A Wide Range of Treatments

The range of tests and treatments for prostate cancer has expanded massively in recent years as the result of collaborative world-wide research.

There are new pathology tests, new and highly sensitive imaging techniques, precise robotic surgery options, very accurate radiation techniques and equipment, and a rapidly widening range of new drugs that target different pathways of cancer development.

Watchful Waiting

For some men, particularly frail older men with major health issues, active treatment might not be appropriate. They will be regularly monitored and if symptoms develop (e.g., bone pain), treatment can be offered to manage these symptoms. The intent is to treat symptoms as they arise.

Active Surveillance

For men who have low-risk prostate cancer, active surveillance is an option. Men are regularly monitored by the Prostate Specific Antigen (PSA) test, digital rectal examination (DRE), MRI and occasional further biopsies. The results from these tests and procedures will show if the cancer has changed. If the disease progresses, they are offered primary treatment with intent to cure, usually by surgery or radiotherapy.

Surgery (Radical Prostatectomy)

The urologist may propose radical prostatectomy in cases of early-stage prostate cancer, for healthy men. The procedure aims to remove the cancer completely. It involves the surgical removal of the prostate gland, part of the urethra and the seminal vesicles. Pelvic lymph nodes may also be removed.

Radiotherapy

Radiotherapy should also be offered to men with early (localised) prostate cancer who are otherwise in good general health. Radiotherapy uses an external beam of high-energy x-rays to kill the accurately targeted tumour. Radio-oncologists deliver this treatment, which includes very detailed mapping to maximise the dose to prostate tissue while minimising collateral damage to adjacent organs..

• Brachytherapy is internal radiotherapy whereby the radiation source is precisely placed directly within the prostate gland, either as permanent seeds (‘low dose’) or as temporary needles (‘high dose’). This allows accurate high doses of radiation to be given, while the effects on nearby tissues such as the rectum and bladder are minimised.
• Radiopharmaceutical treatment is an emerging new systemic radiotherapy that attaches a radioactive element (e.g., lutetium) to a cancer-targeting molecule that fixes to the surface of prostate cancer cells. This treatment is delivered by a nuclear medicine specialist and is awaiting regulatory approvals.

Hormone Therapy

Androgen deprivation therapy (ADT), also known as hormone therapy, ADT is administered by a medical oncologist. ADT is a systemic form of treatment for advanced prostate cancer when disease has spread beyond the prostate. In this situation, these treatments are unlikely to cure the cancer but can keep it under control, often for many years. Radiotherapy and chemotherapy are also standard treatment options in combination with ADT.

Chemotherapy

Chemotherapy, ordered by a medical oncologist, involves the use of drug infusions to kill or slow the growth of cancer cells. Chemotherapy in combination with ADT may be offered as a first-line treatment for advanced disease, and / or during later stages of the journey. Most men can tolerate the side effects of this ‘taxane’ class of drugs quite well, especially when they are still fit.

Immunotherapy

Immunotherapy is an emerging treatment that can be used in specific cases indicated by gene testing.

Targeted Therapies

Targeted therapies such as PARP inhibitors are emerging treatments that are effective in other specific cases of aberrant genes.

• Complementary therapies are not used to treat cancer specifically but are sometimes used together with conventional treatments to help manage treatment side-effects, or to improve mental and physical wellbeing. You might read about complementary and conventional treatments being used together as ‘integrative medicine’.

Such therapies might include special diets, dietary supplements such as vitamins and minerals, meditation, yoga, acupuncture, and massage.

• Alternative therapies are those used in place of the conventional treatment options, e.g., using naturopathy or herbal medicine to treat your cancer instead of conventional care. You may come across many options for alternative therapies. These are currently considered to be scientifically unproven treatments (i.e., not evidence-based), but there are a number of men who claim to have gained benefits from them.

Before using any complementary or alternative therapies, you should talk to your doctor or other members of your healthcare team about all the possible risks and benefits. You can find further information on these treatments and their possible side effects on the Prostate Cancer Foundation of Australia website.

This material is also available as a free set of printed booklets that you can pick up at one of our regular monthly meetings.