Treatment choices

WHAT ARE THE TREATMENTS FOR PROSTATE CANCER?

Surgery

Surgery usually involves removal of the prostate gland and some surrounding tissues (known as prostatectomy). Surgery is generally used for localised prostate cancer, when the cancer is contained in the prostate gland.

Radiotherapy

This treatment is given by external radiation beams or radioactive implants (brachytherapy). Radiotherapy can be used in:
· In localised prostate cancer, when the cancer is contained in the prostate gland
· In locally advanced prostate cancer when the cancer has spread into the capsule of the prostate or through the prostate into the surrounding tissues
· In advanced prostate cancer when the cancer has spread out to other parts of the body, palliative radiotherapy may be given to particular areas, which cause pain.

Hormone therapy

Most prostate tumours are stimulated by androgens (male hormones); so inhibiting this androgen stimulation generally results in shrinkage of the tumour.

The original treatment for prostate cancer was surgical castration (orchidectomy), which implies removing the testes, and halts androgens production.

There are two main types of medicines used in hormone therapy for prostate cancer:

1. Luteinising Hormone-Releasing Hormone Agonists (LHRHas)

e.g. Zoladex®(goserelin), Prostap®(leuprorelin) and Decapeptyl®(triptorelin)
· LHRHas block the production of androgens from the testes (medical castration)
· LHRHas are administered by injection.

LHRHa tolerability is as expected for castration therapy, the main adverse events being hot flushes, decreased potency, and loss of bone mineral density.

2. Anti-Androgens

e.g. Casodex®150mg(bicalutamide), Casodex®50mg(bicalutamide), Drogenil® (flutamide) and Cyprostat®(cyproterone)
· Anti-androgens attach themselves to receptors on the surface of the cancer cells preventing androgens from stimulating growth
· Anti-androgens are administered in a tablet formulation.

Despite the most common side effects seen with anti-androgens including breast tenderness, breast swelling and diarrhoea, Casodex (bicalutamide) when copmpared to castration can show some improvements in quality of life benefits related to maintained sexual function, physical energy and strength. It has also been demonstrated that Casodex (bicalutamide) helps patients retain bone mineral density and physical capacity.

Hormone therapy can be used:
· In localised prostate cancer, when the cancer is contained in the prostate gland. LHRHa (goserelin the only LHRHa licenced for localised prostate cancer)9 can be used alongside surgery, external bean radiotherapy or brachytherapy (implanted radioactive seeds) or alone as your treatment choice
· In locally advanced prostate cancer when the cancer has spread into the capsule of the prostate or through the prostate into the surrounding tissue, some anti-androgens and LHRHas (goserelin the only LHRHa licenced for locally advanced disease) 9 can be used either alongside radiotherapy or alone
· In advanced prostate cancer when the cancer has spread out to other parts of the body, all LHRHas can be used alone or in combination with an anti-androgen (this is called maximum androgen blockade MAB) or alongside radiotherapy to ease pain
· Sometimes hormones can be used prior to radiotherapy and surgery to reduce the size of the tumour.

Watchful Waiting

The progression of the tumour will be monitored by regular PSA tests and digital rectal examination, but no active treatment will be given until symptoms become troublesome.

Active Surveillance

In early prostate cancer (also called localised), this involves close monitoring of patients and tends to be aimed at younger, fit gentlemen. If patients show any signs of progression in their disease radical treatment would be considered.