If you have been diagnosed with cancer, the first thing you want to do is properly understand the severity of your diagnosis by knowing its grade and stage to determine the risk of the prostate cancer and figure out appropriate treatment options.
The staging tells us how much tumour is there and where it is. There are 4 different stages which depict how large the lumps are on the prostate. Stage 4 involves a tumour extending beyond the prostate into the lymph glands and bones.
The grade depicts how aggressive the disease is and the risk category is whether the cancer is low, moderate or high risk.
Choosing a treatment
The most appropriate treatment options for low risk prostate cancer involves active surveillance with ongoing PSAs, Biopsys and MRIs. This is the best option when it is unclear that a cancer will cause you harm so you can avoid the side effects of treatment. The aim of active surveillance is to avoid the side effects of treatment whilst the harm of the cancer is unclear. There is still a risk of disease progression during this stage so this must be considered before choosing this treatment as progression in some cases may be beyond cure.
A PSA Test measures the level of PSA in blood to monitor the progression of prostate cancer, a high PSA level would suggest the presence of cancer.
During a biopsy an ultrasound is placed into the rectum to visualise the prostate gland and a series of biopsies are taken, taking around 20 minutes.
An MRI uses magnet and radio waves to show whether the cancer has spread from the prostate to nearby areas
Focal therapy can also be undertaken where the cancer is treated by heating, freezing or electrical current, leaving the prostate in place. There is a low rate of side effects consisting of heat and cold damage to erections, continence, bladder and bowel function. Most cancers are multifocal, therefore incomplete treatment is common.
Treatment for moderate risk patients commonly involves observation with delayed treatment. We can control the prostate cancer through radiotherapy and chemotherapy or cure the cancer through robotic surgery.
Radiotherapy involves ionising radiation to treat the prostate and kill cancer. The best radiotherapy gives the highest dose to the cancer (effectiveness) and the least to the surrounding tissues (side effects). It doesn’t however kill all cancer and the disease can reoccur over the long term. It is also not possible to do surgery after radiotherapy, limiting its use for younger patients. There may also be other side effects include damage to tissue, bladder and bowel urgency, bleeding, irritation and pain. Most radiotherapy courses will run daily for 2 months and commence approximately 6 months after medication to block testosterone.
Chemotherapy involves using anti-cancer drugs injected into a vein or given orally to reach and kill cancer cells. It is particularly useful for prostate cancer if the prostate cancer has spread outside of the prostate gland. Chemo is given in cycles, often 2 or 3 weeks long, the length of treatment being based on what the side effects are and the treatment’s success rate. Common side effects of Chemo may include hair loss, nausea and vomiting, fatigue, diarrhea, loss of appetite etc.
Treatment for high risk patients is centred on curing the cancer through robotic surgery. Other treatment may also be needed before or after surgery such as radiotherapy or chemotherapy.
Radical prostatectomy is recognised as the most successful treatment for localised prostate cancer as cure rates are the highest for any treatment.
The surgery removes the prostate to cure the disease, even if the cancer extends beyond the prostate.
Radical prostatectomy is a type of keyhole surgery that improves results using a magnified view and precise instruments. It involves small incisions made on the abdomen and long robot instruments being placed inside the abdomen to remove the prostate.
It usually involves a 1-2 night hospital stay and one week catheter time.
There is a shorter recovery, faster return to work, less blood loss and less pain compared to open surgery.
Robotic radical prostatectomy is a very low risk procedure with complication rates less than one in 500, however all surgeries carry side effects and risks.
Side effects can include a period of incontinence which depends on the grade of cancer, the size of your prostate gland and anatomy. A significant improvement in continence will be observed within the first 6 weeks.
Erectile dysfunction is also expected post surgery but we have a number of treatment options available for you by our nurses and physiotherapists. For men with good erections before surgery, they will be regained although this can take over 12 months.
Specific problems may also include port side bleeds (1 in 200), ureteric injury (1 in 1000) and rectal injury (1 in 1000).
1 Yr Later
Indefinite period of observation.
1-2 days. Back to work in 1-3 weeks.
8 months combined medical and radiotherapy treatment. Daily radiotherapy for 2 months.
Short, day surgery. Rapid recovery.
MRI, PSA and repeat biopsies
Most patients recover previous sexual and urinary function. Others treated.
Less than 40% of men recover testosterone. Sexual, urinary and bowel problems can worsen late.
20% incomplete treatment rate at 1 yr
No side effects from treatment, but increased risk of bone metastases and death.
Highest chance of living beyond 10 yrs
Increased risk of late failure. Lower survival rate than surgery. Small risk of a radiation induced cancer.