Treatment options

There are several ways that prostate cancer can be managed and treated. These include:1

  • Watchful waiting
  • Active surveillance
  • Radiotherapy
    • External beam radiotherapy (EBRT)
    • Stereotactic Body radiation therapy (SBRT)
    • Brachytherapy (interventional radiotherapy)
  • Surgery
  • Chemotherapy
  • Hormone therapy

The types of treatment you receive will depend on how far the cancer has progressed.

You can find out more about the progression and stages of prostate cancer in the introduction section.

The table below provides a broad overview of the different treatments.1 Each treatment has advantages and disadvantages. These should be considered and discussed with your healthcare professional when choosing the most suitable treatment options for you.

Treatment Low risk Medium risk High risk

Watchful waiting

If the cancer is thought to be unlikely to progress during a patient's natural lifespan, treatment is avoided unless the cancer starts to advance. This approach may be offered to older men or those with other serious illnesses. However, for most other men, active surveillance or a form of treatment (see below) are more common options.

Active surveillance

If the cancer is not causing any health problems, immediate treatment may not be required. In these circumstances you can undergo regular check-ups. If tests start to indicate that the cancer might progress, treatment can start straight away.

Brachytherapy (interventional radiotherapy)

Works by precisely targeting the cancerous tumor. The source of radiation is placed directly next to the tumor.

External beam radiotherapy (EBRT)

The source of radiation is directed at the tumor from outside of the body.

Stereotactic body radiation therapy (SBRT)

This is a special type of EBRT that is irradiated with a high radiation dose of 4-5 fractions (compared with a standard 45-day course of radiation therapy).

Surgery (prostatectomy)

Removal of the prostate and surrounding tissues.

Hormone therapy

Treatment to remove hormones or block their action and stop cancer cells from growing. Hormone therapy is usually given in addition to another treatment. Androgen deprivation therapy (ADT) is an example of hormone therapy.

Chemotherapy

A course of chemotherapy may be recommended in addition to surgery and/or radiotherapy. Several pharmaceutical products are effective and your doctor will be able to advise the best one for you.

Advantages and disadvantages of prostate cancer treatments

Treatment Advantages Disadvantages

Watchful waiting

Avoids unnecessary investigations and treatment if the cancer is unlikely to progress during a patient's natural lifespan.2

If the cancer progresses, the available treatment options may be limited.2

Active surveillance

Regular monitoring means treatments can start immediately, if required.2

Some patients may feel concerned that the cancer will spread if actual treatment is not being received.2

Brachytherapy (interventional radiotherapy)

Reduced risk of unnecessary damage to surrounding healthy tissues and organs, which reduces the chance of side effects.3,4,5

Clinically proven to be highly effective.3,4,5

Minimally invasive technique.3,4,5

Short treatment times – the procedure can be completed within two hours.3,4,5

Short recovery time.3,4,5

Can be used in combination with other treatments.3,4,5

May require more than one visit to the hospital depending on the procedure.3,4,5

External beam radiotherapy (EBRT)

Clinically proven to be highly effective.2

Short recovery time.

Can be used in combination with other treatments.

Increased chance of some long-term side effects compared with brachytherapy, as the radiation passes through healthy tissues.2

Longer treatment times than brachytherapy.2

Stereotactic body radiation therapy (SBRT)

Clinically proven to be highly effective with a similar outcome to brachytherapy.6,7,8

Short recovery time.

Can be used in combination with other treatments.6,7,8

SBRT is often claimed to be shorter than brachytherapy. However, HDR brachytherapy can be done in 2 sessions, very convenient for patients. SBRT can take up to 7-8 visits to complete.9

Surgery (prostatectomy)

Clinically proven to be highly effective.2

One-time procedure.

Increased chance of some long-term side effects compared with brachytherapy.2

Invasive technique.

Longer treatment and recovery times than brachytherapy.2

Hormone therapy

Can be used in combination with other treatments.2

Does not provide a cure.2

Chemotherapy

Can be used in combination with other treatments.

Depending on the pharmaceutical product, outpatient treatment is possible.

Depending on the pharmaceutical product, a stay in hospital may be required.

References

  1. National Cancer Institute. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq . Accessed June 2021
  2. National Cancer Institute. Available at: https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq Accessed June 2021
  3. Grimm P et al. BJU Int 2012;109(1):22-9. Available at: https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.2011.10827.x Accessed June 2021
  4. Mottet N et al. Eur Urology 2017;71(4):618-29. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0302283816304705?via%3Dihub Accessed June 2021
  5. Morton GC at al. Clin Oncol 2020;32(3):163-9. Available at: https://www.clinicaloncologyonline.net/article/S0936-6555(19)30491-1/fulltext Accessed June 2021
  6. Miralbell R. Lancet Oncol 2019;11:471-472. Available at: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30652-7/fulltext Accessed June 2021
  7. van Dams R et al. Int J Radiat Oncol Biol Phys 2021. Available at: https://www.redjournal.org/article/S0360-3016(21)00068-7/fulltext . Accessed June 2021
  8. Gonzales-Motta A et al. J Clin Oncol 2018;36(6 suppl). Available at: https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.6_suppl.12 Accessed June 2021
  9. Folkert M. Intermediate-risk prostate cancer: SBRT/SAbR vs brachytherapy. Proceedings of the ASTRO 2020 Annual Meeting, Oct 2020