Recurrent prostate cancer A guide to treatment and support

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1 Recurrent prostate cancer A guide to treatment and support

2 2 Recurrent prostate cancer About this booklet This booklet is for you if your prostate cancer has come back after treatment that aimed to get rid of it. This is called recurrent prostate cancer. Partners, family and friends might also find it useful. We describe recurrent prostate cancer, how it could affect you and the different treatments that may be available. There s also information about support to help you deal with the impact of cancer coming back. Each hospital will do things slightly differently, so use this booklet as a guide to what to expect and ask your doctor or nurse for more information on the care and support available to you. Or you could call our Specialist Nurses on our confidential helpline. The following symbols appear throughout the booklet to guide you to sources of further information: Prostate Cancer UK Specialist Nurse helpline Prostate Cancer UK publications Sections for you to fill in If you would like to know more about anything you read in this booklet, you can call our Specialist Nurses on our confidential helpline on

3 Specialist Nurses Contents About this booklet...2 What is recurrent prostate cancer?...4 Why has my cancer come back?....6 Treatment for recurrent prostate cancer...7 What second-line treatments are there?...7 Which second line treatments are available to me?...9 When will my treatment start?...12 Making a decision...15 What happens after second-line treatment?...15 Dealing with recurrent prostate cancer...18 What can help?...19 More information from us...30 Other useful organisations About Prostate Cancer UK...34 Sections for you to fill in Your health professional team Questions to ask your doctor or nurse Appointment diary... 28

4 4 Recurrent prostate cancer What is recurrent prostate cancer? Recurrent prostate cancer is cancer that has come back after the following treatments: surgery (radical prostatectomy) external beam radiotherapy (EBRT) permanent seed brachytherapy where radioactive seeds are implanted into the prostate temporary brachytherapy which involves inserting a source of high dose radiation into the prostate for a few minutes at a time high intensity focused ultrasound (HIFU) cryotherapy. All these treatments aim to get rid of the prostate cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. See page 6 for information about why prostate cancer comes back. Finding out your cancer has returned Your doctors and nurses will have monitored you after your first treatment to check for any signs that the cancer has come back. Usually the first sign that your cancer is starting to return is a rise in the level of prostate specific antigen (PSA) in your blood. The PSA test is a very effective way of checking how successful your treatment has been. The exact change in PSA level that suggests that your cancer has come back depends on which treatment you had. Your doctor may do other tests to check if, and where, your cancer has come back. Read more about this in our booklet: Follow-up after prostate cancer treatment: What happens next?

5 Specialist Nurses Your prostate cancer may have come back in one or more areas. It could be: in your prostate gland, if it hasn t been removed by surgery in the area around where your prostate gland used to be (called the prostate bed) if the prostate has been removed by surgery in the area just outside your prostate gland in other areas of your body. Prostate cancer can spread to any part of the body but it most commonly spreads to the bones and lymph nodes. Ask your doctor or nurse for more details about where your cancer is or is likely to be. Sometimes it s not clear where the cancer is. Some men may have a rise in their PSA level but the cancer may not show up on other tests, at least at first. This is quite common and your doctor will discuss treatment options with you. It can be a big shock to find out your cancer has come back. There s more about how men often feel about this, ways to deal with it and support that s available on page 18.

6 6 Recurrent prostate cancer Why has my cancer come back? It s not completely clear why prostate cancer comes back, but scientists have suggested some possible reasons. The cancer was more advanced than your doctor originally thought. Tests or scans you had when you were diagnosed might not have picked up small clusters of cancer cells outside the prostate gland. Your first treatment would have missed these cells. Over time, the small clusters of cells may have grown large enough to be picked up by tests or to cause symptoms. Not all of the cancer cells in your prostate were treated during your first treatment. Small clusters of cells might have been left behind. Over time, these may have grown large enough to be picked up by tests or to cause symptoms. When you were diagnosed your doctor would not have been able to tell you whether or not your cancer would come back. But they may have said how likely it was. Read more about your chance of cancer coming back in our booklet: Follow-up after prostate cancer treatment: What happens next?

7 Specialist Nurses Treatment for recurrent prostate cancer Treatments for recurrent prostate cancer are called second-line (or salvage) treatments. Many of the treatments used to treat prostate cancer when it s first diagnosed can also be used as second-line treatments. What second-line treatments are there? There are two main types. These are: treatments that aim to get rid of the cancer (curative treatments) treatments that aim to control the cancer these aim to stop the cancer growing but do not get rid of it. The treatments are described below but you can also read more in our Tool Kit fact sheets. Most of these fact sheets are aimed at men thinking about their first treatment for prostate cancer so some of the information, such as the chances of getting side effects, may be different for you. Ask your doctor or nurse for more information. You can also call one of our Specialist Nurses on our confidential helpline. Treatments aiming to get rid of the cancer External beam radiotherapy (EBRT) uses high energy X-ray beams to destroy the cancer cells. You might have it with or without hormone therapy. High intensity focused ultrasound (HIFU) uses ultrasound waves to heat and destroy cancer cells in your prostate. It is newer than other treatments and so we don t have as much information on how well it works and its possible side effects.

8 8 Recurrent prostate cancer Cryotherapy uses freezing and thawing of your prostate gland to destroy cancer cells. Like HIFU, it s newer than other treatments and so we don t have as much information on how well it works and its possible side effects. Surgery (radical prostatectomy) to remove your prostate and the cancer contained within it. This is rarely used as a secondline treatment see page 12 for more on this. Treatments aiming to control the cancer Hormone therapy helps control prostate cancer by stopping testosterone reaching the prostate cancer cells, wherever they are in the body. Clinical trials Some men who have recurrent prostate cancer decide to take part in clinical trials of new treatments or new combinations of existing treatments. If you are interested in taking part in a clinical trial, ask your doctor if there are any that would be suitable for you. For general information on clinical trials, read our Tool Kit fact sheet, A guide to prostate cancer clinical trials. Observing your prostate cancer This is an alternative to having second-line treatment straight away. It s a way of monitoring prostate cancer that is not causing any symptoms or problems at the time. The aim is to keep an eye on the cancer over the long term and delay treatment until it s really necessary. Prostate cancer is often slow-growing and may not cause you any problems or symptoms in your lifetime.

9 Specialist Nurses If your prostate cancer is being observed, you will not start second-line treatment until tests show that your cancer is growing or you start to get symptoms, such as problems urinating or bone pain. But symptoms can be caused by other things, like an enlarged prostate, a urine infection, or the side effects of treatment. So to get a better idea if the cancer is the cause, your doctor will also look at your PSA level and how fast it is rising. Observing your prostate cancer involves regular PSA tests. You may also have other scans and tests. If these suggest your cancer is growing, or if you start to get symptoms, then you are likely to be offered hormone therapy to control the cancer and help relieve symptoms. Which second-line treatments are available to me? It s unlikely that all of the treatments will be available to you. Speak to your doctor or nurse about which treatment options are available to you. Several factors affect which treatments are suitable, including: where your cancer is your general health your PSA level and other test results what treatment you ve already had. Where your cancer is If your cancer has returned in the prostate gland or in the prostate bed (localised prostate cancer) then you might be offered further treatment aiming to get rid of the cancer.

10 10 Recurrent prostate cancer Some men whose cancer has spread to the area just outside the prostate but not to other parts of the body (locally advanced prostate cancer) may also be offered treatment aiming to get rid of the cancer. If you have localised or locally advanced cancer, hormone therapy will usually be an option as well a treatment which aims to control the cancer. If your cancer has spread to other parts of your body (advanced prostate cancer) then you will be offered hormone therapy which controls the cancer, rather than getting rid of it. Your general health Your health and any other medical conditions also affect what treatments are available to you. For example, you may already have side effects from the treatment you ve had. Having another treatment can cause side effects as well, so you ll need to be fit enough to cope with this. PSA and other test results Your PSA level and how fast it is rising will affect what treatments you are offered. If your PSA is rising quickly, this suggests that your cancer is more likely to have spread further. Your doctor or nurse may decide to monitor your PSA for a while before they offer you further treatment, particularly if your PSA is rising slowly. What treatment you have already had The table opposite shows which second-line treatments might be options for you, based on your first treatment. But this will also depend on the other factors described above.

11 Specialist Nurses First treatment for prostate cancer Surgery (radical prostatectomy) Second-line treatments that may be available Radiotherapy to the prostate bed (with or without hormone therapy) Hormone therapy Radiotherapy HIFU (high intensity focused ultrasound) Cryotherapy Hormone therapy Very rarely, surgery Permanent seed brachytherapy or temporary brachytherapy Cryotherapy Hormone therapy Rarely, HIFU Very rarely, surgery HIFU More HIFU External beam radiotherapy Cryotherapy Hormone therapy Very rarely, surgery Cryotherapy More cryotherapy External beam radiotherapy Hormone therapy Very rarely, surgery

12 12 Recurrent prostate cancer Not all types of treatment are available at every hospital. For example, cryotherapy and HIFU are not widely available. You may be able to ask for referral to another hospital but this won t always be possible. Surgery is very rarely available as a second-line treatment because first treatments affect the nature of the prostate tissue. This makes it very hard for a surgeon to remove the prostate gland and there is a higher risk of side effects. If you had brachytherapy as a first treatment, it s unlikely that you will be offered HIFU as a second-line treatment. This is because there is a bigger risk you will develop an opening between the urethra and the back passage (called a fistula). Your doctor might suggest observing your prostate cancer (see page 8) as an alternative to second-line treatment. When will my treatment start? The timing of second-line treatment varies from man to man. For example, your doctor might want to delay it if you re still recovering from the side effects of your first treatment. Ask your doctor for more information about when your treatment will start. If you re having treatment that aims to get rid of the cancer, treatment could start straight away. If you re having treatment that aims to control the cancer (hormone therapy), when you start treatment will depend on several things, including: whether your prostate cancer has spread to other parts of your body whether you have any symptoms from your cancer

13 Specialist Nurses how quickly your PSA level is rising how you feel about starting treatment. If you re having hormone therapy, your doctor or nurse may decide to monitor your PSA and then begin treatment once it has reached a certain level, or if other tests show that your cancer is growing. Waiting to start treatment means that you will delay any side effects of hormone therapy, such as sexual problems, hot flushes and fatigue. Read more about the side effects in our booklet, Living with hormone therapy: A guide for men with prostate cancer. If you are concerned about delaying the start of treatment, discuss this with your doctor or nurse.

14 14 Recurrent prostate cancer Side effects of second-line treatment All treatments have side effects. The risk of side effects is usually higher when a treatment is used as a second-line treatment than when it s used as a first treatment. This is because your first treatment may have already caused some damage to the tissue surrounding the prostate gland. Side effects may also be more severe with a second-line treatment. And you might still have side effects from your first treatment. Our Tool Kit fact sheets provide information about the most common side effects of each treatment. However, these fact sheets describe first-line treatments so bear in mind that the risks of side effects may be higher if you have second-line treatment. Ask your doctor or nurse for more information about the possible side effects from the second-line treatments they offer you. Knowing about the possible side effects can help you make a decision about your treatment. There are things you can do to manage side effects. For example, eating healthily and being physically active can help you manage the effects of prostate cancer and its treatment. Read more in our Tool Kit fact sheet, Diet, physical activity and prostate cancer. For information on how to manage problems with controlling or passing urine read our Tool Kit fact sheet, Urinary problems after prostate cancer treatment. Find out about managing sexual side effects in our booklet, Prostate cancer and your sex life. Read about managing other side effects in our booklet, Living with and after prostate cancer: A guide to physical, emotional and practical issues.

15 Specialist Nurses Making a decision Your doctor might offer you one treatment, or a choice of treatments. They may also offer you the option of observing your prostate cancer (see page 8). All treatments have advantages, disadvantages and side effects. It s important to discuss these with your doctor before deciding on a treatment. There s a list of possible questions to ask your doctor or nurse on pages 26 to 27. You could also talk through your options with your partner, family or friends, or speak to one of our Specialist Nurses on our confidential helpline. Make sure you have all the information you need before you make any decisions. What if I don t want further treatment? Some men weigh up the advantages and disadvantages and decide that they don t want to have second-line treatment for their cancer. Speak to your doctor or nurse if you re thinking about not having further treatment. They may suggest observing your prostate cancer with regular tests. If it starts to cause symptoms then you re likely to be offered hormone therapy to control the cancer and help relieve symptoms. There are also other treatments to manage symptoms. Read more on page 17. What happens after second-line treatment? You will have regular follow-up appointments to monitor how well your treatment is working. The aim is to: check how your cancer has responded to treatment deal with any side effects of treatment give you a chance to raise any concerns or ask any questions. You will have regular PSA tests as part of this follow up.

16 16 Recurrent prostate cancer What happens if my cancer comes back after second-line treatment? If your cancer comes back again after treatment that aimed to get rid of it, you will be offered hormone therapy to control your cancer, though you may not need to start it straight away. Read about the different types of hormone therapy in our Tool Kit fact sheet, Hormone therapy. And read about the side effects and how to manage them in our booklet, Living with hormone therapy: A guide for men with prostate cancer. Some men decide they would like to take part in a clinical trial of a new treatment or a new combination of existing treatments. Read more in our Tool Kit fact sheet A guide to prostate cancer clinical trials. How long will hormone therapy control my cancer? Hormone therapy can keep your cancer under control for many months or years before you need to think about other treatments. Hormone therapy treats prostate cancer wherever it is in the body. But over time, the behaviour of your cancer cells may change and your cancer may start to grow again. You may continue having your original hormone therapy, but there are also other treatments available. These include other types of hormone therapy as well as chemotherapy. Read more about these treatments in our Tool Kit fact sheet, Second-line hormone therapy and further treatment options.

17 Specialist Nurses What if I develop symptoms? Tell your doctor or nurse about any symptoms you have. If you have symptoms between your check-ups, tell your doctor or nurse as soon as possible. If these are signs of the cancer coming back they can talk to you about treatment options. Your doctor or nurse can also give you advice and treatment to help manage your symptoms. For example, if your cancer has spread to the bones and is causing pain, there are treatments to help, such as pain-relieving medication, drugs called bisphosphonates and pain-relieving radiotherapy. Read more about these in our Tool Kit fact sheet, Managing pain in advanced cancer. Find out more about managing symptoms of advanced prostate cancer and support that s available in our booklet, Advanced prostate cancer: Managing symptoms and getting support.

18 18 Recurrent prostate cancer Dealing with recurrent prostate cancer A lot of men find it hard if they discover their cancer has come back. You may have hoped it had gone forever and life was starting to get back to normal. All the emotions you had when you were first diagnosed can resurface and they may be even stronger the second time round. Some men feel angry that their cancer has come back. It s unfair that you ve been through a difficult time, and now you have to do it all again. It is normal to want to find an explanation, but remember it s not your fault try to go easy on yourself. It s natural to find it difficult when you think about the future. This is especially true if you have recurrent prostate cancer. The thought of more treatment can be overwhelming. You may feel less hopeful than you did before. However, men do have successful treatment for recurrent prostate cancer. Even if you re offered hormone therapy to control the cancer rather than treatment to get rid of it, it can keep the cancer under control for many months or years before you need to think about other treatments. You may also have practical concerns about your cancer coming back, for example, worries about work or money. Read more about these issues in our booklet, Living with and after prostate cancer: A guide to physical, emotional and practical issues.

19 Specialist Nurses Depression seeing the signs Men with prostate cancer have an increased risk of depression and anxiety. Being depressed doesn t always mean being tearful or low. Some men who are depressed find they get angry more easily, start drinking more and stop taking care of themselves. If you recognise these kinds of changes in yourself, there are things that can help. Let your nurse or GP know. What can help? There is no right way to deal with your thoughts and feelings. Try to go easy on yourself and don t expect to have all the answers. You have been through a difficult time before, and you may have learned lots of things along the way that helped you to manage. You could try those things again now. How can I help myself? Find out about recurrent prostate cancer and the treatments available to you, so you know what s going on and what to expect. Be as active as you can. Physical activity can lift your mood. Think about what you eat and drink. Some men find they manage better by aiming for a healthy, balanced diet. Unload what s going around in your head find someone you can talk to. It could be someone close, or someone trained to listen, like a counsellor or your medical team. Take time out to look after yourself. When you feel up to it, learn some techniques to manage stress and to relax like listening to music or breathing exercises. Set yourself goals and things to look forward to. Find more strategies in our booklet, Living with and after prostate cancer: A guide to physical, emotional and practical issues.

20 20 Recurrent prostate cancer Trying to distract yourself from difficult emotions can work for some men with recurrent prostate cancer. This could be through doing something enjoyable, like physical activity, watching TV, reading a good book or seeing friends. But at some point you may need to deal with these feelings, particularly if they are stopping you getting on with your life. Some men find it helpful to get some emotional and practical support from others. There are a number of people who can offer support. Family and friends Talking to your partner, family and friends can help take some of the pressure off you. It can be hard to know how to start a conversation, but Macmillan Cancer Support have a booklet called Talking about your cancer, which may help. Support groups Get in touch with your local prostate cancer support group. Support groups can be a good way for you to meet people with similar experiences. These groups are often set up by local health professionals, or by people who have experience of prostate cancer. Meetings are usually informal and offer an opportunity to find out about other people s experiences as well as discussing your own thoughts and concerns.

21 Specialist Nurses Many support groups also welcome partners, friends and relatives sometimes at the same meeting, sometimes at separate ones. You can find details on our website, by calling our Specialist Nurses on our confidential helpline or by asking your nurse. Online community If you have access to the internet, sign up to our online community, where you can share your views and experiences with others affected by prostate cancer. Visit our website to sign up. Peer support service Our peer support service gives you the chance to talk with a trained volunteer who has direct experience of prostate cancer. Many people find it helpful to talk to someone who has been in a similar situation. Our volunteers are all personally affected by prostate cancer, either as a man with prostate cancer or as a family member. They are trained to listen and offer support over the phone. To arrange to speak to a volunteer, call our Specialist Nurses on our confidential helpline. Health professionals You can talk to your nurse, doctor or any other health professionals you see about how you re feeling. You can also speak to our Specialist Nurses on our confidential helpline.

22 22 Recurrent prostate cancer Counselling It s sometimes hard to speak to those closest to you because you don t want to upset them or show your emotions. Some people find it easier to talk to someone they don t know which is where a counsellor might come in. They re trained to listen and can help you to find your own ways to deal with things. For some men, talking to a counsellor is a good way to share their worries. There are different types of counselling so you can try various approaches. Your GP can refer you to a counsellor or you could find one yourself. The British Association for Counselling & Psychotherapy has information about counsellors in your area. Spiritual support You might begin to think more about spiritual beliefs as a result of having recurrent prostate cancer. Beliefs are not necessarily religious, but might help you to make sense of life or your cancer. You may find that your beliefs offer you great comfort or support. Or you might start to question your current beliefs. It s important that you get spiritual support if you need it. This could be from your friends or family, or from your religious leader or faith community.

23 Specialist Nurses My father found talking to someone was a surprisingly calming and reassuring experience, especially when we found his cancer had come back. Personal experience

24 24 Recurrent prostate cancer Your health professional team Use this space to record names and contact details of the health professionals involved in your care. They will discuss your diagnosis and agree which treatment options will be available to you. We have listed the health professionals you are most likely to see, but you may not come into contact with all of these. Key worker Your key worker is your main point of contact. They help to co-ordinate your care and guide you to the appropriate team member or source of information. Your key worker is often your specialist nurse, but may also be your hospital doctor, GP, radiographer or another health professional. Name Telephone no. Out of hours contact details Notes Specialist nurse You may have a urology, uro-oncology or prostate cancer specialist nurse as part of your health professional team. They can answer questions you may have about your cancer and your care. Name Telephone no. Out of hours contact details Notes

25 Specialist Nurses Consultant oncologist This type of doctor specialises in cancer treatments other than surgery, for example radiotherapy or chemotherapy. Name Telephone no. Out of hours contact details Notes Consultant urologist This type of doctor specialises in the urinary system. Urologists are also surgeons. Name Telephone no. Out of hours contact details Notes Other health professionals You can record contact details of other health professionals in the space below. These might include a radiographer, pharmacist, dietitian, sex therapist, continence nurse, community nurse, practice nurse or GP. Name Telephone no. Out of hours contact details Notes

26 26 Recurrent prostate cancer Questions to ask your doctor or nurse Which second-line treatments are available to me? Are there any clinical trials I could take part in? How long do I have to decide on my treatment? Does the treatment aim to get rid of the cancer or to control it?

27 Specialist Nurses What are the side effects of the treatment? What are the chances of treatment being successful? What happens if the cancer comes back again? What check-ups will I have after treatment? Who can I contact if I have questions or concerns?

28 28 Recurrent prostate cancer Appointment diary You can fill in this diary before and after your follow-up appointments, to help you get the most out of them. You might want to photocopy these pages so you have enough copies to last you for a while. Date of appointment: Fill in before your appointment How I ve been feeling you can include physical things (for example, side effects of treatment) as well as emotional things My questions or concerns

29 Specialist Nurses Fill in during or after your appointment Answers to my questions or concerns Advice from my doctor or nurse PSA level: Date and time of next appointment:

30 30 Recurrent prostate cancer More information from us The Tool Kit The Tool Kit information pack contains fact sheets that explain how prostate cancer is diagnosed, how it is treated and how it may affect your lifestyle. Each treatment fact sheet also includes a list of suggested questions to ask your doctor. Leaflets and booklets Other leaflets and booklets about prostate cancer and other prostate problems can be ordered free of charge from Prostate Cancer UK. To order publications: Call us on Visit our website Call our Specialist Nurses If you want to talk about prostate cancer or other prostate problems, call our Specialist Nurses in confidence. You can also the nurses using the contact form on our website. Visit and click on we can help. Speak to our Specialist Nurses * * Calls are recorded for training purposes only. Confidentiality is maintained between callers and Prostate Cancer UK.

31 Specialist Nurses Other useful organisations Bladder and Bowel Foundation Helpline Information and support for all types of bladder and bowel problems. British Association for Counselling & Psychotherapy Phone Information about counselling and details of therapists in your area. CancerHelp UK Nurse helpline Cancer Research UK s patient information resource. College of Sexual and Relationship Therapists (COSRT) Phone Information about sexual and relationship therapy, and details of accredited therapists. Macmillan Cancer Support Helpline Practical, financial and emotional support for people with cancer, their family and friends.

32 32 Recurrent prostate cancer Maggie s Centres Phone A network of drop-in centres for cancer information and support. Includes an online support group. NHS Choices Information about treatments, conditions and lifestyle. Support for carers and a directory of health services in England. NHS Inform Helpline Provides health information and details of NHS and other support services in Scotland. NHS Direct Wales Phone Provides health advice 24 hours a day, and lists local health services in Wales, including GPs and dentists. nidirect Information about government services in Northern Ireland, including health services. Penny Brohn Cancer Care Helpline Complementary care for people with cancer and their families.

33 Specialist Nurses PromoCon (Promoting Continence and Product Awareness) Helpline Impartial information and advice about bladder and bowel problems. Samaritans Helpline Confidential, non-judgemental emotional support, 24 hours a day, by telephone, , letter or face to face. Sexual Advice Association Helpline Treatment information for erection difficulties and other sexual problems.

34 34 Recurrent prostate cancer About Prostate Cancer UK Prostate Cancer UK fights to help more men survive prostate cancer and enjoy a better life. We support men by providing vital information and services. We find answers by funding research into causes and treatments and we lead change, raising the profile of all prostate diseases and improving care. We believe that men deserve better. At Prostate Cancer UK, we take great care to provide up-to-date, unbiased and accurate facts about prostate diseases. We hope these will add to the medical advice you have had and help you to make decisions. Our services are not intended to replace advice from your doctor. References to sources of information used in the production of this booklet are available on our website. This publication was written and edited by: Prostate Cancer UK s Information Team. It was reviewed by: Louisa Fleure, Prostate Cancer Specialist Nurse, Guy s Hospital, London Patricia McClurey, Specialist Nurse Prostate Cancer, James Cook University Hospital, Middlesbrough Chris Parker, Clinical Oncologist, Royal Marsden Hospital, Sutton Christopher Scrase, Macmillan Consultant Clinical Oncologist and Honorary Senior Lecturer Ipswich Hospital Prostate Cancer UK Specialist Nurses Prostate Cancer UK Volunteers

35 Specialist Nurses Donate today help others like you Did you find this information useful? Would you like to help others in your situation access the facts they need? Every year, 40,000 men face a prostate cancer diagnosis. Thanks to our generous supporters, we offer information free to all who need it. If you would like to help us continue this service, please consider making a donation. Your gift could fund the following services: 10 could buy a Tool Kit a set of fact sheets, tailored to the needs of each man with vital information on diagnosis, treatment and lifestyle. 25 could give a man diagnosed with prostate cancer unlimited time to talk over treatment options with one of our specialist nurses. To make a donation of any amount, please call us on , visit /donations or text PROSTATE to 70004*. There are many other ways to support us. For more details please visit /get-involved *You can donate up to 10 via SMS and we will receive 100% of your donation. Texts are charged at your standard rate. For full terms and conditions and more information, please visit /terms

36 Speak to our Specialist Nurses * Like us on Facebook: Prostate Cancer UK Follow us on Prostate Cancer UK November 2013 To be reviewed November 2015 Call our Specialist Nurses from Mon to Fri 9am - 6pm, Wed 10am - 8pm * Calls are recorded for training purposes only. Confidentiality is maintained between callers and Prostate Cancer UK. Prostate Cancer UK is a registered charity in England and Wales ( ) and in Scotland (SC039332). Registered company number REC/NOV2013

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