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Learn more about the options available after a diagnosis of Prostate Cancer
What is Hormone Therapy and how can it help?
Hormone Therapy is a cancer treatment which uses hormones to slow or stop the growth of cancer. Hormone therapy can also be called, ADT (Androgen Deprivation Therapy).
The hormone testosterone fuels prostate cancer growth which is why the drugs used in hormone therapy can help as it prevents the testicles from producing testosterone.
Sometimes the drugs used in hormone therapy can fail to control the growth of cancer cells, as they become ‘hormone resistant’ or ‘castrate resistant’. This happens because other areas in the body produce testosterone, or the tumour develops the ability to also produce its own testosterone. If this occurs, the standard hormone therapy becomes less effective, and the PSA level will start to rise.
If this happens, other treatments can be used in addition to conventional hormone therapy. These are called ‘Novel Hormonal Agents’ or NHAs.
Abiraterone works by reducing testosterone production. It has a different way of doing this to normal hormone therapy and can therefore affect all areas of testosterone production, including that made by tumour cells themselves.
Enzalutamide, Darolutamide and Apalutamide all act by blocking the action of testosterone on the cancer cells (Androgen receptor blockers).
Bicalutamide is an older NHA. It is most used at the start of hormone treatments such as Zoladex where there can be an initial surge in testosterone before it is reduced.
The team looking after you will decide which drug is best for you depending on the stage of your cancer and other medical conditions that might be present.
Radiotherapy aims to destroy the prostate cancer cells without damaging too many healthy cells. It can be used to treat localised prostate cancer (cancer that’s inside the prostate), locally advanced prostate cancer (cancer that’s in the area just outside the prostate) or advanced prostate cancer (cancer that has spread to other areas of the body).
The area to be treated is carefully assessed and planned before treatment starts. Your doctors will study the size and site of the cancer and try to give a full dose of radiation but without damaging the surrounding areas. However, some problems and side effects can still occur.
External Beam Radiotherapy uses a machine to produce X-ray beams. Although it looks like a normal X-ray machine, the head rotates and the power and shape of the beams can be altered to specifically target the prostate cancer. EBR is also used to treat the whole prostate, to ensure that even the smallest of cancers that might not show up in the scans are treated.
Around 20 daily sessions are usually needed, however longer or shorter treatment cycles can be used depending on the size and position of the tumour.
Side effects can occur so if you start to see anything abnormal do speak with your radiographer supervising your radiotherapy or it might be useful to chat with your local support group members, who have also gone through radiotherapy.
Low dose-rate Brachytherapy / Permanent seed brachytherapy: This involves implanting small radioactive seeds in the prostate gland. These remain permanently inside the prostate and their radioactivity is released over a relatively long treatment time. The seeds remain permanently in the patient.
High dose-rate (HDR) brachytherapy: this can also be called temporary brachytherapy. Highly radioactive sources are inserted into the prostate for a brief period under general anaesthesia and then removed.
Brachytherapy is often suggested when the tumour is relatively small and well contained within the prostate capsule. The potential for side effects is lower than with EBR.
Both external beam radiotherapy and brachytherapy may be used one after another. This is known as ‘Brachtherapy Boost’ therapy.
Cryotherapy is a treatment that uses the extreme cold to freeze and destroy cancer cells. It could also be called cryosurgery or cryoablation.
This uses high-frequency ultrasound energy to heat and destroy cancer cells in the prostate.
Although both of these treatments have a potential for producing side effects such as incontinence and erectile dysfunction, these appear to be much less because the treatments can be more easily localised to the area of tumour only. These therapies may not always be available to the NHS.
Radical Prostatectomy is offered to those who have localised prostate cancer (where the cancer hasn’t spread outside the prostate) and aims to remove the whole prostate and the prostate cancer cells inside it. This is a major operation which requires a general anaesthetic, where your overall age, health, fitness and whether you’re taking other medications will be carefully assessed. It is likely that you will be in hospital for only two days.
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Prostate cancer can be slow growing and therefore not cause any problems or symptoms. Patients with a low-risk disease may be recommended to have their prostate cancer monitored over time to avoid dealing with the side effects that radical treatments can have.
Each type of monitoring is recommended depending on how far the prostate cancer has spread, so it’s important to check with your doctor / GP to see which is right for you.
This is a way of monitoring localised prostate cancer that is slow growing. It aims to delay or avoid any treatment that might be unnecessary and the side effects that can occur. Regular intensive monitoring aims to pick up progression of the cancer early so that radical treatment can be commenced in good time.
This is normally suggested for men whose cancer may never cause any problems during their lifetime, or who have other health problems and might not be suitable for radical treatment. This will involve fewer check-ups than active surveillance. Treatments will be aimed at controlling the cancer rather than attempting to cure it.
Monitoring the progress of your cancer during and after treatment will firstly be based on measuring your PSA levels on regular intervals. A rise in PSA may indicate that your cancer needs further treatment. In addition, you maybe advised to have further scans.
Chemotherapy is used to treat advanced prostate cancer (cancer that’s spread beyond the prostate to other parts of the body). It uses anti-cancer (cytotoxic) drugs to kill the cancer cells, wherever they are in the body.
Chemotherapy can either be used as a first treatment or as further treatment for advanced prostate cancer. This depends on the severity of your prostate cancer and/or whether your body has responded to other treatments (such as hormone therapy) as effectively as hoped.
It can help some men live longer, improve or delay certain symptoms. If your doctor thinks you will benefit from chemotherapy, they will do some tests to make sure it’s suitable for you.
Chemotherapy may cause significant side effects such as immune system and bone marrow suppression. Severe infections and anaemia can be a problem. Some patients feel very fatigued and generally unwell during treatment. Very elderly and patients with other co-existing problems may not be able to tolerate chemotherapy. Other drug options such as abiraterone and enzalutamide may be used in place of chemotherapy.
Monitoring the progress of your cancer during and after treatment will firstly be based on measuring your PSA levels on regular intervals. A rise in PSA may indicate that your cancer needs further treatment. In addition, you maybe advised to have further scans.
If the cancer has spread to the bones, bisphosphonates are used to slow down the breakdown of the bones. Although it doesn’t treat the cancer itself, they can help relieve bone pain. Patients on long-term hormone therapy are also at risk of thinning of the bones and bisphosphonates may be used to prevent this.
We’ve curated a collection of resources to help you learn more about Prostate Cancer and what you can expect through the process from diagnosis to treatment and beyond.
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