Curative Treatment Options for Prostate Cancer

Information on treatment options for prostate cancer would easily fill a large textbook. This information sheet aims to help you understand your possible options. Usually there will be several appropriate options to choose from. Options become more limited with more aggressive disease.

This document is only a guide, and it must be emphasised that there may be reasons why some options are not suitable for you. We will discuss the pros and cons of all treatment options, specific for you. At the end of the day, the choice is yours.

When discussing treatment options, the three most important “prostate” factors are your;
 - PSA -the lower the better, ie <10 
 - Prostate examination - if it feels normal, or only slightly abnormal on one side is favourable
 - Gleason Grade on prostate biopsy

Treatment Options - General Guide

1. Gleason Grade 3+3
- Active Surveillance*, Radical Prostatectomy (Open or Robotic), Brachytherapy, External Beam Radiotherapy

*Active Surveillance is particularly relevant if there is only a small amount of cancer on biopsy

2. Gleason Grade 3+4 or 4+3
- Open or Robotic Radical Prostatectomy, External Beam Radiotherapy

3. Gleason Grade 8 or greater - this is aggressive/high risk cancer.
- Open or Robotic Radical Prostatectomy and/or External Beam radiotherapy

In men with this type of cancer (high-risk), the usual initial treatment we use is surgery, followed by external beam radiotherapy. These two treatments are complementary; radiotherapy is an excellent secondary treatment in this scenario, and surgery is much better suited as as initial treatment. In men with this type of cancer, it is more likely that the cancer has spread, and MRI and bone scans are usually performed to check for this. If there is evidence of cancer spread (ie to the bones), radical treatment is not an option, and hormonal ablation is used as a first line treatment.