​Treatment and follow-up of local prostate cancer  

The prognosis of prostate cancer is good if the disease has not metastasized. In localized prostate cancer with a good prognosis, i.e. a low risk 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 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. In active follow-up, during the first two years of monitoring, we usually measure the PSA value every three months and twice a year thereafter. In addition, we usually 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 usually once a year. We usually take new biopsies of the prostate one year after diagnosis.  Active follow-up is always carried out at the Urology Outpatient Clinic.  

If there are indications during monitoring that the cancer has developed into a form that requires treatment, meaning medium or high-risk cancer, active treatment is initiated, i.e. surgery or radiation therapy. Switching to curative treatment may also be considered if active monitoring becomes mentally burdensome for the patient. 

In the surgery, the prostate is removed entirely, including the capsule of the prostate, meaning that a radical prostatectomy is performed. Most removal surgeries are performed as keyhole procedures using a surgical robot (da Vinci or Hugo surgical robot). The advantage of keyhole surgery is the patient’s quick recovery. After prostatectomy, patients are typically discharged the next day. 

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

You will receive radiation therapy at the HUS Comprehensive Cancer Center. At the first appointment, the radiation oncologist will evaluate your eligibility for radiation therapy, advise you of the benefits and potential disadvantages of the treatment, and agree with you on how the radiation therapy will be delivered. You will receive radiation therapy as external or internal treatment, or a combination of both.   

Treatment planning involves imaging examinations and prior to the external radiation therapy, three gold grains (fiducial markers) may be inserted into the prostate to locate the prostate and target treatment during radiation therapy. Under local anesthesia, we will insert the gold grains into the prostate through the rectum under ultrasound guidance.  

External radiation therapy is administered through the pelvic area skin to the prostate. One radiation therapy session lasts about 10–15 minutes, of which the duration of radiation is 2–3 minutes.  

You will receive internal radiation therapy, i.e. brachytherapy, under general anesthesia. A radiation source is directed inside the prostate through needles inserted temporarily. The procedure usually takes 2–3 hours, with the actual radiation lasting for 10–15 minutes. You will spend the night following the procedure on the ward.  

Radiation therapy typically causes urinary and intestinal symptoms, but the adverse effects are usually temporary. 

Hormone therapy is used both in conjunction with radiation therapy and alone. Hormone therapy prevents the progression of the disease and enhances the effect of radiation therapy. Hormone therapy given before and during radiotherapy is usually administered as injections. You will receive your first hormone injection at the Urology Outpatient Clinic or at the Comprehensive Cancer Center. After the initial dose, the injections will be given at your local health center.