Treatment for Prostate Cancer Part 2

Radical prostatectomy

In radical prostatectomy, the prostate gland is usually removed through a cut in the abdomen or the skin between the testicles and the rectum. This is a big operation, but it can cure cancer that has not spread from the prostate gland.
Some doctors use keyhole (laparoscopic) surgery to remove the prostate gland through a smaller cut in the skin. Research suggests that this type of surgery is as good at removing the prostate gland as surgery that uses a larger cut. There is less bleeding and pain, and it requires a shorter stay in hospital. But its effectiveness in the long term is not known, and it isn’t available in all hospitals.

The main side effects of radical prostatectomy can include erectile dysfunction, urinary incontinence (when you can’t control when you pass urine) and infertility. You can read more about this treatment.

Steroids

Steroid tablets are recommended by NICE when hormone therapy no longer works (hormone-refractory cancer). The most effective steroid treatment, which is measured by PSA levels, is dexamethasone, but prednisolone and hydrocortisone may also work.

Chemotherapy

Chemotherapy is mainly used to treat prostate cancer that has spread to other parts of the body (metastatic prostate cancer) and is not responding to hormone therapy.

Chemotherapy destroys cancer cells by interfering with the way in which they multiply. Chemotherapy does not cure prostate cancer, but it keeps it and the symptoms (such as pain) under control, so that the person’s everyday life is less affected.

The main side effects of chemotherapy are caused by their effects on healthy cells, such as immune cells. They include infections, tiredness, hair loss, sore mouth, loss of appetite, nausea and vomiting. Many of these side effects can be prevented or controlled with other medicines that your doctor can prescribe for you.

The drug that is used most often in chemotherapy for prostate cancer, and which NICE has approved, is docetaxel (brand name Taxotere). This is put into a vein once every three or four weeks, up to 10 times. Each treatment takes about an hour. Docetaxel is often given with the steroid. You will find more details in the recommended reading: Management of Prostate Cancer.

Cryotherapy

Cryotherapy is a new method of killing cancer cells by freezing them. It is still undergoing clinical trials because of uncertainties surrounding it. It is sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate gland. Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum. They freeze the prostate gland and kill the cancer cells, but some normal cells also die. The aim is to kill cancer cells while causing as little damage as possible to healthy cells. The main side effects of cryotherapy include impotence, urinary symptoms and rectal problems. More details in the recommended reading: Management of Prostate Cancer.

High intensity focused ultrasound (HIFU)

HIFU is sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate. HIFU is a new treatment still going through clinical trials, and is not widely available. An ultrasound probe put into the rectum releases high-frequency sound waves (which cannot be heard by humans) through the wall of the rectum. These sound waves kill cancer cells in the prostate gland by heating them to a high temperature. The main side effects of HIFU are impotence, urinary symptoms or fistula – an abnormal connection (fistula) between the urinary system and rectum. In a small number of men (about 1–3%), an abnormal connection occurs between the rectum and the urethra (which carries the urine down to the penis).

Radioisotope therapy for bone metastases

Men with cancer that has spread (metastasised) to the bone may be offered a radioactive ‘isotope’ such as strontium-89 or samarium-153. These are given by an injection into the veins, and are particularly absorbed where prostate cancers have spread to bone. Strontium improves pain control and prevents new sites of pain, but it may interfere with some forms of chemotherapy. Samarium is also effective, but is more difficult to give.

Therapies and palliative care

Many men feel anxious, depressed, angry or frustrated when they are diagnosed with prostate cancer and sometimes during treatment. They and their family and friends are likely to feel especially sad if their treatment doesn’t work, or they relapse and their cancer spreads. They can also feel very down about some of the side effects of treatment, with some feeling that they are ‘less of a man’.

Talking to a counsellor or psychologist can help you and your family feel less worried and sad, and they can also help you deal with financial and other practical matters. You can ask for this type of help at any stage during your treatment. Some men find that a course of antidepressant drugs may help to relieve depression.

Alternative and complementary therapies, such as acupuncture, homeopathy, reflexology, massage, aromatherapy, relaxation and visualisation techniques do not cure or control prostate cancer. Some people say they make them feel better and more able to deal with their cancer, but some doctors question the evidence.

Men with advanced prostate cancer may need treatment for pain and other symptoms they get as their cancer progresses. This is called palliative care, and is provided by doctors, nurses and other members of the palliative care team. You can have palliative care at home, in hospital or in a hospice or other care centre. Your needs are likely to change with time, and it is important that someone from the palliative care team is in charge of your care so that it is available whenever and wherever you need it.

As part of palliative care you may be prescribed:

Painkilling drugs (analgesics). These drugs relieve pain caused when the cancer presses on nerves or other tissues or spreads to your bones. There are many different drugs available, and your palliative care team should be able to find the right drugs that can control your pain without causing too many side-effects.
Bisphosphonates. These can relieve pain from prostate cancer that has spread to your bones, and slow down further bone damage. It is not known for certain that these drugs work, so they tend to be used only when other treatments are not helping. NICE recommends them only for bone pain that does not respond to other forms of treatment.

You may also have radiotherapy to control bone metastases (cancer that has spread into your bones).

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