Treatment Plan

Conservative:

• Watchful waiting:
  • Yearly PSA
  • Suitable for elderly with comorbidities
• Active surveillance:
  o PSA every 3-4 months
  o DRE at 12 months
  o MRI every 12-18 months Radical treatments:
• Prostatectomy
• Radiotherapy
• PSA within 6 weeks, 6-monthly for 2 years & Yearly thereafter Adjunct/Palliative:
• Hormonal therapy:
• Androgen deprivation (LHRH)
• Androgen blockade (cyproterone acetate)
• Chemotherapy

Management of complications:

• Hot flushes: cyproterone acetate
• Fatigue: 12-week supervised exercise
• Osteoporosis: bisphosphonates (if contraindicated: denosumab)
• Sexual dysfunction: psychosexual counselling, PDE5 inhibitors
• Urinary symptoms: pelvic floor training, bladder training, medications (duloxetine, antimuscarinics, botulinum toxin)