Choosing between different treatments for prostate cancer?

Mr Alan Doherty

For men with organ-confined early stage disease, there is a wider range of different treatments for prostate cancer than any other type of cancer.

Mr Alan Doherty, consultant urologist at the Birmingham Prostate Clinic, discusses the relative merits and disadvantages of the different types of treatment, answering the questions patients most commonly ask in clinic.

Why have I been recommended prostate cancer surgery?

  • It is unlikely that any treatment is better than removing the whole prostate: if the cancer has been removed before it has spread, it can never come back!
  • The prostate serves no useful function (unless further children are planned).
  • Successful surgery means no radiotherapy (which has a risk of causing cancer) and no hormone therapy (medical castration).
  • Surgery has back up treatments that are effective and safe.
  • Surgery provides certainty of outcome: you know where you are! There is the advantage of the histology – this refers to the tissue samples which are taken during surgery and then analysed in the laboratory to provide extra information about the spread and aggressiveness of your cancer. You also have the assurance of PSA information after surgery – if your PSA at three months is at 0.01ng/ml, this provides the most certain measure of full cure.
  • Surgery improves urinary flow and reduces urinary symptoms.
  • Surgery is not affected by size of prostate and any existing bowel conditions.

All these advantages should not come at the price of incontinence and impotence: surgery that is well done gives good results! You can see our live results centre which shows continence and erection recovery of our prostate cancer patients. Currently, 83 per cent are reporting erectile function at 12 months and 95 per cent are reporting continence at 12 months.

What about active surveillance?

Cancers do keep growing, albeit slowly in most cases. When the decision to treat is made, the PSA is usually higher and the chances of cure with good nerve-sparing are likely to be reduced.

What about radiotherapy?

There are clearly advantages to radiotherapy for prostate cancer, however they should be considered together with these disadvantages:

  • Lack of certainty.
  • Use of hormone.
  • No reliable back up curative treatments.
  • More urinary symptoms, in short term and long term.
  • Risk of second malignancy; there is a small risk of prostate radiotherapy causing a secondary cancer, specifically bladder, colon and rectal cancer although unlikely to develop for at least five years. This small risk is believed to be reduced by the new Intensity Modulated Radiotherapy (IMRT) technology and Tomotherapy.

What about HIFU?

  • Long term data is lacking: this makes it difficult to predict likely cure rate.
  • Lack of certainty and ability to tell whether it has worked.
  • You are likely to need more interventions: more biopsies, more HIFU, TURP, more catheters over the course of your future treatment.
  • HIFU may compromise future surgical interventions.