Your doctor will explain the benefits and possible disadvantages and side effects of the treatments to you. You can then decide which is best for your particular situation. The benefits and disadvantages of the treatments for locally-advanced prostate cancer are outlined in the following pages. Before you have any treatment it is important that you are fully aware of them.

It is not possible for doctors to predict accurately who is going to be affected by the side effects of each treatment. For this reason you need to be given full information about the risks beforehand and have plenty of opportunity to discuss them. Remember, there are often choices to be made about which treatment you have, or even whether to have treatment. You can take as large or small a part in those choices as you wish.

This is the use of high-energy rays to destroy cancer cells.

Benefits: Radiotherapy can help to control locally-advanced prostate cancer for many years and may lead to a cure in some situations. The benefits in small, slow-growing cancers are uncertain. A complete course takes up to seven weeks. Giving hormonal therapy before and during the radiotherapy may improve the results.

Risks: For every 100 men who have external beam radiotherapy: up to 30 will develop occasional bleeding from the rectum (back passage); about 10 may have bleeding, a change in bowel habit and some discomfort; and up to 70 will develop erection problems (though this depends on age). Rarely, some men may have leakage or incontinence of urine.

This lowers the levels of testosterone in the body, using tablets or injections, or by surgical removal of the testes. Hormonal therapy may be used on its own or given with radiotherapy or surgery.

Benefits: Can slow or stop the growth of cancer cells for many years. Does not involve surgery or radiation so there is little risk of bowel or bladder problems.

Risks: It will not get rid of all the cancer cells if it is the only treatment given. It can cause a range of side effects that include breast swelling and hot flushes, impotence and lowered sex drive.

Some locally-advanced prostate cancers are very slow-growing and may never cause any symptoms. For this reason, some men and their specialists decide to wait and see whether the cancer is getting bigger (progressing) before starting any treatment. The watchful waiting approach involves regular check-ups with PSA tests and digital rectal examinations.

Benefits: Many men who choose watchful waiting will avoid the side effects of treatments like radiotherapy or hormonal therapy.

Risks: Some men find it difficult just to wait and see if their cancer progresses before starting any therapy. Some men will need treatment with radiotherapy or hormonal therapy if their cancer shows signs of developing.

Surgery can be used to remove the whole prostate gland (prostatectomy), or to relieve symptoms of urinary obstruction (Trans-urethral resection of the prostate – TURP).

Benefits of a prostatectomy: Removing the whole prostate gland may stop the cancer from spreading and may result in a cure. Radical prostatectomy appears to prolong life for some men with a higher grade cancer (see page 00), but isn’t suitable for many men with locally-advanced prostate cancer.

Risks of a prostatectomy: Over half of men who have a prostatectomy for locally-advanced prostate cancer will have a recurrence of their cancer and need further treatment, with either radiotherapy or hormonal therapy.

For every 100 men who have a radical prostatectomy: up to 20 will develop slight leaking of urine; around 5 will have incontinence of urine; and around 70 will have problems getting an erection. One in 200 men over 65, and one in 1000 men under 65, may die from problems caused by the surgery.

Benefits of a TURP: Can help to relieve symptoms with passing urine.

Risks of a TURP: It will not get rid of the cancer cells. There a risk of urinary incontinence. Some men have problems getting an erection after a TURP.