Each year more than 17,000 Australian men are diagnosed with prostate cancer. Prostate cancer is now the most common cancer among men, excluding non-melanoma skin cancers.

Nowadays a lot of prostate cancers are detected following an abnormal PSA (prostate specific antigen) blood test and/or digital examination performed by GP. Prostate biopsy is required in most cases to confirm the diagnosis. Patient may or may not have symptoms of lower urinary tract, such as frequency, urgency, slow flow, hesitancy, and rarely, blood in the urine. When the prostate cancer has spread to the bone, patient could present with bone pain at the first instance. There is now evidence to suggest that prostate cancer can run in the family.

Prostate cancer is unusual in that it is slow growing in some men and not a threat, but for others the cancer can be aggressive. Therefore early treatment in selected patients will lead to improving patient survival in the long run. However, side effects of treatment may affect patients’ lifestyle including their sexual function and continence.

Management of prostate cancer may involve a number of different health care professionals. The decision on how best to treat prostate cancer depends on age and general health of the patient, as well as the grade and stage of the cancer. Although nearly all treatments have side-effects, most can be effectively managed.

OPTIONS

Active surveillance or watchful waiting is offered for slow growing cancer that occurs in older men, so they are not always a threat to life. The possible side-effects of active treatment such as surgery may have more impact on life of the patient than the cancer. You will still need regular prostate tests, which may include repeated biopsies to make sure things haven’t changed.

Surgery is the removal of the prostate (prostatectomy). Surgery requires on average three to six days in hospital, followed by a six week recovery period. Once the cancer has spread outside the prostate gland, surgery is not normally an option, however other treatments are available.

Radiotherapy treats cancer by using high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells or organs, such as the back passage (rectum) or the bladder. It may be used instead of surgery or in combination with surgery. It can also be used to reduce the size of the cancer and relieve pain, discomfort or other symptoms. There are two ways of giving radiotherapy, one way is external beam radiotherapy, and the other is brachytherapy.

Hormone treatment involves reducing the male hormone, testosterone, to help slow the growth of the cancer. This is done by using drugs that stop the release of hormones that cause the testicles to produce testosterone.

Chemotherapy may not be routinely used when prostate cancer is first diagnosed, however may be offered if the cancer spreads and other treatments have not been effective.

CURATIVE TREATMENT FOR PROSTATE CANCER

Surgery (Prostatectomy)
We have a dedicated team of urologists in Macquarie University Hospital specialise in treating prostate cancer and cancer of the urinary system. Radical prostatectomy can be performed by either an open cut in the lower abdomen or laparoscopically (using a camera and smaller cuts). The result in terms of cancer control success rate are similar with the two, however, some studies suggest that there is less bleeding and quicker recovery time for patients undergone laparoscopic prostatectomy.

Radiotherapy
At Macquarie University hospital, our radiation oncology department offers a range of radiotherapy in treatment of prostate cancer. Some of our doctors have sub-specialty training in treating cancer of different types.
External beam radiotherapy and brachytherapy both appear to be effective in curing prostate cancer.

External beam radiotherapy is given in the hospital radiotherapy department, usually as daily sessions from Monday–Friday, with a rest at the weekend. For early prostate cancer, the course of treatment may last from 7 to 8 weeks.
Intensity Modulated Radio Therapy (IMRT) and Volumetric Modulated Arc Therapy (V-MAT) are more complex types of radiotherapy and allow the radiation oncologist to vary the dose of radiation given to different parts of the tumour and surrounding tissue.

Brachytherapy- “Brachy” means “short-distance” in Greek, and therefore brachytherapy refers to radiotherapy treatment when the radiation source is placed right next to or within the tumour.

Seed implant brachytherapy can be carried out under a general anaesthetic or a spinal anaesthetic (epidural). Small radioactive metal ‘seeds’ are inserted into the prostate so that radiation is released slowly over a period of time.
The seeds are not removed, but the radiation gradually fades away over about six months. There is no risk of this treatment affecting other people.

High Dose Rate (HDR) brachytherapy is another method of giving brachytherapy; it is used to treat more high risk or locally advanced prostate cancer. Temporary hollow needles are implanted into patient’s prostate under general anaesthetics and radioactive seed is delivered into the needles at calculated positions and retracted back to the delivery machine once treatment is finished. The needles are removed once the numbers of treatments are delivered. Patient needs to stay in bed while implant needles are in place, usually for less than 24 hours.