Treatment and prognosis
When choosing the form of treatment for prostate cancer, a lot depends on how far the cancer has advanced, the tumour’s growth pattern and the patient’s age and general state of health. Consideration should also be given to how side effects might affect the patient’s lifestyle with regard to general health and quality of life. Prostate cancer grows rapidly, and is ‘kind’ to some but can grow and spread rapidly in others. If the tumour can be detected whilst it is small and localised in the prostate gland, the disease can be cured.
Treating localised, non-metastatic disease:
- Surgery: removal of the prostate gland, sometimes combined with radiation therapy.
- Radiation therapy: external radiation therapy and/or brachytherapy (internal radiation therapy)
- In the event of locally advanced disease (when the tumour extends outside the prostate capsule), radiation therapy is combined with hormonal therapy.
Treatment of metastatic (hormone-naive) disease or locally advanced disease when radiation therapy is not appropriate:
Primary treatment is hormonal manipulation. Antiandrogens are first choice in the event of disease which has not yet developed remote metastases (usually to the skeleton). Antiandrogens block stimulation of the tumour cells by testosterone (the male hormone). In cases where tumour disease has become metastatic, castration therapy is usually initiated with a medication given in injection form, usually every 3 months. This type of medication impairs the testicles’ production of testosterone.
The risk of dying from prostate cancer depends on factors such tumour spread and how aggressive it is. The risk of dying from prostate cancer increases the younger the patient is and how widely spread the cancer is in the body. The relative 5-year survival rate is over 90%. Prostate cancer often grows slowly and many cases do not occur until late in life. That’s why it is uncommon that the disease shortens life, even if the patient is not given treatment intended to cure. Around a quarter of all patients operated or given radiation therapy for prostate cancer experience recurrence in the form of rising PSA values. Patients who develop CRPC with skeletal metastasis invariably die prematurely as a result of their disease.