Prostate cancer: treatment options

Updated November 2023 | 4 min read
Expert contributor Malcolm Freame, chief operating officer of the Prostate Cancer Foundation of Australia
Words by Charmaine Yabsley

Prostate cancer treatment, if detected early, can be highly effective, with many options now available. Prostate cancer is the most commonly diagnosed cancer in men in Australia. Here’s what you need to know.

In Australia it’s estimated that a male has a one in six (or 17%) risk of being diagnosed with prostate cancer by the age of 85. Prostate cancer occurs when abnormal cells develop in the prostate – the small, walnut-sized gland that sits below the bladder near the rectum.

And although over 3,500 men die of prostate cancer in Australia every year according to the Australian Institute of Health and Welfare, the prostate cancer survival rate has improved significantly in the last 30 years, according to Cancer Australia.

Malcolm Freame, chief operating officer of the Prostate Cancer Foundation of Australia (PCFA), says "Early detection is key for healthcare professionals to determine the best treatment options."

According to the Victorian Cancer Registry, the five-year survival rate for prostate cancer has improved from 57% between 1986 and 1990 to 94% between 2016 and 2020.

Symptoms of prostate cancer

As prostate cancer is a slow-growing disease, the majority of men with low-grade prostate cancer can be symptom-free in the early stages.

However, the PCFA and Cancer Council recommend looking out for the following symptoms, which may be more noticeable if the disease is at a later stage:

• feeling the frequent and sudden need to urinate
• finding it difficult to urinate – trouble starting or not being able to urinate, or poor urine flow
• discomfort when urinating
• finding blood in urine or semen
• pain in the lower back, upper thighs or hips
• unexplained weight loss.

These symptoms don’t mean you have prostate cancer, but if you do experience any of them, see your doctor.

If you don’t have any symptoms but are over the age of 40 and have a family history of prostate cancer, or you’re over 50, ask your doctor about the pros and cons of a prostate check.

How is prostate cancer diagnosed?

When you visit your doctor to check the health of your prostate, they’ll usually do a blood test. This blood test, also known as the prostate specific antigen (PSA) test, shows if there’s an increase in this protein. If your PSA level is high, you’ll need to see a specialist. Not all high PSA levels mean cancer is present, as other health issues, like a urinary tract infection, can cause a higher-than-normal level.

You’ll also have a prostate examination by your doctor, which involves a gloved, lubricated finger inserted into the rectum to check the size of the prostate and determine if it’s enlarged, or if there are any abnormalities.

To confirm the presence of cancer, you’ll be referred to a urologist. They may recommend an MRI before potentially proceeding to a more invasive biopsy. Eligible patients can claim a Medicare rebate for MRI scans to diagnose and monitor prostate cancer.

If a biopsy is needed, your urologist will be guided by an ultrasound as they insert thin, hollow needles through the rectum, or the perineum (the area between the anus and the scrotum), and remove a small sample of tissue from the prostate.

Prostate cancer treatment options

If you’ve been diagnosed with prostate cancer, your healthcare team will discuss the best treatment options with you. These may include:

Watchful waiting: In some cases, such as in older men who may not live longer than and additional 10 years due to age or other health issues, the most appropriate option may be to continue monitoring symptoms which can be treated as and when they occur.

Active surveillance: If your healthcare team has determined that your diagnosis is low risk, you may be advised that you’ll be regularly monitored through ongoing PSA testing, digital rectal examination and biopsy. The advantages of this form of treatment include fewer side effects than other treatments, the fact that your cancer is still closely monitored and if the situation stabilises, further treatment may not be needed.

Prostate removal: A radical prostatectomy, where the prostate is removed through surgery, can successfully stop the disease if it hasn’t spread beyond the prostate gland. The surgeon will remove the entire prostate gland and some of the tissue surrounding it.

There can be downsides to surgery, which may include long-term impotence, inability to ejaculate, infertility, possibility of incontinence, temporary or permanent difficulty in getting and maintaining an erection, and change in penis size.

Radiation: There are two main types of radiotherapy: external beam radiation therapy (EBRT), often used for earlier-stage cancers, and brachytherapy, often used for localised prostate cancer.

After treatment, your prostate may be sore, and you could have difficult or frequent urinating, and possible bowel discomfort. You will be advised to avoid sexual intercourse for a period, and sexual and fertility issues may also be a side effect.

Hormone treatment is another way to treat prostate cancer.

Before beginning treatment, ask your doctor or healthcare professional for any information or options available to you, including risks, how the procedures are carried out, recovery time, side effects and practical information such as how long you may need to take off work, or need help from others. By gathering all the information, you can then make an informed choice about which is best for your situation.

Taking charge of your health

Our Preparing for Hospital tool gives peace of mind with information and explainer videos on common procedures, like prostate cancer treatment options and questions to ask your doctor. This resource helps members make informed decisions and find out what they need to know and do, before they head to hospital.