Not all prostate cancer is the same. Your Prostate Cancer Team will initially discuss the treatment that is most favourable for you at our Specialist Multidisciplinary Team Meeting. At a subsequent appointment you will be informed of the options available. We want our patients to make fully informed decisions before committing to a given treatment regime.
Patients diagnosed with prostate cancer are assigned to a risk category based on their PSA blood level, the extent of cancer within their prostate (the T-stage), and the grade of cancer on their prostate biopsy (the Gleason score). Low-risk prostate cancer patients and selected patients with intermediate-risk cancer may be offered active surveillance, which has been confirmed in clinical trials as a safe method to monitor patients until they have definitive treatment at a later date when their cancer has become more substantial.
Intermediate-risk prostate cancer may be treated with Prostate Surgery, External Beam Radiotherapy (EBRT) combined with hormone therapy, or a permanent Prostate LDR (Low Dose Rate) Brachytherapy implant. Clinical Oncologists assess the suitability of patients for External Beam Radiotherapy (EBRT) or brachytherapy, and enable patients to make an informed choice between their definitive treatment options.
Our dedicated specialist nurses will be in close contact with you and will support you throughout your journey from diagnosis to recovery.
The options available for Prostate Cancer include:
- Watchful Waiting
- Active Surveillance
- Robot Assisted Radical Prostatectomy (Surgical Removal of the Prostate)
- Prostate Brachytherapy
- External Beam Radiotherapy (EBRT)
*Patients who request for other types of treatment including HIFU are reminded that these treatments are still considered as within the realms of clinical trials.
External Beam Radiotherapy (EBRT), Prostate Brachytherapy or a combination of the two.
External Beam Radiotherapy (EBRT) patients receive hormone therapy for several months before, during and after their weeks of daily image-guided radiotherapy (Monday to Friday) because this has been proven to enhance treatment results. Image-guided radiotherapy (IGRT) involves checking the location of the prostate just before each radiotherapy treatment and making fine adjustments to targeting. IGRT is guided either by inserting 3 tiny fiducial markers into the prostate and tracking their positions or by performing a cone-beam CT scan on the radiotherapy machine before each treatment.
Prostate LDR Brachytherapy treats prostate cancer by permanently implanting intensely radioactive Iodine-125 seeds within the prostate where they deliver their short-range radiation throughout the prostate, with rapid drop-off of radiation dose outside the prostate, sparing the nearby rectum, bladder and the nerves supplying the penis more that IGRT. Our patients have their implants performed at Maidstone Hospital, which is one of the busiest Prostate LDR Brachytherapy Units in the UK.
Prostate LDR Brachytherapy and selected IGRT patients can have their rectums protected from high radiation doses by inserting a SpaceOAR hydrogel between the back of the prostate and the front of the rectum, which dissolves away 3 months later. Although SpaceOAR hydrogel is not funded by the NHS, we have had access to some SpaceOAR hydrogel implants for selected patients via the NHS Innovative Treatment Programme.
Stereotactic Radiotherapy (SBRT) treating the prostate in only 5 precise, large-dose treatments will be delivered at Maidstone Hospital within the PACE-C clinical trial.
Patients with high-risk prostate cancer may be treated with IGRT or, for the highest doses to the prostate, with a combination of a Prostate LDR Brachytherapy implant and weeks of IGRT.