Prostate Mapping is a modern prostate biopsy method
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Treatment Options

What treatments are available?

At the time of diagnosis, prostate cancer may be confined to the prostate itself, or may have spread to other sites within the body. If prostate cancer is confined to the prostate, so-called localized prostate cancer, there are a number of treatments available. Many men over the age of 50 years actually have prostate cancer that 'they will die with rather than die from'. In other words, the prostate cancer in many cases will not kill.

Men with localised prostate cancer have to choose between two extremes of care - active surveillance versus radical therapy.

Active surveillance

Active surveillance involves monitoring the disease with regular 3 monthly blood tests (a PSA test), examination of your prostate in clinic, and 2 or 3 yearly biopsies. If any of these show signs that the disease is progressing, then treatment will be recommended.

Radical treatment

Radical therapy involves treatment that aims to destroy the whole prostate. These include surgery (radical prostatectomy), external beam radiotherapy, brachytherapy (small implanted radioactive seeds), cryosurgery (freezing) or high intensity focused ultrasound (HIFU). The best evidence we have shows that the difference between active surveillance and radical surgery is not large in terms of preventing an individual from dying of prostate cancer within a 10 year period - 14% of men died within ten years whilst on active surveillance, compared to a rate of 9% for men who had surgery.

On the other hand, we know that the side effects of radical treatments are high - they include, amongst others, deterioration in urinary, sexual and bowel function. It is these harms of therapy that many men are keen to avoid. These harms arise because when the whole gland is treated, there is damage to surrounding areas such as the muscle that controls urine flow and the nerve bundles that control erections.

In men who are diagnosed with a PSA screening test, the difference between active surveillance and radical treatment may be smaller. This is because we are detecting men with lower risk prostate cancer at a younger age.

How do I decide which treatment is suitable for me if I have localized prostate cancer?

Your doctor will advise you. However, the information in this section should help you. The information that is used to decide whether you are suitable for certain treatments depends on a number of things:
  • your age and general health condition. Your age may be used to decide whether you even need treatment since in most cases the prostate cancer and can be watched carefully
  • health condition may influence whether you are fit for surgery or radiotherapy
  • PSA level. PSA levels above 10ng/ml are considered a higher risk
  • Gleason score. Gleason scores higher than 3+4=7 are usually not suitable for active surveillance
  • how much prostate cancer was in your prostate biopsies. The more cancer in the prostate, the less likely that you will be suitable for active surveillance.
It is therefore very important that the prostate biopsy gives the correct Gleason grade and also accurate information about how much prostate cancer there is in the prostate. Unfortunately, a prostate biopsy can give incorrect information in a significant number of men.

Precise treatment

Prostate Mapping can help your oncologist target areas of cancer with high grade with greater radiation through the method of 'intensity modulation radiotherapy' (a new precise form of radiotherapy compared to traditional external radiation methods) or by placing a larger number of radioactive 'seeds' into the prostate for 'brachytherapy'. Prostate mapping can also help your surgeon decide whether he should perform 'nerve sparing radical prostatectomy' whether using the open, laparoscopic (keyhole) or robotic prostatectomy. This is because the surgeons keep very close to the prostate gland when performing nerve-sparing surgery and may risk cutting into the cancer if they do not know that there is cancer on that side. Prostate Mapping will allow them to be more precise during surgery and advise you appropriately.

Focal therapy

Finally, there is a lot of research at the moment into reducing the treatment side-effects of incontinence, impotence and back passage problems from traditional treatments like surgery and radiotherapy. Focal therapy involves destroying just the areas of cancer within the prostate gland rather than the whole prostate. By doing so, damage to the sphincter muscle (which controls continence), nerves (supplying the penis) and back passage can be minimised. Early results show that this is indeed the case with very high rates of post-treatment erections. Prostate Mapping will allow you to access trials currently recruiting in focal therapy. These trials use high-intensity focused ultrasound (HIFU), cryosurgery (freezing the gland) or photodynamic therapy (light treatment) to destroy just areas of the prostate which have cancer. Prostate Mapping is the only sure way of knowing that untreated areas do not have cancer within them.

Prostate mapping offers greater accuracy of 95% in cancer detection and correct Gleason score as well as giving accurate information about how much prostate cancer is present.

See Prostate mapping section
Prostate cancer treatment