The treatment options for advanced prostate cancer include hormonal therapy, surgery (to relieve symptoms), chemotherapy, radiotherapy (to relieve bone pain) and controlling symptoms.

Deciding on the best treatment is not always straightforward and a number of factors have to be taken into account. The most important of these are:

• your general health
• your age
• where the cancer is and the symptoms it’s causing
• the likely side effects of treatment
• your views about the possible side effects of treatment, and how much you are willing to risk side effects for the possible benefits in controlling the cancer
• which treatments, if any, you have had before.

The possible treatments for your situation are likely to be discussed by a group of doctors working together. This is known as a multidisciplinary team and includes a doctor who specialises in treating conditions of the prostate (urologist), and doctors who are specialists in radiotherapy, hormonal therapy and chemotherapy treatments (clinical oncologists). The team may also include specialist nurses, social workers, and physiotherapists. It is common to see a surgeon, an oncologist and a specialist nurse to help you to make a decision about treatment.

Some people find it helpful to have another medical opinion to help them to decide about their treatment. Doctors can refer you to another specialist for a second opinion if you feel that this would be helpful

When prostate cancer has spread beyond the prostate gland and is affecting other parts of the body, it can no longer be cured. However, treatment can usually be given to control the cancer for as long as possible, relieve any symptoms and improve quality of life.

Most men with advanced prostate cancer are recommended to have hormonal therapy. A range of hormonal therapies are available.

Surgery to remove the prostate gland is not suitable for men with advanced prostate cancer, but occasionally a trans-urethral resection of the prostate (TURP) can be useful to relieve problems with passing urine.

Chemotherapy may be used if hormone therapy is no longer able to control the cancer. Radiotherapy is sometimes used to treat bone pain.

Treatments to relieve symptoms may also be given, such as painkillers. Each of the treatments has different benefits and side effects.

Before you have any treatment, your doctor will explain its aims to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

You may feel that the hospital staff are too busy to answer your questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.