The best treatment for locally advanced prostate cancer remains unclear and there are still variations in the way it is managed in the UK.
The main treatment options are hormonal therapy alone or hormonal therapy in combination with radiotherapy. Some older men may be managed by watchful waiting.
Occasionally surgery or surgery followed by radiotherapy (within a clinical trial) is used.
The patient's age, life expectancy, PSA, tumour stage and grade are all considered when deciding on treatment. The potential side effects of treatment play an important part in the decision making process.(5)
The key to the process of decision-making is open communication between health professionals and the patient. There should be access to clear information regarding the potential benefits and disadvantages of each treatment option. Patients should be supported in making treatment decisions based on their values and quality of life issues as much as their survival.
Sexual dysfunction is frequently experienced as a result of treatments. Men should be given the option of referral to a psycho-sexual health professional to discuss treatment options for erectile dysfunction. Erectile dysfunction can be treated with sildenafil (Viagra), vacuum pumps and penile injections. There are no effective treatments for loss of sexual desire. Sperm banking should be available to men who want to preserve their fertility.
Referrals can also be made for help with continence problems and bowel problems resulting from radical treatments, such as radiotherapy and radical prostatectomy.