Prostate cancer: choosing a treatment

Nurse and Health Coach at Bupa UK
06 March 2017

If you’ve just been diagnosed with prostate cancer, you might be overwhelmed by the number of treatment options you have to choose from. So making a decision about how to treat it can add confusion to what’s already an emotional situation. But you’re not alone. There are people you can talk to and resources available to help you choose what’s right for you and your situation.

What treatment options are available?

The treatments that are available to you will depend of a few things, but mainly on whether your cancer is:

  • localised – within your prostate gland
  • locally advanced – spread outside of your prostate to the surrounding tissues
  • metastatic – spread further from your prostate, to your lymph nodes, bones and other parts of your body

The list below highlights some of the available treatments with a brief overview of each one. There are some great resources available online to help you find out more about each one. Prostate Cancer UK is a good place to start.

An image showing the position of the prostate gland and surrounding structures

  • Active surveillance – this is a way of monitoring prostate cancer that hasn’t spread outside of your prostate.
  • Watchful waiting – this is a way of monitoring prostate cancer that isn't causing any symptoms or problems. So you avoid treatment until you start to experience symptoms.
  • Radical prostatectomy – this is an operation to remove your prostate gland and the cancer contained inside it.
  • External beam radiotherapy – this involves directing high-energy X-ray beams at your prostate gland from outside your body. The cancer cells can’t recover from the damage and die, but healthy cells will repair themselves.
  • Permanent seed brachytherapy – this is where tiny radioactive seeds are implanted in your prostate gland. Radiation from these ‘seeds’ destroys the cancer cells in your prostate.
  • Hormone therapy – this works by stopping your brain from telling your body to make the hormone testosterone and stopping it testosterone from reaching the cancer cells.
  • High dose-rate (HDR) brachytherapy – this is a type of radiotherapy where radiation is passed through tubes into your prostate for a few minutes. The source of radiation is removed so none is left in your body. Because the radiation is put directly into the prostate, healthy tissue nearby has less chance of being damaged.
  • High-intensity focused ultrasound (HIFU) – this is a kind of ultrasound which heats and destroys the cancer cells in your prostate. A beam of ultrasound energy travels into your prostate from a probe put into your back passage (rectum).
  • Cryotherapy – this treatment uses extreme cold to freeze and destroy cancer cells. Thin needles are inserted into your prostate and a gas is passed down to freeze it and kill the cancer cells.
  • Chemotherapy – this uses anti-cancer drugs to kill prostate cancer cells. It doesn’t get rid of prostate cancer but aims to shrink and slow its growth.

How do I make a decision?

Your doctor may explain to you that there’s more than one treatment you can choose from. Each treatment will have its own risks and benefits, as well as affecting your quality of your life. Making a decision like this by yourself can be daunting. So it often helps to talk with your family and friends and even men who have been in the same situation as you. Macmillan Cancer Support and Prostate Cancer UK have great online forums where you can ask questions, share experiences and offer support to others in similar situations.

A healthcare specialist, such as myself, can also help guide you through the decision making process using specific decision making tools. They help you work out what your needs are and what’s important to you. This can then help you when you’re having a conversation with your doctor. Generally, we try to cover the following three areas.

  • Explore – this helps us discover more about where you are in your decision making process. We can get an idea of how you’re feeling about making this decision. As well as this, we can find out what information you have about the treatment options available to you and which treatments you’re leaning towards. Once we know this, we can look at your goals and how involved you want to be in making the decision.
  • Identify – we also discuss how much you know about your treatment options and if you understand the benefits and risks of each of them. From here, we can help you determine which benefits and risks are most important to you. This could be by assigning a value to each benefit and risk. Feeling supported during the process is extremely important so we’ll look at what support you have in place once you’ve made a choice.
  • Impact – you can now start to plan your next steps based on your knowledge, values and the support network you have in place. This could mean, getting additional information, having conversations with trusted people and finding help to support your choice.

Working through your decision in a logical way like this can help to remove some of the confusion because you’re identifying what’s important to you. You can then plan your next steps appropriately. Many men worry about choosing the “wrong” treatment but there’s often no one right answer. That’s why it’s important to take your time, speak to your family and health professionals and choose the option that’s right for you.

For pro-active healthcare that’s part of your health insurance benefits, learn about our Treatment options service.

Christine Thomasson
Nurse and Health Coach at Bupa UK

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