| Prostate cancer | Diagnosing prostate cancer | Treatment for prostate cancer |
| Coping with side effects of treatment for prostate cancer |
This information has been reviewed by:
Associate Professor Jeremy Millar, The Alfred
Options for men whose cancer has not spread
Transurethral resection of the prostate (TURP)
Brachytherapy (internal radiotherapy)
Options for men whose prostate cancer has spread
Hormone treatment with surgery
Regular check-ups will tell you and your doctor if treatment is needed. Sometimes the best thing to do is to ‘watch and wait'. Prostate cancer may be treated by surgery, radiotherapy or hormone treatment. Treatment will depend on the size, type, growth and spread of the cancer. It will also depend on your age, general health, symptoms and what you want.
If your doctor recommends treatment, make sure that you know what to expect. In most cases you can take time to make your decision. Talk about this with your doctor.
Side effects of treatments for prostate cancer can involve erectile dysfunction (impotence), urinary incontinence or bowel problems.
Try to have a partner or a friend with you when you talk with the doctor. You may also find it helpful to make a list of questions before your visit: a sample list is included at the end of this booklet.
There are several options for men whose cancer has not spread beyond the prostate.
Sometimes, for example, if you are over 70 years of age and the cancer is at a very early stage, your doctor will advise that treatment is not needed. This is because older patients with slowly growing cancers are more likely to die of something other than prostate cancer.
However, you will still need regular check-ups to see that the cancer is not growing too fast. If it does, your doctor will talk about other treatments with you.
If the cancer has not spread beyond the prostate, the whole prostate and some tissue around it may be removed. This is called a radical prostatectomy. It is done to cure the cancer.
It is a major operation. Your doctor will only advise this if you have no other health problems.
The operation is done through a cut in the lower abdomen. Keyhole surgery may be possible: ask your doctor about it.
The operation usually takes two to three hours and you will need to stay four to eight days in hospital.
You may still have a catheter in place when you go home. This may be up to two weeks. You will be able to get back to normal activities within six weeks.
Side effects of radical prostatectomy: A radical prostatectomy causes some urinary incontinence (loss of bladder control) in many men. This is temporary (short-term) in most men. Less than 5% have severe permanent incontinence (meaning it doesn't get better).
Almost all men have a change in their sexual function. Most men have erectile dysfunction (also known as impotence or loss of erections). Some men improve but many have ongoing problems. Some men need more operations to correct strictures (scars that cause narrowing in the urethra). Your doctor will talk about the chance of you having these problems. If you would like to discuss these side effects with others, contact the Cancer Council Helpline; telephone 13 11 20.
If it is not possible to remove the prostate, you may be able to have surgery to remove blockages in the urinary tract. This is called a transurethral resection of the prostate. This will not remove the cancer, however it should relieve symptoms such as difficulty passing urine. You may have other treatments for your cancer.
A telescope-like instrument is passed up the urethra through the penis. An instrument inside the telescope is then used to remove the prostate tissue causing the blockage. This is sometimes called a rebore.
This operation is also used to treat benign prostatic hyperplasia. It does not completely remove the prostate, so it is unlikely to cure the cancer, but it should help with urination problems. A catheter may be left in after the procedure.
External radiotherapy uses x-rays to destroy cancer cells. It can be done instead of surgery when the cancer is confined to the prostate. It can also be added to surgery if your PSA level continues to rise after surgery.
The x-rays can be targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue.
To make sure that exactly the same area is being treated each time, the radiation therapist will make some marks on your skin: lines, crosses and dots applied with special inks. Either they will be re-done during the course of the treatment or they will be permanent marks.
Most people have the treatment each day (except for weekends) for several weeks. The length of the treatment course will depend on the size and type of the cancer and on your general health.
You have the treatment as an outpatient. It takes a few minutes each time. Having radiotherapy in a number of small doses helps to reduce side effects.
Short-term side effects of external radiotherapy: You may become tired, or find that you need to urinate more often and that it is uncomfortable. You may have bowel problems during or just after treatment, resulting in a mucus-type discharge or diarrhoea with or without cramping. These problems usually disappear.
Side effects like reddening or burning of the skin and nausea are uncommon. Ask your doctor or nurse what side effects to expect and how to cope with them. They will gradually get better when treatment has finished.
Long-term side effects of external radiotherapy: In the years after treatment, radiotherapy for prostate cancer can cause other problems. These are related to the parts of the body treated with radiation: the bladder, the rectum, other parts of the bowel, and the nerves and blood vessels required for erections.
A small number of men continue to have bowel problems. These may include needing to go to the toilet often and urgently, and some looseness, sometimes with mucus in the bowel motion. Bleeding from the bowel affects some men treated with radiotherapy. For every 100 men who have external radiotherapy for prostate cancer, 40 to 80 have erectile dysfunction (impotence). Impotence is less likely to occur after radiation than surgery and usually occurs more slowly. Urinary incontinence is an uncommon side effect of external radiotherapy.
See the ‘Coping with side effects' section later in this booklet for more information.
Brachytherapy is a type of radiotherapy where the radiation source is placed in the area being treated.
Two types of brachytherapy are used to treat prostate cancer.
One is radioactive ‘seeds'. The seeds are put in the prostate, where they treat the cancer. They are often put into the prostate as a day procedure, however some patients will stay overnight in hospital.
The seeds lose their radioactivity over time. They are not removed.
This type of brachytherapy may be used instead of external radiotherapy or a radical prostatectomy. It is for small tumours with a low Gleason score and with a low PSA.
The other type of brachytherapy is a temporary (short-term) implant. In this case, hollow needles are placed in the prostate. Radioactive sources can then be put into the prostate down the hollow needles. After a few treatments, the needles are removed.
It usually requires a stay in hospital for a few days. This type of brachytherapy is used with external radiotherapy, for men with a higher PSA, higher Gleason score and larger tumours.
Side effects of brachytherapy: There can be discomfort from having the needles or seeds put in. Pain relievers usually help. Otherwise, the side effects of seed brachytherapy and temporary needle implants are different.
With the seeds, painful urination, poor urine flow and bladder irritation are common side effects. These can start a month after treatment and gradually get better over 12 months. Urinary incontinence and rectal problems are not usually a problem. Erectile dysfunction (impotence) can also occur with brachytherapy.
There is a tiny risk of radiation exposure to other people. Don't hold babies and small children on your lap for two months after treatment. Don't have prolonged contact with a pregnant woman for the first two months following your implant.
You can sleep in the same bed as your partner. If you are resuming sexual intercourse, use condoms for the first two months after the seeds are implanted. This is in case a seed is accidentally moved and ejaculated in the semen. Talk to your doctor for more advice.
Temporary needle implants are usually used with external radiotherapy. The side effects of the temporary implants are very similar to those of external radiotherapy alone.
Hormone treatment is an option for men whose prostate cancer has spread beyond the prostate.
Prostate cancers need the hormone testosterone (produced in men by the testes) for their growth. It is possible to slow down or shrink the cancers by reducing the body's testosterone levels. Hormone treatment can help with symptoms such as pain caused by the cancer spreading. It can also help symptoms such as needing to urinate often.
Hormone treatment may be given for some months before radiotherapy or surgery to help these treatments work better.
Hormone treatment does not aim to cure the cancer but can help shrink the cancer or relieve symptoms for most men.
The two main ways of reducing testosterone levels are by surgery or by injections. For most men, these two treatments will be equally effective. Your doctor will help you with your choice.
Two operations can be done to reduce testosterone levels.
The first removes the testes. This operation is known as an orchidectomy (also known as orchiectomy). A plastic prosthesis can be put into the scrotum to keep its shape and appearance.
A smaller operation involves removing the inner part of the testes (a ‘subcapsular orchidectomy'). In this case, a prosthesis is not needed.
Injections of luteinising hormone-releasing hormone (LHRH) can control the production of testosterone. You may have LHRH every month or every three months.
Side effects of hormone treatment: Hormone treatment for prostate cancer can cause loss of libido (sex drive), weight gain, erectile dysfunction (impotence), hot flushes, swelling of the breasts, fluid retention, softening of the bones (osteoporosis) and mood swings.
Prostate cancer can be treated best when the cancer is found early and is still confined to the prostate.
In many cases, the cancer does not go away after treatment but stops growing or shrinks in size. Men usually return to normal or near normal good health. This may last for months or many years.
After your treatment is finished, your doctor will recommend regular check-ups. If you have any new symptoms, you should see your doctor.
If you would like information about your own prognosis, you need to speak to your doctor, who knows your full medical history.
