Sometimes a man, with his doctor, may choose not to have extra treatment when the PSA rises. This may be because the cancer does not pose a current threat and/or is slow growing. This is called medical observation and is different from active surveillance or watchful waiting. The doctor may suggest a PSA test every 3–6 months. If the PSA level rises sharply or symptoms of the disease develop that affect quality of life, the doctor may suggest more treatment. The PSA doubling time is often used to gauge how rapidly a cancer is growing and how much of a threat it may be. A PSA doubling time of fewer than 12 months may suggest a need for further treatment (usually hormone treatment).

We are not sure yet whether starting hormone treatment early or late changes the overall longer term control of the prostate cancer. Quality of life is also a factor in these additional treatment choices.

Looking after your overall health after treatment for localised prostate cancer

Some of the most interesting recent research suggests that improving your health in other areas may improve your outcome from prostate cancer.

These are:

• Your diet: a diet high in vegetables, fruit, whole grain cereals and low in saturated fat. Legumes, soy products, tomatoes and fish all contain nutrients that may be beneficial for prostate cancer.

• Avoid excessive use of vitamin supplements. Some recent trials of multivitamins, vitamin C and E have shown they may not reduce risk but in some cases increase it.

• Exercise: moderate to strenuous exercise – both resistance training (improves muscle fitness) and aerobic exercise (improves heart and circulatory health) can provide benefits (and you will feel better too!).

• If you are overweight, losing some of the excess. Obesity appears to affect the chance of recurrence and predict a poorer outcome. Ask your doctor about your body mass index (BMI) (weight divided by height in metres squared). Aim for a BMI of less than 25.