Treatment options for local and advanced prostate cancer

Written by: Dr Christos Mikropoulos
Edited by: Carlota Pano

Prostate cancer is the most commonly diagnosed cancer in men in the UK, affecting more than 52,000 men every year.


Here to provide an expert insight into prostate cancer, including diagnosis and treatment options, is Dr Christos Mikropoulos, distinguished consultant clinical oncologist.



How is prostate cancer detected and diagnosed?


Besides urinary frequency or urgency, and incomplete bladder emptying, there are no major symptoms of prostate cancer.


Screening with a blood PSA test, however, has been shown to make a difference in targeted populations, especially in men who have a family history of prostate cancer or men who have symptoms.


If the blood PSA test is abnormal, this will trigger further investigations, including an MRI scan and prostate biopsies. These tests will confirm the diagnosis and provide information relevant to treatment decisions and prognosis.


What are the stages of prostate cancer and how do they affect treatment options?


Prostate cancer first presents as a localised disease that can be treated with a curative intent. Early diagnosis at the localised stage is important and leads to better outcomes.


Once the prostate cancer has metastasised, treatment is aimed at prolonging life expectancy and controlling symptoms.


What are the treatment options for prostate cancer and how are they chosen?


For patients with a localised prostate cancer disease, there are a variety of options available, including:


  1. External Beam Radiotherapy: This is the option favoured by the majority of patients, because it is non-invasive, well-tolerated and increasingly, can be delivered over two to four weeks.
  2. Surgery: This is the second most preferred option, due to the availability of Robotic Nerve-Sparing Prostatectomy.
  3. Brachytherapy (internal radiotherapy) with a permanent seed implant: This is an attractive day-case option for eligible patients.
  4. Focal treatments (HiFU/Cryotherapy): These are available and currently looked at within clinical trials.


For patients with an advanced prostate cancer disease, there has been a revolution in treatments over the last decade, with a doubling of the expected survival rate. Treatments include:


  1. Novel Anti-androgens (Apalutamide/Darolutamide/Abiraterone/Enzalutamide)
  2. Cytotoxic agents (Docetaxel/Cabazitaxel)
  3. Targeted treatments (Olaparib/Pembrolizumab)
  4. Radioisotope Antibody Ligands (Lutetium PSMA)
  5. Radium
  6. SABR (stereotactic radiotherapy)


How can the side effects of prostate cancer treatment be managed?


Due to the complexity of the available treatments, the potential side effects have increased. Designated protocols are used to define management strategies.


What is the prognosis for prostate cancer and how is it determined?


Patients with localised prostate cancer are cured in the majority of cases.


For metastatic prostate cancer, the survival rate is several years, depending on stage and biology.



If you require state-of-the-art treatment and management for prostate cancer, do not hesitate to visit Dr Mikropoulos’ Top Doctors profile today.

By Dr Christos Mikropoulos
Clinical oncology

Dr Christos Mikropoulos is a distinguished consultant clinical oncologist who specialises in bladder cancer, prostate cancer, breast cancer, testicular cancer, stereotactic ablative radiotherapy, as well as prostate brachytherapy. He currently practises at the Mount Alvernia Hospital in Guildford. 

Dr Mikropoulos, who is also an expert when it comes to advanced radiotherapy, biomarkers, cancer genetics, immunotherapy, and PARP inhibitors (DNA repair), but to mention a few, notably obtained an MD in medicine from the prestigious Aristotle University of Thessaloniki in 1998, before going on to complete an MSc at Newcastle University in 2007. He also successfully undertook specialist training in clinical oncology after following the completion of a medical rotation throughout the UK, as well as completing oncological training with the London rotation, including at the Royal Marsden Hospital. 

Dr Mikropoulos, who also specialises in oligometastatic disease and radiotherapy for lymphoma, also went on to complete prostate LDR brachytherapy and gynaecology HDR brachytherapy, and was notably awarded on two occasions by ASCO for the research that he undertook during the completion of his MD research project in prostate cancer genetics

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