Treatment Options
The information below reflects the Treatment Options available at the Royal Berkshire Hospital that has been gathered by non-medical members of the RPCSG and should be regarded as non-expert and non-definitive. There are other treatments being offered around this country and in others - hence this information must be viewed purely for general interest by the reader. An outline of other treatments we have heard about can be added if there is sufficient interest shown. Please refer to Prostate Cancer UK for more information on treatments in the UK.
General Outline
Following diagnosis for Prostate Cancer there appears to be 5 paths being taken in Reading at the Royal Berkshire Hospital. These are based on our membership information:
- Active Surveillance (Watch and Pounce) - this appears to be for borderline cases where more decisive action is not immediately required.
- Radical treatment involving direct action on the Prostate requiring an operation.
- Either internal or external Radiotherapy treatment.
- Hormone treatment aims to reduce levels of testosterone. It may be used as a primary treatment or on combination with other therapies.
- Chemotherapy aims to destroy highly active cancerous cells. It is commonly used if hormone therapy becomes ineffective.
Active Surveillance
Active surveillance is where no immediate treatment is given, but the patient’s condition is closely monitored by Consultants by way of regular PSA measurements, repeat prostate biopsies, and scans.
Cancerous conditions that are small, confined to the prostate and slow growing (least aggressive) may never need treatment during the patient’s life. Some active treatment can be taken up if the results of active surveillance indicate that the extent or degree of the cancer condition is increasing.
Radical Surgery
In radical prostatectomy surgery the urethra is separated from the bottom of the prostate and the entire prostate and seminal vesicles are removed. The urethra is then lifted up and attached to the base of the bladder.
There are two bundles of nerves that run from the spinal column to the penis and carry the signals needed to cause erections. The bundles run past either side of the prostate and can become attached to it. Surgeons’ priority is to remove the cancer, but where possible a surgeon will attempt to save both of the nerves (bilateral nerve sparing) or at least one set of nerves (unilateral nerve sparing). Where neither bundle can be saved it is known as non-nerve sparing surgery.
Internal Radiotherapy (aka Brachytherapy)
Brachytherapy treatment is the insertion of a number of radioactive seeds throughout the prostate gland. The number of seeds used is generally between 40 and 100. The radioactivity from the seeds kills the cancerous cells.
The seeds are about the size of a grain of rice and remain inside the prostate gland for evermore, although some may be expelled in the urine. The seeds lose their radioactivity in time and effectively lose all of it in either six months or twelve months, dependent upon the isotope used.
External Radio-Therapy
The patient undergoes a series of sessions in which radioactive beams are directed at the prostate from guns outside the body. The number of sessions varies and is dependent upon the cancer, but typically involves one session per day on five days per week for a few months.
Other Known Treatments
- WATCHFUL WAITING
The term “Watchful Waiting” is often confused with “Active Surveillance” and even experts have different interpretations and criteria. Generally, Watchful Waiting is carried out by GPs rather than consultants, and is generally applied for older patients or those who are unsuitable for surgery, and the tests are less frequent and less intensive. The objective is the same as for Active Surveillance, which is to carry out some treatment if the results indicate that the extent or degree of the cancer condition is increasing.
- HIGH INTENSITY FOCUSED ULTRASOUND (HIFU)
Ultrasound generators placed outside the body produce ultrasound beams that converge at the prostate where the temperature is raised to a level that kills the prostate and cancerous cells.
- CRYOTHERAPY
Very low temperature probes are used to freeze and hence destroy the prostate cells including the cancer.Currently it is only used for small, well localised tumours.
Please note the last two treatments above are not widely available in the UK - they are still undergoing evaluation.
Emerging Treatments
Significant advances in scanning technologies are presenting much better definition and identification of cancer within the prostate gland. In the future more accurate pin-pointing of the tumour will reduce the need for radical treatment. In parallel with improvements in localisation new more focused treatments can be expected to emerge.
Exercising the Pelvic Floor - BEFORE and AFTER Treatment
At probably our best attended presentation and Q/A session of 2014 we heard from Diane Wootton about Pelvic Floor exercises for MEN (and an alternative set of exercises for Women). As we all get older these muscles need special attention if we wish our bladder and bowel functions to remain in good condition - this especially applies after treatment in the pelvic area - and following childbirth for women. Links to Word Documents for Men and Women follow - with thanks and appreciation to Diane Wootton (who is a specialist physiotherapist). By clicking on Diane's full name you can visit her own excellent website.
Advice on safety of gay sex after prostate cancer
Advice for men following prostate cancer treatment is available on many website, including Prostate Cancer UK and Macmillan Trust. However, specific advice for gay men is almost nonexistant. The only link we are aware off is this BBC article:
BBC Article: Advice on safety of gay sex after prostate cancer - BBC News