On this page:
- Watchful waiting
- Active surveillance
- Radiation therapy (external beam and brachytherapy)
- Surgery (prostatectomy)
- Hormone therapy
- New treatments in clinical trials
Unsure what methods are used to treat prostate cancer? This is a general introduction to help you know the treatment options. Your specialist will explain the options recommended, as treatment can be highly individual.
Each treatment has advantages and disadvantages, and some side effects may continue into the long term. Your care team at Epworth will support you with the tools you need to understand your options. They are here to answer any questions you have, and speak openly about survival, quality of life, sexual function, fertility, and bladder and bowel health.
Also known as observation, watchful waiting for prostate cancer doesn’t involve treatment to cure prostate cancer. It is generally used for localised prostate cancer but is an option at all stages.
Watchful waiting is a plan to monitor and watch for symptoms caused by prostate cancer. If you start experiencing symptoms, you receive treatment with the goal to give relief and improve your quality of life.
Any treatment given is for symptom management, rather than cure.
Not the same as watchful waiting, active surveillance is a conservative approach with testing but no treatment at first. It involves regular monitoring to check if the prostate cancer is growing.
Active surveillance is an option for prostate cancer considered low risk. The goal is to avoid treatment that may not be needed.
Tests during this phase include regular PSA testing, digital rectal examination, prostate biopsy and MRI.
If tests during active surveillance show the prostate cancer is progressing, your specialist will discuss starting treatment with the aim to cure the cancer. Your options may include surgery, radiotherapy, or other treatments outlined on this page.
Some people feel surprised or nervous about not having treatment after a cancer diagnosis. Your care team is here to support you and can explain the reasoning behind this approach. Some people remain on active surveillance and never require treatment.
Surgery – prostatectomy
Radical prostatectomy is a surgery to treat prostate cancer. It involves removing the cancer by removing the prostate, seminal vesicles and some tissue.
A prostatectomy is a major surgery performed by a urologist under general anaesthetic. It is an option for localised prostate cancer (where it has not spread outside of the prostate).
Side effects of prostatectomy may include the risk of erectile dysfunction, urinary incontinence, shorter penis length, and surgery complications. A prostatectomy results in infertility, meaning you cannot conceive a child naturally afterwards. Your specialist can speak to you about fertility options.
Read more about types of prostatectomy, what to expect and how you’re supported pre and post surgery at Epworth.
Radiation therapy treats prostate cancer by aiming radiation (high energy rays) at cancer cells to kill or damage them. A radiation oncologist is a specialist in this type of treatment.
There are two main categories of radiation therapy for prostate cancer: external and internal.
- External beam radiation therapy uses low dose radiation from outside the body to target the pelvis. This requires you to come in for a short appointment every weekday, over a period of weeks.
Side effects of external beam radiation therapy may include erectile dysfunction (inability to get an erection), urinary urgency, urinary incontinence, bladder pain, and swelling and pain in the rectum.
- Brachytherapy uses internal radiation that is inserted in a one-off procedure into the prostate, to target the cancer. There are two types:
- Low dose rate brachytherapy permanently inserts seeds (about the size of rice grains) that send out gradual radiation in the prostate. The seeds stay there but stop being radioactive after several months to a year.
- High dose rate brachytherapy is a temporary implant of radiation under general anaesthetic. You stay in hospital for one to two days with removal of the radiation source before you go home.
Hormone therapy – androgen deprivation therapy (ADT)
Hormone therapy lowers levels of male sex hormones, called androgens, to stop or slow down prostate cancer. It is the most common treatment for advanced prostate cancer, where the cancer has spread.
Because prostate cancer needs androgens to grow, this type of therapy works to block them. Testosterone is the most common type of androgen.
Androgen deprivation therapy (ADT) is taken as an injection or medication tablet (drug). Types of ADTs include gonadotropin-releasing hormone (GnRH) analogues and antagonists, and anti-androgens.
Side effects of androgen deprivation therapy may include fatigue, decreased sex drive, erectile dysfunction, hot flushes, loss of muscle, weight gain, breast tissue growth, bone weakness, increased risk of type 2 diabetes.
Your care team is here to help you manage side effects. There are also actions you can take, such as exercise. Exercise can help with muscle mass, strength, fatigue, urinary issues and sexual wellbeing in men receiving ADT.
Chemotherapy is a drug that attacks prostate cancer cells. It is a part of treatment for advanced prostate cancer, together or after ADT.
Chemotherapy targets rapidly dividing cells, such as cancer cells. But it can also damage non-cancer cells, leading to side effects such as hair loss, nausea and vomiting, and increased risk of infection.
You receive chemotherapy in cycles to allow you to recover from side effects.
A medical oncologist is a specialist in this type of treatment.
Novel (new) treatments in clinical trials
Prostate cancer treatments are constantly evolving, with researchers aiming for better survival, reduced side effects and lower toxicity. New treatments available at the E.J. Whitten Prostate Cancer Research Centre at Epworth include a range of clinical trials and Victoria’s first Irreversible Electroporation (IRE) service.
Access to novel treatments requires taking part in a clinical trial, as they need to be proven in a large group of people. More recent clinical trial treatments don’t yet have long term data or comparison to existing options.
Irreversible Electroporation (NanoKnife)
Irreversible Electroporation (IRE) is a surgical technique and type of focal therapy used for prostate cancer.
The urologist uses a device called the NanoKnife, with ultrasound vision, to pass an electrical current through prostate tissue. This destroys the cancer cells but aims to protect important organs and healthy tissue around the prostate.
Irreversible Electroporation is a short, day procedure available at Epworth.
Immunotherapy is a category of treatment that uses your own immune system to fight prostate cancer. It is for advanced prostate cancer or prostate cancer with specific genetic mutations (changes).
A medical oncologist is also a specialist in this type of treatment.
There are two types of immunotherapy for prostate cancer:
- Sipuleucel-T is a cancer vaccine made from your white blood cells. This vaccine works to build your immunity against cancer.
- Checkpoint inhibitors are medications that block certain ‘switches’ in the body. To be eligible for standard treatment with inhibitors, your cancer must have specific genetic mutations.