This where patients defer curative treatments such as surgery or radiotherapy until there is evidence of actual tumour growth such as rising PSA, new lumps on digital rectal examination or repeat biopsy.
Close monitoring is required (3-6 monthly PSA and 6-12 month REPEAT BIOPSY) This option may be more suitable for patients with:
- Low grade low stage cancer
- Low PSA which can be easily monitored
- Sexual function or continence are major priorities
- Motivated patients able to comply with close PSA follow up and repeat prostate biopsies
- Older age
Where patients choose to OBSERVE their disease AND intervene with treatments such as hormone therapy IF AND WHEN THEY DEVELOP SYMPTOMS such as pain
This the surgical removal of the prostate. It is use to treat localised prostate cancer in men who are fit and well and >10year life expectancy when their age and other illness are taken into account. The main side effects that may arise are Potential incontinence and impotence.
Laparoscopic radical prostatectomy is the keyhole removal of the prostate using special instruments passed through small incisions or “keyhole” into the abdomen. Potential Advantages over traditional open surgery may include, decreased blood loss & risk of transfusion, less postoperative pain medication requirements and decreased wound complications Robotic Assisted Radical Prostatectomy is the use of a robotic device guided by the surgeon to hold the key hole instruments. Advantages over traditional open surgery include shorter hospital stay, less blood loss, less pain medications required in some studies.
Low Dose Rate (Seed) Brachytherapy is radiotherapy delivered from within the prostatenusing tiny radioactive seeds. It has equivalent survival outcomes to surgery in the short term and has benefits including convenience for patients, high potency rate (~50 – 75%), incontinence & rectal side effects are rare. It may have some complications seed migration, urethritis and retention. It is only suitable for some patients with appropriate tumour and prostate features.
High Dose Rate (Rods) Brachytherapy involves the placement of needles into prostate and through which highly radioactive rods are passed for very short periods into the prostate by an automated system. May be given in combination with hormone therapy and external beam radiotherapy. It is generally reserved for the higher risk and more aggressive cancers.
External Beam Radiation Therapy has the advantage of being a non invasive treatment. It generally runs for a period of 7 – 8 weeks of daily treatment using multiple beams of radiation. There are risks of late bladder and bowel side effects. Technological improvement is allowing better targeting of prostate with reductions in side effects. It is of particular usefulness when there is a high likelihood of spread locally outside the prostate.
- Individualised treatment is vital as one size does not fit all
- Multidisciplinary care
- Patient centered approach
- Patient empowered with information and time to make informed choices