Management and treatment of prostate cancer

Options for managing and treating prostate cancer

There are different options for managing and treating prostate cancer, and more than one treatment may be suitable for you. Your specialists will let you know your options and discuss them with you, so you can make an informed decision. This is called shared decision-making. You can ask about other options and what they would mean for you. For example, if surgery is suggested, you could ask if radiation therapy is an option. Treatment recommended by your doctors will depend on the stage and grade of the cancer, your general health, age and preferences.

Prostate cancer is typically slow growing, even in its most aggressive form, giving you time to make decisions about your management or treatment options.

Management and treatment options by stage

Localised (early)

• active surveillance
• surgery and/or radiation therapy
• watchful waiting

Locally advanced

• surgery and/or radiation therapy
• androgen deprivation therapy (ADT) may also be suggested
• watchful waiting

Advanced (metastatic)

• usually androgen deprivation therapy (ADT)
• additional hormone therapy, newer drug therapy or targeted therapy is often combined with ADT
• sometimes chemotherapy or radiation therapy
• watchful waiting may be an option
• newer treatments as part of a clinical trial

For localised or locally advanced prostate cancer, it is advised that you see both a urologist and a radiation oncologist to discuss your options before deciding on treatment. 

For advanced prostate cancer that has spread to bones or other organs, you should also see a medical oncologist. Your urologist or GP can give you a referral to a radiation oncologist or medical oncologist. 

Active surveillance

This is close monitoring of low-risk prostate cancer that isn’t causing symptoms. The aim is to avoid treatment that’s not yet needed, while watching for any changes that mean treatment should start.

Active surveillance is usually suggested for prostate cancers with a PSA level under 10 ng/mL, stage T1–2, and Gleason 6 or less (Grade Group 1). It may also be suggested for certain cancers with a PSA level between 10 and 20, and some Grade Group 2 cancers.

About 80% of Australians with low-risk prostate cancer choose active surveillance. It involves PSA tests every 3–6 months, mpMRI scans, possible digital rectal examinations and biopsies if advised by your urologist. If results show the cancer is growing faster or more aggressively, your specialist may suggest starting active treatment.

Watchful waiting

Watchful waiting may be suggested if you are older and the cancer is unlikely to cause a problem in your lifetime. It may be an alternative to active treatment if the cancer is advanced at diagnosis, or if other health problems would make it hard to handle surgery or radiation therapy.

The aim of watchful waiting is to maintain quality of life rather than to treat the cancer. If the cancer spreads or causes symptoms, you will have treatment to relieve symptoms or slow the growth of the cancer, rather than to cure it.

Watchful waiting may involve fewer tests than active surveillance. You will have regular PSA tests and your doctor may suggest an mpMRI if your PSA is of concern. They may discuss whether to have a biopsy.

More treatment options for prostate cancer