Prostate Cancer

Early detection of prostate cancer while it is still confined to the gland gives a patient the best chance of cure.  Prostate cancer screening is usually reserved for men over the age of fifty, however, men with a family history of prostate cancer or who have other risk factors should consider screening from the age of forty years to establish a ‘baseline’ level that will act as a benchmark and will provide some indication about the future risk of developing prostate cancer.

Statistics reveal that the morbidity associated with prostate cancer has significantly decreased with recent technological advances such as modern radiation machines and robotic assisted surgery.

On receiving a diagnosis of prostate cancer your urologist will discuss the management options available.  There are three options to consider:  active surveillance; androgen blockage; or attempted cure.  The particular management course your urologist takes is dependent on the cancers grade (Gleason score) and the extent of the cancer within the prostate. 

Active surveillance

Active surveillance may be a consideration, typically with a patient who has a low risk prostate cancer, especially in patients aged over 65.  This usually means that close monitoring of the PSA continues.  This would generally be every three months in addition, a repeat prostate biopsy or MRI prostate would be considered - usually at 12 months from the time of the original diagnosis.

If the PSA levels trend is upwards or a repeat biopsy showed the cancer had become more extensive or of a higher grade, then this conservative management approach would generally be abandoned.

This approach has not been widely utilised to date.  There are potential traps.  Up to 30% of patients have a higher grade or more extensive cancer than the original biopsy suggests.  The PSA is not always reliable at demonstrating progression of the cancer.  On the other hand, not all prostate cancers diagnosed ultimately threaten to get you in trouble and certainly some can be safely watched.  An MRI may be useful to help rule out more extensive disease before a programme of active surveillance is followed.

Androgen blockade

This is generally reserved for patients who have incurable disease, or where curative treatment does not seem appropriate.  This is conservative treatment, but it is not without potential problems.  It is mostly effective at controlling the cancer forbut will not cure the disease.  It can be effective for many years but on average is effective for two to three years.  After this time the cancer may become androgen independent and despite the medication, PSA levels may start to trend upwards and the cancer progresses. 

Attempted cure

In principle, a cure is only possible if the cancer is confined to the prostate itself.  If there is evidence of spread it is beyond cure.  The curative options for early stage of disease are either radiotherapy or surgery.  Surgery or radiotherapy can take various forms.

Radiotherapy is generally employed as external beam treatment.  The dosage is measured in units of grey.  It is generally advised that 70 grey or more is used.  This treatment usually occurs on an outpatient basis from Monday to Friday for a period of six weeks or longer.

Brachytherapy is another form of radiotherapy.  This is where radioactive seeds are placed in the prostate.  It is attractive, because it involves only a short hospital stay, typically day only.  However, it is generally recommended that this is used only for low risk prostate cancers.

For high risk prostate cancer, external beam treatment can be enhanced by utilising high dose rate brachytherapy where there is a combination of both brachytherapy in the form of wires in the prostate for two or three days, and subsequent external beam treatment.  This allows higher dosages of radiotherapy to be administered and possibly offers better results than external beam alone.  In general androgen blockade is also used prior to this treatment to try and improve the results still further.

Surgical Options

Surgery on the other hand is utilised to remove the prostate and as a consequence remove the cancer.  Radiotherapy aims to sterilise the cancer but you keep the prostate gland intact.  Based on nomogram studies, surgery generally appears to offer a slightly higher cure rate particularly in younger patients.  If ultimately surgery fails to cure, radiotherapy does remain a potential second line treatment option; unfortunately, the reverse is not the case.  If radiotherapy is used initially, surgery becomes much more risky under those circumstances.

There are two surgical methods used to remove the prostate; the conventional open radical prostatectomy and the new technique, Robotic assisted radical prostatectomy.  Both techniques have their pros and cons though the Robotic assisted radical prostatectomy is fast replacing, locally and internationally, the open technique.  Please click on the link below to see further information on each of the methods.

• Open Radical Prostatectomy
• Robotic Radical Prostatectomy

The information on this website is provided to reinforce any advice you have received from your GP and others involved in your care and is not intended to replace discussions with your doctor.