Treatment options for prostate cancer part 3

Treatment options for locally advanced prostate cancer

When
the cancer has spread into the capsule of the prostate or into the
surrounding tissues near to the prostate then it is called locally
advanced prostate cancer.

You may be offered hormone treatment
with radiotherapy. The radiotherapy given is usually similar to that
given for men with early prostate cancer although the radiotherapy may
include the surrounding structures in addition to the prostate. Some
men just receive hormone treatment. As the choice of treatment depends
on many factors, your doctor will discuss the treatment with you in
more detail.

Hormone treatment

Prostate cancer cells need
the male hormone called testosterone to grow and multiply well.
Testosterone is made in the testes and circulates in the bloodstream.
Hormone treatments aim to stop you from making testosterone or to block
the effect of testosterone on prostate cancer cells. Hormone treatments
do not cure prostate cancer but may greatly slow down the growth of the
cancer for a number of years.

Two groups of drugs are available:

• Drugs
  which work on the pituitary gland. For example: goserelin and
  leuprorelin. (Your pituitary gland makes a hormone which circulates in
  the bloodstream to stimulate the testes to make testosterone. These
  drugs stop your pituitary from making this stimulating hormone.) These
  drugs are given by an injection.
• Drugs which block the action of testosterone (anti-androgen drugs).
  For example: flutamide and cyproterone acetate. These drugs are tablets.

Hormone treatments can cause side-effects such as erectile dysfunction (impotence), hot flushes, sweating and other problems.

Treatment options for late or advanced prostate cancer

Late
or advanced prostate cancer is when the cancer has spread to other
parts of the body. Hormone treatments are usually given as the cancer
cells in other parts of the body still need testosterone to grow and
multiply.

Another type of hormone treatment which may be offered
is surgical removal of the testes (orchidectomy). Without testes you no
longer make testosterone.

You may decide not to start hormone
treatment until you develop symptoms. Your doctor will be able to
discuss the timings of treatments with you in more detail.

Chemotherapy

Chemotherapy is a treatment of
cancer by using anti-cancer drugs which kill cancer cells, or stop them
from multiplying. See separate leaflet called 'Chemotherapy'
for more details. Chemotherapy is not commonly used for the treatment
of prostate cancer. It may be used for more advanced cancers.

Radiotherapy

Even if the cancer is advanced
and a cure is not possible, radiotherapy may have a place to ease
symptoms. For example, radiotherapy may be used to shrink secondary
tumours which have spread to bones and are causing pain.

Watchful waiting

In some cases it may be
best not to have any active treatment but to see how the cancer
develops. This is called 'watchful waiting'. Various factors are taken
into account such as the stage of the cancer, your age, general health,
the impact and potential side-effects if treatment were to be used.
Watchful waiting may be more appropriate for men where the cancer is
not causing much in the way of symptoms, is slow-growing, especially in
older men. With a watchful waiting approach you will still have regular
check ups and the decision about treatment can be reviewed at any time.

Newer treatments

Cryotherapy (also known as
cryosurgery) is an alternative treatment for men with early prostate
cancer. It is not yet available in all hospitals in the UK. It involves
placing a number of metal probes through the skin and into the affected
area of the prostate gland. The probes contain liquid nitrogen, which
freezes and destroys the cancer cells.

High intensity focused
ultrasound (HIFU) treatment may be offered to some men, again with
early prostate cancer. As this is still a relatively new procedure, it
is not yet available in all hospitals in the UK. HIFU involves
inserting a probe into the rectum. It is then pushed through the wall
of the bowel into the prostate gland. The probe produces a high-energy
beam of ultrasound which then heats and destroys the cancer. The probe
is surrounded by a cooling balloon to protect the normal prostate
tissue from damage.