(after prostate cancer has been diagnosed)
*Please note that these are general options applying to Basingstoke practice. If you have questions or concerns about your specific diagnosis and treatment, you should talk to your specialist nurse.
Prostate cancer treatment depends on the stage of the cancer. We need to know if it is localised to the gland only, or if it has spread beyond the capsule which envelopes the gland. We then need to assess to what level it has spread – locally, to lymph glands, or to bone and other organs.
Prostate cancer which is localised to the gland has a number of treatment options:
Active surveillance
As many men with early prostate cancer die with the disease rather than from it, we can manage early prostate cancer by regular monitoring with clinical examination of the prostate and a regular blood test. If there are any signs from this that the disease may be progressing then other treatments can be offered.
Radical treatment (radiotherapy or surgery)
This involves treating the whole gland to destroy it and some surrounding structures.
Hormonal therapy
Prostate cancer tissue is dependent on testosterone to survive, so using hormonal therapy to reduce or make zero the level of testosterone in your blood can control the prostate cancer. However, after a number of years, some prostate cancer cells adapt so that they are no longer dependent on testosterone and hormonal therapy no longer helps.
Energy based modalities that can deliver therapy for prostate cancer
Crytherapy – probes inserted into the prostate via the perineum and undergo freezing to temperatures of -40°C. Two freeze-thaw cycles are required to destroy cells using coagulative necrosis
High-intensity focused ultrasound (HIFU) – uses both thermal (temperatures ˃56°C) and mechanical energy to destroy tissue. It is usually delivered using a transrectal probe under ultrasound guidance, there is hope that new devices using MRI-guidance and ultra-urethral HIFU will be developed
Photodynamic therapy – a photosensitizer (via injected intravenous) by a specific wavelength of light transmitted through laser fibres inserted transperineally into the prostate to create cell damage and tissue necrosis through the production of reactive oxygen species. This technique is being evaluated within regulatory trials
Laser-based photothermal therapy – Laser fibres, inserted transperineally or transrectally, cause coagulative necrosis through a direct thermal effect, with monitoring of effect using MRI-thermometry
Brachytherapy – Low dose-rate brachytherapy involves implantation of small radioactive seeds. High dose-rate brachytherapy involves inserting a source of high does-rate radiation into the prostate gland for a few minutes
Irreversible electroporation therapy – an electric field to open nano-sized pores in the cell membrane, which when applied with sufficient amplitude and duration causes permanent damage to the cell membrane
Radiofrequency therapy– High-frequency alternating current (in the range of 350-500kHz) is used to generate heat capable of causing coagulative necrosis.
About prostate treatment in Basingstoke
In mid-2005, a dedicated Urological Treatment Unit in Basingstoke was initiated. The initial funding for the project was committed in partnership with the Greenham Common Trust in West Berkshire, providing treatment access for both NHS and private patients in the region.
This Unit specialises in delivering current modes of surgical treatment for prostate cancer but, more importantly, pursues advances in technology and techniques to improve treatment for patients across the South of England.
Looking ahead
Consultant Urological Surgeon Richard Hindley has pioneered the use of the high powered KTP (green-light laser) for benign prostate enlargement with considerable success. This vaporises prostate tissue and is set to replace traditional prostate surgery with its inherent side effects of incontinence and impotence.
We are very interested in seeing advances in minimally invasive technology.
High-Intensity Focused Ultrasound (HIFU) employs sound to destroy small prostate cancer tumours, obviating the need for surgical removal, and, as in greenlight laser, reducing the possible side effects from surgery. Pelican is also investigating the use of HIFU for kidney and liver tumours. A HIFU machine has been donated by the Greenham Common Trust to the Basingstoke Unit.
Read more about the ongoing research in London and Basingstoke on focal therapy (HIFU) for prostate cancer in the research section.
