Effective Prostate Cancer Treatment

About prostate cancer

Around 20 000 men will be diagnosed with prostate cancer this year. After skin cancer, it is the most common cancer diagnosed in Australian men.

Doctor Katelaris has had a particular clinical interest and expertise in the management of prostate cancer for over 30 years and understands that a cancer diagnosis can be confusing and confronting. This section aims to explain some of the medical terms you will hear after you have been diagnosed with prostate cancer and what you can expect from treatment.

Learn about prostate cancer:

What is prostate cancer?

Prostate cancer begins when abnormal cells in the prostate start growing in an uncontrolled way. In most cases, prostate cancer grows more slowly than other types of cancer. This might mean that you do not need treatment straight away. However, some prostate cancers can grow and spread quickly, so it is important to investigate any symptoms or unusual test results promptly.

Early (or localised) prostate cancer means cancer cells have grown but, as far as it is possible to tell, have not spread beyond the prostate.

There are two stages of advanced prostate cancer. If cancer grows and spreads outside the prostate gland into the seminal vesicles (glands that lie close to the prostate) or nearby parts of the body, such as the bladder or rectum, it is called locally advanced prostate cancer. Metastatic prostate cancer is when cancer has spread to distant parts of the body such as the lymph glands or bones.

Source: The Cancer Council Australia

How to determine if you have prostate cancer?

The risks of having prostate cancer and how to avoid them:

Prostate cancer symptoms

Early prostate cancer rarely causes symptoms. Even when prostate cancer is advanced at the time of diagnosis, there may be no symptoms. Where symptoms do occur, they are often due to non-cancerous conditions, such as benign prostate hyperplasia.

Symptoms of advanced prostate cancer may include:

  • Unexplained weight loss
  • Frequent or sudden need to urinate
  • Blood in the urine
  • Pain in the lower back, hips or pelvis.

These are not always signs of prostate cancer, but you should see your doctor if you have any of these symptoms.

Source: The Cancer Council of Australia

Prostate cancer diagnosis

In the modern era, the first step to diagnosing prostate cancer is usually by detecting an elevation in PSA through routine screening. Cancer may also be diagnosed after an abnormal digital rectal examination.

A definitive diagnosis requires taking a biopsy of the prostate and examining the tissue under a microscope for cancer cells.

A diagnostic MRI scan is usually ordered.

Biopsies may be performed under ultrasound or MRI guidance

You can read more about how MRI technology is improving prostate cancer management here.

If cancer cells are detected in your biopsy, the cancer will be given a pathological staging, called a Gleason score. This is a score based on the microscopic appearance of the cancer cells, with the minimum score being 2 and the maximum being 10. A higher Gleason score indicates a higher grade, more aggressive cancer and is associated with a poorer prognosis.

Your cancer will be clinically staged with a bone scan and CT scan to check for metastatic disease. PSMA PET Scanning is now the most modern staging scan.

Based on the aggressiveness of your cancer and other factors, such as your age, other medical conditions you may suffer from and the likelihood that treatment will lead to a better outcome, your doctor may recommend active treatment or active surveillance, a “watchful waiting” approach to managing your prostate cancer.

Prostate cancer treatment options

There are a number of options for treating prostate cancer. Depending on how aggressive or advanced the cancer is your options will differ. These options include:

  • Active surveillance
  • Prostate cancer surgery: Radical prostatectomy
  • Brachytherapy
  • External beam radiation therapy
  • Androgen deprivation therapy and biochemical failure

However, no matter what stage your cancer is, it is a good idea to consider the following:

  • Weigh up the pros and cons
  • Consider how important any possible side effects are to you
  • Think about the cost and availability of treatment

Active surveillance

Active surveillance means you will not have any aggressive treatment. It is recommended for low grade, low volume cancers where the best available research to date suggests that there is little (if any) difference in long term survival between men who are treated and men who are not. It allows you to avoid the negative side effects of treatments.

However, prostate cancer is a serious disease and it is important to monitor your progress. Active surveillance means just that – regular testing to ensure the disease has not progressed to a point that it requires treatment.

Our active surveillance program involves regular PSA testing and, if necessary, repeat biopsies. Our use of the new multiparametric MRI prostate technology has enabled us to safely monitor men on the active surveillance program without necessarily subjecting them to regular repeat prostate biopsies. Active surveillance requires patient compliance for it to be a safe management strategy. 

For men who require active management, choice of management becomes the issue.

The choice between surgery and radiation depends on many factors including patient age, patient co-morbidities, lower urinary tract symptoms and tumour characteristics. Younger men with the organ-confined disease and especially men with outflow obstructive symptoms are best managed by radical prostatectomy.

Prostate cancer surgery

Radical prostatectomy

Radical prostatectomy is an operation to completely remove the prostate, seminal vesicles and some of their associated pelvic lymph nodes. The goal is to completely remove any cancer contained within the prostate and surrounding tissues. For locally confined disease, this provides an excellent chance of cure.

Learn more here about robotic surgery: Advanced treatment for prostate cancer

In 1982 Professor Patrick Walsh popularised modern nerve-sparing radical prostatectomy. His improvements allowed better control of important blood vessels to reduce bleeding and precise localisation and preservation of the nerves responsible for erectile function. This surgery remains the gold standard treatment for localised prostate cancer. It is the best management for younger men with the organ-confined disease and especially men with outflow obstructive symptoms. Such men need to choose between open surgery, laparoscopic or robot-assisted laparoscopic radical prostatectomy.

The approach that is best for you will be discussed at your pre-operative appointment.

Brachytherapy: An effective alternative to radical prostate surgery

For certain men with low-risk cancers, brachytherapy may represent an effective alternative to radical prostatectomy surgery or external beam radiation therapy. Brachytherapy may be an option for you if you have:

A Gleason score ≤ 7
A PSA at diagnosis of ≤ 10 ng/mL
≤ 50% positive biopsy cores

There are two kinds of brachytherapy: high dose rate brachytherapy and iodine seed brachytherapy. Both involve implantation radioactive material into the prostate under transrectal ultrasound guidance. This allows the dose of radiation to be targeted to the cancer cells, reducing the impact on surrounding healthy organs and to be lower than in external beam radiotherapy.

Assessing your risk profile is critical in making the decision to undergo brachytherapy instead of radical prostatectomy. For men with high-risk disease, radical prostatectomy remains the most effective treatment for disease-free survival.

External beam radiation therapy

For some patients, who have the disease that is localised but not confined to the prostate or who are unable to undergo surgery, external beam radiation therapy may be the best treatment option. In that event, we will organise a referral to a radiation oncology specialist who will discuss the best means of management.

Androgen deprivation therapy and biochemical failure

No treatment for prostate cancer is 100% effective; there is a risk after any form of treatment that some of your cancer will remain or recur and that you will require further treatment. For many men, this is maybe many years in the future and is detected by monitoring the PSA. “Biochemical failure” is said to have occurred when your PSA rises above a certain level after radical prostatectomy or other definitive treatment. At this point, you may be treated with androgen deprivation therapy.

Androgens are “male hormones” which play an important role in male sexual development and function, the most well-known being testosterone. Androgens can also play a role in prostate cancer growth: blocking the production of male hormones can cause prostate cancers to shrink or grow more slowly for a period of time, prolonging the time that you are symptom-free. Androgen deprivation therapy is not a cure for prostate cancer, and it does have a number of side effects including reduced libido, hot flushes and fatigue.

There are several different types of drugs that block androgen production, some involve oral tablets are taken daily and some involve injections given by your doctor over a much longer period. These either block the ability of the body to respond to androgens or prevent the production of androgens.

Surgical removal of the testes, or orchidectomy is also an effective and permanent way to reduce androgens in the body. The testes are the site of androgen production.

Frequently Asked Questions

The diagnostic procedure has three steps. You undergo a digital prostate examination (DRE), and a PSA blood test, which screens the blood for its prostate-specific antigen level. If these tests reveal a problem, you may undergo a biopsy.

There’s no proven prostate cancer prevention strategy. But you may reduce your risk of prostate cancer by making healthy choices, such as exercising and eating a healthy diet. Mayo Clinic

When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include:
The noticeable symptoms of early-onset prostate cancer include:

  1. Frequent urination, especially at night
  2. Pain on urination
  3. Presence of blood in the urine
  4. Unexplained weight loss

Note that some of these symptoms may be similar to those for benign prostatic hyperplasia or BPH, which is a benign enlargement of the prostate gland. BPH is a normal part of the ageing process, and can easily be treated with prostate enlargement surgery.

If you are concerned about PC or have symptoms of BPH. that you exhibit any of the above symptoms, please refer to us at Katelaris Urology for a consultation with Dr Katelaris.

Prostate Cancer Statistics

The below statistics are referenced from The Australian Institute of Health & Welfare
Dates data collected March 2019

Additional prostate cancer resources