Non-surgical treatment of localised prostate cancer

The non-surgical treatment of localised prostate cancer depends on a number of factors including: PSA, stage, Gleason score, age, fitness for treatment and life expectancy, and is individualised depending on risk. Patients who present with early localised (stage T1 or T2) tumours with low risk features (PSA <10 ng/ml, Gleason score 3+4 or below) and who have a life expectancy of more than 10 years may consider radiotherapy or active surveillance. Permanent brachytherapy seed implantation is suitable for low risk patients who have minimal lower urinary tract symptoms, with equivalent results to external beam radiotherapy Conformal high-dose external beam radiotherapy is effective for patients with high risk disease, and consideration should be given to the use of neoadjuvant and adjuvant anti-androgens. Prophylactic pelvic nodal irradiation is indicated for patients with high risk of lymph node disease, followed by a boost to the prostate using either a smaller external beam volume, or brachytherapy. The definitive treatment depends on both clinical parameters such as the clinical staging, prognostic risk, and the likelihood of acute and late toxicity and the patient's personal choice based on their life style.