can recur in the prostate or somewhere else in the body, and is classified as local or distant (often called metastatic cancer).

If prostate cancer has come back, the type of treatment you have may depend on how your primary cancer was treated. You might have the same treatment again, or a different treatment.