Your Treatment Options

There may be a non-surgical alternative for your cancer, depending on your circumstances.

Prostate cancer is the second most commonly-diagnosed cancer in Australian men. Most men who have prostate cancer don’t die of it — they live with it and die of something else. This is because prostate cancer is usually slow-growing.

However, some cancers are aggressive and need treatment. This can have adverse effects that reduce your quality of life, including incontinence and erectile dysfunction. So, depending on your circumstances and how aggressive your cancer is, you should carefully consider and discuss all options with your doctor before opting for surgery.

Facts to consider before opting for surgery

• Most prostate cancers take many years to extend beyond your prostate.
• Active surveillance is as effective as surgery in low-risk localised prostate cancer in most men.
• Most men with localised prostate cancer die of something unrelated.
• Prostate cancer is found in up to 65% of autopsied men who die in their 60s of something else.
• The odds of a man dying of localised prostate cancer within 10 years of diagnosis is 1%.
• Over 60% of men who have prostate cancer surgery suffer from urinary incontinence.
• Up to 68% of men who have prostate cancer surgery experience erectile dysfunction.
• With active surveillance, you may be able to live without surgery or postpone it for many years.

Read more about the pros and cons of the surgery

Active surveillance and watchful waiting

Active surveillance is an option if your cancer is low-risk, slow-growing and hasn’t spread beyond your prostate. Active surveillance usually involves a blood test for prostate specific antigen (PSA) once or twice a year and repeat prostate biopsies every 2–3 years.

Watchful waiting is the term used to monitor a cancer if you’re elderly or have health problems that increase the risks of surgery. In these situations, watchful waiting may help you avoid possible incontinence or erection problems that can result from surgery. Watchful waiting doesn’t involve biopsy but does include monitoring your PSA and symptoms.

The benefit of active surveillance or watchful waiting is that you avoid all the risks and side effects of treatment. On the downside, your cancer could grow or spread, making it harder to treat. Some men find it stressful knowing they’re living with cancer and would rather take a more active approach.

External beam radiation therapy (EBRT)

Radiation is an alternative for localised prostate cancer surgery and can be as effective. External beam radiation uses a machine that focuses radiation on your prostate gland. You can continue your normal activities during the treatment but you need to commit to treatment 5 days a week for 5–8 weeks.

EBRT can cause erectile dysfunction or an urgent need to urinate which may be associated with incontinence, as well as bladder and rectal pain. Radiation therapy can also be used after surgery when there’s a risk the cancer has spread.

Brachytherapy

Brachytherapy involves inserting permanent radioactive pellets directly into your prostate. By giving off localised radiation, they can destroy the cancer cells. Unlike EBRT, you’ll probably only need one treatment session. The radioactivity lasts for weeks or months.

It can cause erectile dysfunction, urgent need to urinate, painful urination and trouble emptying your bladder. Occasionally it causes bowel problems as well.

You’ll need to have a general anaesthetic and stay in hospital for 1–2 days.

High intensity focused ultrasound (HIFU)

This treatment for localised prostate cancer uses heat from high frequency sound waves to destroy cancer cells. Performed under general anaesthetic, the procedure takes up to 3 hours. Only a few centres in Australia offer HIFU and it is not covered by Medicare or private health insurance.

Cryotherapy (cold therapy)

Cold temperatures can kill prostate cancer cells and your doctor may recommend this approach for localised cancer or if radiation therapy hasn’t worked. Using ultrasound for guidance, your doctor inserts needles into your prostate through the area between your scrotum and anus. The needles create very cold temperatures, causing the cancer cells to die.

Cryotherapy is less invasive than other types of prostate surgery but its long-term effectiveness hasn’t been established. Like surgery, cryotherapy can also leave you with erection problems and/or incontinence. There’s currently no Medicare rebate for cryotherapy and private health funds don’t cover it.

Hormone therapy

Male hormones stimulate prostate cancer cells to grow. Drugs that block the production of male hormones may shrink the cancer or cause it to grow more slowly. You can use hormone therapy as an alternative to surgery or before radiation therapy. Hormone therapies are available as injections, implants or tablets. It doesn’t cure your cancer and can have side effects such as breast swelling, bone thinning, weight gain, hot flushes, erection problems, lowered sex drive, mood swings and heart disease.

Testicle removal

Because most of a man’s male hormones are made in the testicles, removing them has a similar effect to hormone therapy, by reducing the production of the hormones that cause prostate cancer to grow. If you choose this option, your scrotum wouldn’t be removed and you can have implants put in it for an improved cosmetic effect.

Chemotherapy

If cancer has already spread beyond your prostate, or hormone therapy stops working, you may be offered chemotherapy.