​Treatment and follow-up of local prostate cancer

The choice of treatment for prostate cancer depends on whether the disease is local, locally advanced, or metastasized.

What is active monitoring for prostate cancer?

The prognosis for prostate cancer is good if the disease has not spread. For localized prostate cancer with a good prognosis – that is, low-risk prostate cancer – the primary treatment option is active monitoring. In many patients, prostate cancer can remain localized for a long time or for the rest of their lives, and no treatments are needed.

Active monitoring takes place at the Urology Outpatient Clinic. Active monitoring of prostate cancer refers to regular monitoring of symptoms, PSA values and prostate palpation findings, based on which the progression of the cancer and the required treatment can be assessed. As part of active monitoring, we regularly measure PSA levels and perform MRI scans of the prostate at set intervals.

A physician’s appointment is usually arranged every six months up to two years, and from then on once a year, if necessary. If necessary, we will take new biopsies from the prostate one year after diagnosis and, if needed, during follow-up in subsequent years.

If, during follow-up, there are signs that the cancer has progressed to a stage requiring treatment – that is, to a moderate- or high-risk cancer – we will have a discussion with you about the surgical or radiation therapy option that is best suited for you. We can also switch from active monitoring to active treatment if the monitoring becomes too emotionally taxing for you.

What is a prostatectomy?

During the surgery, we remove the entire prostate gland; in other words, we perform what is known as a total prostatectomy, or radical prostatectomy.

We perform most of our resection surgeries as laparoscopic procedures. During the procedure, we often use a surgical robot operated by our urologist. The advantage of keyhole surgery is the patient’s quick recovery. After prostatectomy, you are typically discharged the following day.

Stress incontinence and erectile dysfunction are typical adverse effects of surgery.

External and internal radiation therapy for prostate cancer

Radiation therapy is administered at the Radiation Therapy Unit of the HUS Comprehensive Cancer Center. At your first appointment, the radiation oncologist will assess whether radiation therapy is appropriate for you, explain the benefits and possible adverse effects of the treatment, and work with you to plan the course of your treatment. We can provide radiation therapy as external or internal treatment, or a combination of both.

Prostate radiation therapy can cause urinary and intestinal symptoms that are usually temporary. Erectile function may also be impaired as a result of radiation therapy.

What happens during external radiation therapy for prostate cancer?

Radiation therapy planning involves imaging studies. Before external radiation therapy, we can place three gold grains in the prostate to help target the radiation. The grains are inserted under local anesthesia using ultrasound guidance through the rectum.

In external beam radiation therapy, we direct high-energy radiation at the prostate using a linear accelerator. A single treatment session lasts about 10–15 minutes. The treatment course usually lasts 2–5 weeks. You will discuss the specific details of your treatment during your appointment with the radiation oncologist.

What happens during internal radiation therapy for prostate cancer?

We administer internal radiation therapy, i.e. brachytherapy, under general anesthesia. We direct a radiation source inside the prostate through needles inserted temporarily. The procedure takes about 2–3 hours. After the procedure, you will usually spend one night on the ward. We usually administer internal radiation therapy 1–3 times.

Hormone therapies for the treatment of locally advanced prostate cancer  

Locally advanced prostate cancer refers to a cancer that grows outside the prostate but has not metastasized to the lymph nodes or bones.  

The primary treatment for locally advanced prostate cancer is radiation therapy combined with hormone therapy lasting 2–3 years. In some situations, we may choose prostatectomy instead of radiation therapy.

We use hormone therapy both in conjunction with radiation therapy and as stand-alone treatment. Hormone therapy prevents the progression of the disease and enhances the effect of radiation therapy. Hormone therapy refers to a treatment in which we aim to lower the level of the male hormone, testosterone.

Hormone therapy administered before and during radiation therapy is given as injections or oral tablets. If your treatment involves injections, you will receive your first hormone injection at the urologist’s appointment or at the Comprehensive Cancer Center. After the initial dose, hormone therapy is administered either as injections every 1–6 months at a health center or as oral tablets taken at home.