Active Surveillance
The old adage about the cure being worse than the disease can sometimes be true. Because some forms of prostate cancer are non-aggressive, we may decide it is appropriate not to take action straight away. We continue to monitor the progress of the cancer with biopsies, PSA levels, and also MRI / PET-PSMA scans.
If you have a prostate cancer suitable for active surveillance (Gleason score 3+3 or low volume Gleason score 3+4) then >95% of men are still alive 15 years after diagnosis and ~35% of men will still not have required treatment of their prostate cancer for progression during this time period. Active surveillance is essentially delayed curative treatment if or when it is required due to cancer progression. It allows you to potentially spend years with your normal quality of life and delay the potential side effects of treatment including incontinence, impotence and potential radiation side effects to the bowel or bladder.
One of the concerns of active surveillance is the worry that your cancer may grow or spread during the active surveillance period. We can talk about whether you are suitable for the active surveillance protocol at your appointment.
Brachytherapy
Brachytherapy is the use of radiation to destroy tumours. The radiation is administered directly into the tumour by needles inserted via the perineum area between your scrotal sac and the anus.
Surgery
The surgical removal of the prostate (known as radical prostatectomy) has come a long way in recent years. The chances of successfully removing the prostate and maintaining urinary control and erections have improved thanks to the use of new surgical techniques. The early physical recovery from surgery has also improved with the use of robotic surgical devices. The robotic device allows the surgeon extremely precise control in the tight confines of the pelvis.
Focal Therapy
Focal therapy involves just treating the prostate cancer and not the whole prostate. Whilst this concept is favourable from a quality-of-life point of view, there are few long-term studies beyond 10 years post treatment regarding progression and functional outcome after focal therapy. It is also well known that prostate cancer is a multifocal tumour and there is a
risk you may require subsequent whole gland or salvage therapy after focal therapy.
The benefit of focal therapy includes low peri-operative morbidity and a lower risk of impotence and incontinence of urine compared to a radical prostatectomy or radiotherapy for primary treatment of prostate cancer.
Other Treatments
Other treatments, such as the use of hormones may be used in specific circumstances. We can discuss these options when you come in for your consultation.