Prostate cancer treatment

About treatment options for prostate cancer

Your treatment for prostate cancer will depend on:

your general health
your age
the risk group if you have early prostate cancer
the Gleason score and cancer grade
the stage of the cancer
your preferences.

Your doctor and nurse will talk to you about the different things to think about when making treatment decisions. They will explain the benefits and disadvantages of each treatment. How you feel about treatments and your preferences are a personal choice. Making treatment decisions can be difficult, but there is support to help you.

Multidisciplinary team (MDT) for prostate cancer

After your test results, you and your doctor start to talk about your treatment. Your doctor usually meets with other specialists to get their opinions too.

A team of specialists meet to talk about the best treatment for you. They are called a multidisciplinary team (MDT).

The MDT look at national treatment guidelines or the latest evidence for the type of cancer you have. If you have any treatment preferences, your doctor will tell them about this.

The MDT will usually include the following professionals:

Urologist – a doctor who treats problems with the prostate, kidneys, bladder and male reproductive system.
Surgeon (urologist) – a doctor who specialises in operating on the prostate.
Oncologist – a doctor who treats people who have cancer.
Clinical nurse specialist (CNS) – a nurse who gives information about cancer, and support during treatment.
Radiologist – a doctor who looks at scans and x-rays to diagnose problems.
Pathologist – a doctor who looks at cells or body tissue under a microscope to diagnose cancer.

The MDT may also include:

a physiotherapist
a dietitian
a counsellor or psychologist.

Treatments for prostate cancer

The main types of treatment for early stage or locally advanced prostate cancer include:

Surgery to remove the prostate (prostatectomy). This is usually done with keyhole surgery (laporoscopic) or robotic surgery.
External radiotherapy, which uses high-energy x-rays to destroy the cancer cells. You usually have this over a few weeks as an outpatient.
Internal radiotherapy (brachytherapy) which gives high doses of radiation directly to the prostate. It is often given as a boost with external radiotherapy. Brachytherapy may be given on its own for some early prostate cancers.
Active surveillance to monitor early prostate cancer with regular tests. It can help to avoid unnecessary treatment and side effects.
Hormonal therapy to reduce the amount of testosterone in the body. It is often given before and after radiotherapy. Hormonal therapy is sometimes given on its own to control the cancer if you do not want other treatments.
Watchful waiting is monitoring that does not involve regular tests or biopsies. If the cancer shows signs of changing or symptoms develop you usually start hormonal therapy.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is sometimes used to treat locally advanced prostate cancer that is harder to treat.

High-intensity focused ultrasound (HIFU) or cryotherapy are treatments that use heat or cold to destroy prostate cancer cells. These are less common treatments for early prostate cancer.

Prostate cancer risk groups and treatment

In prostate cancer, doctors offer treatments based on the risk group of the cancer using the Cambridge Prognostic Group system (CPG). Your doctor may still describe your risk as low, moderate or high.

CPG1 (low-risk prostate cancer)
This type of prostate cancer is very slow-growing. Sometimes it never causes problems. You and your doctor may talk about whether you need immediate treatment. This depends on the risk of the cancer progressing and how you feel about the benefits and disadvantages of treatment.

Not having treatment with surgery or radiotherapy may involve a certain amount of risk. To manage this your doctor may advise monitoring the cancer with active surveillance. They assess the risk of the cancer progressing using your:

biopsy

PSA level

scan results.
CPG 2 and 3 (intermediate-risk prostate cancer)

You usually have treatment with either external radiotherapy or prostatectomy straight away. If you have radiotherapy, you may also have brachytherapy. You also usually have hormone therapy before radiotherapy and for a few months after. Active surveillance (monitoring) may also be an option for some men in this group if they have some risk factors that are lower risk.
CPG 4 and 5 (high-risk prostate cancer)

You can have treatment with either a prostatectomy or radiotherapy. If you have radiotherapy, you may also have brachytherapy and hormonal therapy. You usually have hormonal therapy for 3 years. If you have a prostatectomy and your doctor thinks the cancer may not have been completely removed, they may advise having radiotherapy afterwards.

Making treatment decisions

You and your doctor decide on the right treatment plan for you. Your doctor is an expert in the best treatments. But you know your preferences and what is important to you.

You may find the online decision aid called Predict useful. It can be used to help you to choose between monitoring and treatment, such as surgery or radiotherapy.

When you make treatment decisions there are different things you may want to think about:

What your treatment preferences are and how their advantages and disadvantages will affect you. For example, you may prefer not to have surgery if you have heart problems. Or, if you have a bowel condition you may want to avoid radiotherapy.
How much side effects, such as erection difficulties, are likely to bother you. If active surveillance is suitable, you can avoid erectile dysfunction (ED). After surgery you are more likely to get ED straight away. With radiotherapy it may be less likely or take longer to develop.
Whether the cancer is very unlikely to cause you problems over your lifetime. If not, monitoring the cancer with active surveillance or watchful waiting may be more suitable for you.
What your treatment options would be if the cancer came back. You may be able to have radiotherapy after surgery. But it may not be possible to have surgery if you have already had radiotherapy.

Treatment effects on your sex life

The effects of treatment on your sex life and relationships may be a big concern for you. Your doctor and nurse will explain the likely effects of treatments on your sex life. You may worry about talking about your sex life with your healthcare team. But it is important to ask questions. There are different treatments and support available to improve sexual difficulties.

We have more information about prostate cancer and sex.

Fertility

Prostate cancer treatments can affect your fertility. If this is a concern for you, talk to your doctor or nurse. You may be able to store sperm before treatment starts.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online
Visit our cancer treatment forum to talk to people who have been affected by cancer, share your experience, and ask an expert your questions.

About our information

References

Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from www.esmo.org/guidelines/genitourinary-cancers/prostate-cancer

National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131). Last updated December 2021 to include Risk stratification for localised or locally advanced prostate cancer. Available at www.nice.org.uk/guidance/ng131

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.