If a patient is diagnosed with localized prostate cancer, choices for treatments will depend on the estimated tumour growth rate, extent of disease, age and medical conditions of the patient:
(I) Early stage of prostate cancer – small localized tumors without invading surrounding tissues
The prostate and surrounding lymph nodes will be removed in surgery (prostectomy). The resection can be done through conventional incisions or newer laparoscopic approach. After surgery, the patient may have some risk of urinary incontinence and impotence. External radiotherapy and internal radiotherapy (brachytherapy) are viable alternatives with similar treatment outcomes.
For elderly patients or those with chronic ill health, especially those with early slow-growing tumours with no significant discomfort, doctors may recommend only regular monitoring (i.e. “wait and see”) and no specific treatment. It is because some prostate cancer cells can grow very slowly and will not threaten the patient’s life in the near term.
(II) Intermediate stage of prostate cancer – more extensive disease with invasion of surrounding tissues
The usual treatment is external radiotherapy, often used together with hormonal therapy to improve the treatment outcome.
(III) Advanced stage of prostate cancer – cancer cells have spread to bones or other distant organs
The main treatment is hormonal therapy (androgen deprivation treatment) by either surgical removal of testicles or medication. The rationale is to control the growth of prostate cancer by suppressing the male hormone levels. This treatment may control the growth of cancer cells for a few years and relieve the discomfort and pain. For tumors no longer responding to hormonal therapy, palliative chemotherapy may also be considered.
