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Prostate Cancer Treatment Selector

This guide is designed to help patients choose the optimal treatment for themselves.

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Table 1 - Treatment for newly diagnosed prostate cancer
Table 2 - Treatment following radiotherapy treatment
Table 3 - Side effects

It is important to remember that rarely is there only one treatment option available for an individual and prostate cancer is a slow growing disease. Therefore it is important that each patient takes sufficient time to explore all their treatment options before coming to a considered choice, rather than rushing into the first treatment offered.

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In determining the severity of a patients prostate cancer it is sometimes helpful categorise the condition into High, Intermediate or Low risk disease. The risk of the disease relates to its chance of cancer spreading outside of the prostate gland and potentially becoming a lethal disease.

Low Risk

Patients with Low Risk disease have a PSA level below 10ng/ml, and a Gleason Score of six or less.

On rectal examination the prostate gland feels either normal (Stage 1) or as though the cancer is confined to only one side (left or right) of the gland (Stage 2A or 2B). The urologist will be able to tell the patient of their clinical stage.

Intermediate Risk

Intermediate Risk disease patients have either PSA level above 10ng/ml, or a Gleason Score of 7 or more or on rectal examination the prostate cancer is felt on both sides of the gland (Stage 2C) or to be extending outside the prostate (Stage 3).

High Risk

Patients with High Risk disease have two or all three of these adverse risk factors present; i.e. a PSA over 10ng/ml and or a Gleason Score of 7 or more and or the prostate cancer feels present on both sides of the gland (Stage 2C) or to be extending outside the prostate (Stage 3).

Tables

Table 1 indicates the suitability of a patient with different parameters for different treatment options. It should be noted that the best available medical evidence would suggest that there is no discernable difference in the cure rates for patients with similar risk prostate cancer treated either by radical prostatectomy, brachytherapy or conformal beam radiotherapy (the latest machines allowing radiation doses of 72Gy or more to be given).

Table 2 indicates the likelihood of side effects occurring with a particular treatment option. The risk of such side effects developing can be very variable and dependent on the skill and experience of the treating clinicians. Patients should enquire about the complication rates at the actual hospital they are considering being treated at.

Table 1 - Treatment for newly diagnosed prostate cancer

The suitability of a treatment for a newly diagnosed prostate cancer is indicated by the number of green or red dots present.

Desirable treatment option
Acceptable treatment option
Possible treatment option
Avoid treatment option

Patient parameter	Radical Prostatectomy	Brachytherapy	Brachytherapy with External Beam Radiotherapy	Conformal External Beam Radiotherapy	Cryotherapy	HIFU
Cancer risk
Low risk cancer
Intermediate risk cancer
High risk cancer
Patient Age
45-55yrs
55-65yrs
65-75yrs
75+yrs
Pre-treatment urinary symptoms.
IPSS less than 15/35
IPSS more than 15/35
Prostate gland size
10-60cc
60-80cc
+80cc
Other factors
Recent prostate operation; (i.e.TURP)
Previous inflammatory bowel disease i.e.Crohns Disease etc
Medically obese
Medically in poor health

Table 2 - Treatment following radiotherapy treatment

The suitability of a treatment for a recurrent localised prostate cancer following radiotherapy treatment. Patients will normally have been re-investigated by an MRI and bone scan to ensure that there is no evidence that the cancer has spread outside the gland. The suitability of each second-line or salvage treatment is indicated by the number of green or red dots present.

Desirable treatment option
Acceptable treatment option
Possible treatment option
Avoid treatment option

Patient parameter	Radical Prostatectomy	Cryotherapy	HIFU
Cancer risk
Low risk cancer
Intermediate risk cancer
High risk cancer
Patient Age
45-55yrs
55-65yrs
65-75yrs
75+yrs
Pre-treatment urinary symptoms.
IPSS less than 15/35
IPSS more than 15/35
Prostate gland size.
10-60cc
60-80cc
+80cc
Other factors
Recent prostate operation; (i.e.TURP)
Previous inflammatory bowel disease i.e.Crohns Disease etc
Medically obese
Medically in poor health

Table 3 - Side Effects

The possibility of a treatment to cause a specific side effect when treating a newly diagnosed prostate cancer is indicated by the number of blue or red dots present.

Common side effect, occurring in 30-60% of patients
Likely side effect, occurring in 10-30% of patients
Possible side effect, occurring in 1-10% of patients
Rare side effect, occurring in less than 1% of patients

Patient parameter	Conventional Radical Prostatectomy	Laparoscopic Radical Prostatectomy	Brachytherapy	Brachytherapy with External Beam Radiotherapy	Conformal External Beam Radiotherapy	Cryo	HIFU
Dying from procedure
Impotence - unable to get an erection one year after treatment
Urinary incontinence
1 month after treatment
1 year after treatment
Difficulty with urination
1 month after treatment
1 year after treatment
Diarrhoea and urgency of bowels
1 month after treatment
1 year after treatment
Time off work
less than one week
1 - 4 weeks
4 - 12 weeks