PSA North of England makes every effort to ensure that this website reflects up-to-date, objective and accurate facts about prostate cancer. It is our hope that these will complement your medical advice and help you to make any decisions that you may face. The information provided on this website is designed to support, not replace, the relationship that may exist between you and your doctor.
What is Prostate Cancer?
Your body is made up of millions of cells which continuously renew themselves to replace old or damaged tissue. When the renewal process gets out of control and begins to invade healthy tissue it is called cancer.
Cancers are described as ‘malignant'. Other words for cancer are tumours and neoplasms. Sometimes cancer cells can break away from the original site and settle in other parts of the body causing further damage. When this happens the cancers that have spread are called ‘metastases or ‘secondaries'.
What and where is the prostate?
The prostate is a gland found only in men and is just below the bladder. When you pass urine it flows through a tube (urethra) and out through the penis. The urethra has to pass through the prostate before reaching the penis. This is why some men have problems with urinating when they have an enlarged prostate.
Can Prostate Cancer be cured? Can anything be done?
If detected at an early stage, prostate cancer can be relatively straightforward to treat and there is a good chance that it can be dealt with once and for all. Prostate cancers are not the same in all men. Some are fast growing and spread quickly others grow very slowly. Several different treatment options may be open to you.
I need to talk to someone!
Our confidential helpline 0161 474 8222 is manned from 9am-9pm 365 days per year. We are waiting to take your calls and listen to your concerns.
What treatment is there?
There are many treatments. You should discuss the options with your Consultant/doctor.
Some of the treatments are as follows:-
Surgery (radical prostatectomy)
The whole prostate is removed with the seminal vesicles, the deferent canals(conducting the sperm), part of the bladder neck and the surrounding lymph nodes.
At the early localized stage (stages T1 & T2 see below), the radical prostatectomy is the reference treatment. This surgical intervention is complex(general anesthesia for 3 to 4 hours).
External radiotherapy
This treatment involves the use of very high energy rays directed at the prostate gland. Radiotherapy does not require anesthesia, and the treatment is usually done during a regular hospital visit: patients are usually treated five days per week in an outpatient center over a period of four to eight weeks, with each session lasting a few minutes.
Brachytherapy
Standard Brachytherapy
During this technique 50 - 150 radioactive seeds are implanted directly into the prostate gland through the perinea using 20 - 40 needles. This is done under general anesthesia (2 to 3 hours). It is recommended that the patient avoid close contact with children and pregnant women for two months after seed implant.
High Dose Brachytherapy
High dose-rate (HDR) brachytherapy is a type of internal radiotherapy. You might also hear it called temporary brachytherapy. It involves putting thin tubes into the prostate gland. A source of radiation is then passed down the tubes into the prostate for a few minutes to destroy cancer cells. The source of radiation is then removed, so no radiation is left inside your body. Because the radiation is put directly into the prostate, the healthy tissue around the prostate gets a much smaller dose of radiation than the prostate itself. This means healthy tissue is less likely to be damaged than with another type of radiotherapy called external beam radiotherapy
Cryotherapy
In cryotherapy, the prostate is frozen solid under ultrasound guidance to control the extent of the freeze. The procedure is done under anesthesia and requires at least an overnight stay in the hospital.
HIFU: Transrectal High Intensity Focused Ultrasound
High Intensity Focused Ultrasound (HIFU) is a successful Focal Therapy treatment for Prostate Cancer, which is a soundwave-based treatment that uses a pair of high energy ultrasound beams that heat targeted areas of the Prostate, destroying the cancer cells, with out damaging surrounding healthy cells and can be administered multiple times.
In general it is only suitable for men with early to intermediate stage prostate cancer that is confined within the prostate gland and have a Gleeson score of 7 or less and a PSA of less than 20,
Unfortunately currently it has not been recognised by NICE as an available treatment and is only on a trial basis under the NHS. However a number of private clinics offer this treatment at an obvious cost.
Radium-223 (Xofigo)
This treatment is for men whose prostate cancer has spread to the bones and is causing pain and it will help some men to live longer and reduce bone pain.
Radium-223 is a type of internal radiotherapy called a radioisotope. Where a very small amount of a radioactive liquid is injected into a vein in your arm. Travelling around the body in the blood and it is drawn towards bones damaged by prostate cancer. It collects in these parts of the damaged bones and kills the cancer cells there.
Radium-223 helps some men live longer and in some cases help reduce bone pain in up to 7 in every 10 men, even in multiple areas. However this treatment won’t be suitable if the cancer has spread to organs such as the liver or have large amounts of cancer in your lymph nodes.
In England, Wales and NI you can only have Radium-223 as a treatment if you have already had a certain type of chemotherapy called docetaxel or if docetaxel is not suitable for you. In Scotland you can have this treatment either before or after chemotherapy
Lutetium-177 PSMA
This is another innovative targeted therapy used to treat metastatic prostate cancer. This therapy works to reduce the tumour size and prevents the tumour from increasing, whilst also helping to improve the symptoms that these tumours might cause.
PSMA (Prostate Specific Membrane Antigen) is naturally found on the surface of prostate cells; so someone with prostate cancer there will bean increase of PSMA production. If the prostate cancer has spread to other parts of the body the PSMA will also be present in those areas. When administered intravenously the Lutetium-177 PSMA ligand or altered ion/molecule will travel to those areas where the PSMA is present and emits radiation that will destroy the cancer cells; the treatment is targeted to the cancer cells with very little radiation exposure to other parts of the body.
Administered by an expert multi-disciplined Nuclear Medical team. There are very few side effects. However, some patients may experience: dry mouth, tiredness and potential reduction of blood cells production.
Hormone therapy
Cancer of the prostate is dependent on the male hormone, testosterone, produced by the testicles, for its growth. By reducing the amount of testosterone in the body it is possible to slow down or stop the growth of the cancer cells. It can shrink down the tumour and symptoms will often disappear completely. Treatments can take the form of an operation to remove the part of the testicles that produce testosterone or by using drugs as tablets or injections. Hormone therapy may be given before or after surgery or radiotherapy and will not get rid of all the cancer cells if it is the only treatment given.
I have been given a choice – operation or radiotherapy – how can I decide
This will follow shortly.
In the meantime, call our helpline. We can help by putting you in touch with others who are living with prostate cancer and who have had to make similar choices.
We can also provide leaflets/booklets etc. to help in your decision
Watchful waiting – are they saying this because of my age?
No – as some cancers are slow growing and non-aggressive the specialist may recommend watchful waiting where the cancer is monitored by regular PSA tests rather than being treated. The advantage is that there are no side effects. You do not have to choose this option if you are unhappy with it.
What is PSA? How often should I get a test?
Prostate Specific Antigen is a protein made by the prostate gland, which naturally leaks out into the bloodstream. The PSA test measures the level of PSA in the blood. The test is not always reliable as PSA levels also increase as men get older and due to other conditions of the prostate. Your urologist will be able to advise you how often you should have a test - if watchful waiting –prob 6-12 months – following successful radiotherapy or surgery prob every 3-6 months for first two years and annually thereafter.
Is brachytherapy better than radiotherapy?
Brachytherapy is a procedure involving only one treatment session, whereas radiotherapy will involve hospital visits every weekday for a number of weeks, which can cause tiredness during and after the treatment. It is thought that Brachytherapy has a lower risk of bowel problems than radtiotherapy but higher risk of incontinence, inflammation of the urethra and cystitis. Both treatments carry risk of impotence. If cancer returns after brachytherapy treatment, ‘salvage surgery' has a very high risk of complication. It is common to feel mild soreness and some bruising for a few days after the procedure. It provides a quick return to normal life but is only suitable for early or small prostate cancers. It involves having an anesthetic and overnight stay in hospital and is only available at certain treatments centres.
Is the operation (Radical Prostatectomy) the best course?
Add Robotic surgery
Radical prostatectomy is the usual surgical option for early prostate cancer. It involves having a general anaestetic and staying in hospital for approximately6 days. You will be infertile afterwards and may have temporary incontinence and impotence, which is often treatable. The operation may be followed up with radiotherapy or hormone therapy to deal with any remaining cancer cells.
What is the best treatment?
Depending on your individual circumstances, not all treatment options may be available/suitable for you. Discuss with your urologist.
My husband(partner) will not talk about it!
What treatment can he get?
How can I get him to get treatment and advice?
Quite common reaction particularly in the early days after diagnosis. Allow him to talk when he is ready and be prepared to listen to his concerns. Get support for yourself – ring helpline /book appointment with GP – arm yourself with information for when he is ready to talk.
Can I get complimentary therapy? Or are there alternative therapies?
This will be updated shortly.
In the meantime, there are many complimentary therapies available. If you contact our helpline we can provide you with information and leaflets on available organisations
We also have information on appropriate diets .
Information: What sources of information are there?
Refer to our links page.
We also have information booklets and a library service available
Carer: What can I do to help/ look after the patient?
Be a good listener– support them in their decisions about their treatments
Accompany them to appointments /support group meetings. Encourage healthy diet and exercise where appropriate.
