Treatment of prostate cancer

There are different treatments for prostate cancer. The treatment you are offered will vary depending on your age, overall health, and your tumour’s stage and grade. Your doctor will discuss the results from your diagnostic tests and your treatment options with you.

Diagnostic tests are used to confirm or rule out conditions and diseases. They can include urine tests, blood tests, scans, and biopsies.

The main treatments for prostate cancer include:

1. Monitoring the cancer
2. Surgery to remove the prostate
3. Radiotherapy
4. Hormone therapy

The prostate is close to the bladder and rectum. It’s surrounded by a network of nerves and blood vessels that help you get an erection. Treatments for prostate cancer can affect how you urinate, how your bowels work, and your sex life.

It's important to talk to your doctor about any side effects you have while you are being treated. Keeping your doctor updated will help them handle your side effects as soon as possible.

Leaking urine

It’s normal to lose some bladder control (called urinary incontinence) and leak urine after surgery or radiation, but for most men, this gets better over time. For more information, see our section on what it is like living with prostate cancer.

Bladder problems

Needing to urinate often, feeling urgent need to go, waking up at night to urinate, or having a weak stream are common after radiotherapy and can sometimes happen after prostate surgery too. Many of these symptoms improve over time. If they continue and bother you, talk to your doctor about ways to manage them. 

Bowel problems
Damage to the rectum caused by surgery or radiation therapy can lead to bowel problems, including bleeding from the rectum, diarrhoea, or feeling an urgent need to go to the toilet. But this is very rare. Some men have softer stools during radiotherapy, but this goes away after the treatment has stopped.

Erection problems
Some treatments can damage the nerves and blood flow to the penis, which can make it hard to get or keep an erection. This is known as erectile dysfunction, and it’s the most common side effect of prostate cancer treatment.

The good news is that there are ways to manage this during treatment, and most men with intact nerves see improvement over time once treatment has stopped. For more information on coping with this and other changes, see our section on what it’s like living with prostate cancer.

If you are having surgery, you may be offered nerve-sparing surgery, depending on the stage and type of your cancer. This type of surgery aims to protect the nerves that help with erections and bladder control, reducing the risk of erectile dysfunction and leaking urine. However, for some cancers, it’s not possible to remove the tumour without cutting or damaging these nerves. In those cases, you might always need treatments to help get an erection.

What happens if the cancer comes back?

It can be really difficult to hear that your cancer has returned. All the feelings and worries you had when you were first diagnosed may come flooding back, and they might feel even stronger this time. 

For many men, even when the cancer comes back after treatment, it may still be slow-growing, and they continue to live long and active lives. Your doctor will discuss your treatment options with you.

If your cancer has come back, you may hear it called recurrence, as well as other terms like PSA-only, local, locally-advanced, regional, distant, or metastasis. These terms can feel very overwhelming, but here’s an explanation of what it all means to help you understand.

In cancer, recurrence means that the cancer has come back after treatment. This can happen after a time when the cancer was not detected or was under control.

• PSA-only recurrence
  After prostate cancer treatment, doctors expect PSA levels to drop. In up to half of patients PSA may rise after they have had their prostate removed or have been treated with radiotherapy. If PSA levels start rising again without any signs of cancer on scans, it's called PSA-only recurrence. This condition is common, and while it can be worrying, it doesn't always mean the cancer has come back in a way that will cause problems or the cancer spreading. Doctors use PSA tests to keep an eye on your condition. If your PSA levels are rising quickly, they might do further scans or suggest treatments. It’s really important to talk with your doctor about the best options for you and your situation.
• Local recurrence
  The new tumour is in the prostate again, but the good news is that the cancer hasn’t spread to other parts of your body. If your cancer comes back in the same area, your doctor might suggest more treatment to help get rid of it again.
• Regional or locally-advanced recurrence
  The cancer has spread to the area right outside the prostate, but it hasn’t gone to other parts of the body. You may be offered more treatment to help remove the cancer again.
• Distant or metastatic recurrence
  The cancer has spread, or "metastasised," to other parts of your body, and there may also be cancer cells in your blood or bones. Unfortunately, this means that treatment can no longer cure the cancer.

Hearing that your cancer cannot be cured can be very distressing and shocking. However, there are still treatments available that can help manage the cancer’s growth, such as hormone therapy or chemotherapy.

Your doctor may start talking to you about supportive or palliative care. The goal of palliative care is to manage any pain you may have and help find ways of coping with distressing symptoms. It’s important to know that palliative care is not just for men in the final stages of life. Men with metastatic cancer can receive this type of care for many months or even years.

This chapter contains general information about prostate cancer treatments. If you have any specific questions about your own medical situation you should consult your doctor or other professional healthcare provider. No website or leaflet can replace a personal conversation with your doctor.

Last updated: January 2025