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What treatments are there?

The treatment depends on where the cancer is, how big it is, whether it has spread anywhere else in the body and the patient’s general health.  Treatment options depend on the extent of the cancer as well as the patient’s age and fitness.


Active surveillance or watchful waiting:  As some prostate cancers grow very slowly and may take many years to show symptoms or spread, certain men diagnosed with prostate cancer may not need immediate treatment.  Active surveillance refers to the strategy of closely observing patients with low-risk localised prostate cancer, while keeping the option of deferred curative treatment open.


Surgery:  An open or robot-assisted radical prostatectomy may be recommended if the tumour is localised at the prostate.  It involves the complete removal of the prostate, which often includes the pelvic lymph nodes.  This procedure is commonly used to treat prostate cancer in its early stages.  The possible side effects of radical prostatectomy include incontinence (not being able to control urination) and impotence (not being able to have an erection). These side effects may also occur with other forms of treatment for prostate cancer.


Radiotherapy:  Radiotherapy uses high-energy beams to kill cancer cells or prevent them from growing.


Hormone (Androgen Deprivation) Therapy:     Hormonal therapy is commonly used to treat prostate cancer when it has spread or is used in combination with radiotherapy when the cancer is locally advanced or at high-risk.  Hormonal therapy can slow or stop the growth and spread of prostate cancer by interfering with the effects of male hormones on prostate cancer.

There are two ways:  Surgical or medical castration.  Surgical castration removes the testes, which produces 95% of the body’s androgens (male sex hormone).  An alternative to surgery is medical castration using Luteinising Hormone-Releasing Hormone (LHRH) analogs such as leuprolide and goserelin.


Surgical or medical castration cannot completely block the production of androgens in the body.  Androgen biosynthesis inhibitor such as abiraterone acetate blocks androgen production by inhibiting CYP17, an enzyme that converts cholesterol to androgens in the testes, adrenal gland and prostate tumours.


Antiandrogens like flutamide, bicalutamide and enzalutamide can also be used to block the binding of androgens to androgen receptors which drive prostate cancer growth.  


Chemotherapy:  Chemotherapy uses drugs to stop the growth of cancer cells either by killing them or stopping them from dividing.  Chemotherapy is generally given to patients at an advanced or metastatic stage of prostate cancer when they are no longer responsive to hormonal treatment.  It won’t cure prostate cancer but it will shrink and slow its growth.  Chemotherapy may cause side effects such as nausea, hair loss (alopecia), inflammation of the cheeks, gums, tongue, lips, and roof or floor of the mouth (stomatitis), and an abnormal blood profile that could increase the risk of infection.

What is prostate cancer?