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
Treatment may involve the following:
Surgery
Some patients may have surgery to remove their prostate, particularly if the cancer is confined to the prostate gland. This is referred to as a radical prostatectomy, of which there are currently two types:
Retropubic prostatectomy – where the prostate gland is removed through an incision in the abdomen.
Perineal prostatectomy – where the prostate gland is removed through an incision in the perineum.
A prostatectomy can either be done by making a large incision or laparoscopic (keyhole surgery) where a number of small cuts will be made. Thanks to advances in research and technology, patients can now opt for a robotic prostatectomy which is a laparoscopic surgery where a robot assists the surgeon.
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 is another way of treating prostate cancer. It can come in two forms, either external or internal radiation therapy.
External beam radiotherapy – radiation is directed from a machine outside of the body towards the prostate.
Internal radiation therapy – small radioactive implants called ‘seeds’ are placed inside the prostate and give off radiation in low doses
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
Androgen deprivation therapy (hormone therapy)
Androgen deprivation therapy involves reducing the levels of the androgen hormone (e.g. testosterone) within the prostate, to stop it from helping the prostate cancer to grow or in some cases helping it to shrink.
There are several types of hormone therapy for prostate cancer:
- Surgical removal of male testicles, which produce androgens.
- Administering medication that stops the production of androgen
- Medication that blocks androgen receptors in prostate cancer cells so they can’t receive androgens to help the cancer survive.
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).