Prostate cancer can be described as:^4,5

• Localised (early stage) – the cancer is contained within the prostate
• Locally advanced – the cancer has spread to nearby areas such as the bladder, rectum, or pelvic wall
• Advanced (metastatic) – the cancer has spread to more distant parts of the body, such as the lymph nodes or bones

Prostate cancer is often slow growing, and many men experience few or no symptoms and may live for many years without the cancer spreading.^4,5

The prostate is a small gland that sits just below the bladder and in front of the rectum in men. It surrounds the urethra (the tube that carries urine and semen out of the body through the penis). The prostate gland is part of the male reproductive system. It produces prostate fluid — one of the main components of semen — and a protein called prostate-specific antigen (PSA).⁵

The prostate gland is often described as being about the size of a walnut, and it is normal for it to grow as men age. To grow and function, the prostate relies on the male hormone testosterone, which is produced by the testicles.⁵

Most men with early or localised prostate cancer do not experience any symptoms. Prostate cancer may remain asymptomatic even after it has spread. Symptoms that may occur with prostate cancer include:^4,5

• Frequent or sudden urges to urinate
• Difficulty or discomfort when urinating
• Blood in the urine or semen
• Pain in the lower back, hips, or upper thighs
• Unexplained weight loss

These are not all the possible symptoms of prostate cancer, and they are not always caused by prostate cancer. Symptoms and their severity can vary between individuals, and some may be difficult to notice.^4,5

If you experience any of these symptoms and they persist, it is recommended that you make an appointment with your GP.

The exact cause of prostate cancer is not known, although there are several factors that are known to increase the risk of developing the disease. Common risk factors include:^3-5

• Age – the risk increases significantly after the age of 50
• Family history – the risk is higher in men who have a father or brother diagnosed with prostate cancer
• Inherited gene mutations – changes in certain genes, such as BRCA1 or BRCA2 (also linked to breast and ovarian cancers), can increase the risk of prostate cancer

If you have concerns about your risk or are experiencing possible symptoms, speak with your doctor.

A number of different tests can be used to check for changes in the prostate and confirm a diagnosis of prostate cancer. Some of these tests include:^4,5

• Blood test (PSA test) – checks for raised levels of prostate-specific antigen (PSA). The PSA level can indicate whether prostate cancer is likely or unlikely, but many factors can affect PSA levels. This test alone cannot diagnose prostate cancer and is usually used to guide further testing.
• Digital rectal examination (DRE) – a urologist inserts a gloved, lubricated finger into the rectum to feel for changes in the size, shape, or firmness of the prostate.
• Magnetic resonance imaging (MRI) – uses detailed imaging to identify abnormalities in the prostate and surrounding tissues.
• Biopsy – involves using a needle guided by ultrasound or MRI to take small samples of prostate tissue. These are examined under a microscope to confirm whether the cells are cancerous (malignant) or non-cancerous (benign).

If you are diagnosed with prostate cancer, your care will usually be managed by a multidisciplinary team (MDT) – a group of health professionals that may include a urologist, radiation oncologist, and medical oncologist.^3-5

Making a decision about which cancer treatment to have can be difficult. It is recommended that you discuss all available options – including those suggested by your multidisciplinary team – with your specialist before starting treatment.

Some important considerations may include the location of the treatment centre, the duration of treatment, potential side effects, and any additional costs that may be involved.⁴

Different factors can influence the treatment plan recommended for your prostate cancer, including:^3-5

• The location of the cancer
• How advanced the cancer is
• The severity of any symptoms
• Your age and general health
• Your personal preferences

Radiation therapy, also called radiotherapy, helps to kill cancer cells. Radiation therapy uses controlled doses of radiation to damage or destroy cancer cells, and can be delivered from outside the body (called external beam radiation therapy, or EBRT) or from inside the body (called brachytherapy).^2,3

Radiation therapy may be offered in the early stages of cancer treatment, or after it has started to spread. Different radiation therapy techniques may be suitable for different cancer types at different stages.^2,3

Intensity Modulated Radiotherapy (IMRT) helps precisely deliver high doses of radiation to the tumour whilst protecting normal tissues, resulting in fewer side effects.⁴

Image Guided Radiation Therapy (IGRT) uses imaging (x-rays and scans) before and during treatment to track the exact shape, size, and location of the tumour, allowing for adjustments during treatment sessions to precisely target the tumour.⁴

Stereotactic ablative radiation therapy (SABR) uses modern 3D camera technology aiming to target and help kill cancer cells. It targets tumours in the body with high doses of radiation therapy with minimum damage to surrounding healthy tissues.¹⁰

Stereotactic Body Radiation Therapy (SBRT) delivers high doses of radiation from many angles, allowing treatment of small tumours. SBRT can deliver a high dose of radiation over a shorter period, meaning fewer sessions and treatment duration (within clinics, not necessarily in hospitals).⁴

Low Dose Rate Brachytherapy (LDR) involves permanently placing brachytherapy seeds in, or near, the tumour inside the prostate. The seeds continually release low-dose radiation over several months.^2,3

Volumetric Modulated Arc Therapy (VMAT) is a form of IMRT that uses a moving machine to shape the radiation to fit the target area, and usually involves shorter treatment sessions.⁴

Hormonal therapy - Hormone therapy, also called androgen deprivation therapy, can be used to reduce the testosterone that drives the growth of prostate cancer. It can be given before, during, and sometimes after radiation therapy to help improve the effectiveness of the radiation therapy and reducing the risk of the cancer spreading or returning.^2,3

Chemotherapy - uses medication to treat cancer by killing cancer cells or slowing their growth and spread. The medication is usually given intravenously (via a needle inserted into a vein). Chemotherapy may be used in conjunction with other cancer treatments. The type and duration of chemotherapy are determined on an individual basis by a patient’s medical oncologist.^2,3

Theranostics - is an approach to cancer therapy that combines diagnostic and treatment techniques to detect and treat some cancer types. Theranostics may be used to treat cancers that have spread (metastasised), or where the cancer is advanced and/or has not responded to other treatments.^8,9

Based on current research and clinical experience, theranostics is most likely to be suitable for patients with metastatic prostate cancer or neuroendocrine tumours.^8,9 Your GenesisCare oncologist will determine if theranostics may be suitable for you.

Theranostics treatment may involve one or more therapeutic goods which have not been reviewed for safety, quality, or efficacy by the Therapeutic Goods Administration (TGA). Some patients may be eligible to access this treatment under the Special Access Scheme. The cost of treatment may be an out-of-pocket expense.¹⁰