Treatment and prognosis

Treatment

When choosing a form of treatment for prostate cancer, a lot depends on how far the cancer has advanced, the growth pattern of the tumor and, not least, the patient’s age and general condition. When choosing treatment, one should also take into account how the side effects will affect the patient’s life situation both in terms of general health and quality of life. Prostate cancer grows slowly and is “kind” in some, in others it can grow and spread quickly. If the tumor is detected when it is small and located inside the prostate, the disease can be cured.

Treatment of localized, non-metastatic disease:

• Surgery: removal of the prostate gland, sometimes combined with radiotherapy
• Radiotherapy: external radiotherapy and/or brachytherapy (so-called internal radiotherapy)
• In locally advanced disease (when the tumor reaches outside the prostate capsule), radiotherapy is given in combination with hormonal therapy.

Treatment of metastatic (hormone-naïve) disease or locally advanced disease where radiotherapy is not applicable:

First-line treatment is so-called hormonal manipulation. Antiandrogens are the first choice for diseases that have not had time to metastasize remotely (usually to the bones). Antiandrogens block the stimulation of tumour cells by testosterone, i.e. the male sex hormone. In cases where the tumor disease has metastasized, so-called castration treatment is usually initiated with drugs given in injection form, usually every 3 months. This type of drug inhibits the testicles’ production of testosterone.

Prognosis

The risk of dying from prostate cancer depends, among other things, on the extent of the tumor and how aggressive it is. The risk of dying from prostate cancer increases the younger the patient is and the more the cancer has spread in the body. The relative 5-year survival rate is just over 90 percent. Prostate cancer often grows slowly, and many people are not diagnosed until old age. Therefore, it is common that the disease does not shorten life, even if the man does not receive treatment aimed at curing. About a quarter of all those who undergo surgery or radiotherapy for prostate cancer experience a recurrence in the form of rising PSA. Patients who develop CRPC with bone metastases usually die prematurely due to their disease.