The latest treatment options for prostate cancer

Prostate cancer is the second most common cancer in men (after lung cancer), with more than 1.2 million cases reported globally each year.¹

Almost 60% of those diagnosed are over the age of 65, with age being a risk factor alongside family history. However, survival rates are encouraging and range from 76-98% after five years.¹

While there may be no symptoms in the early stages, common symptoms of advanced cancer may include:²

• Frequent urination
• Pain while urinating
• Blood in the urine and/or semen
• Weak urination stream
• A feeling of weakness in the legs
• Pain in the back, pelvis, groin, or lower limbs

None of these symptoms necessarily mean you have cancer, but it is best to discuss any concerns with a GP. In addition, men older than 50 can ask their GP about the risks and benefits of screening for prostate cancer with periodic prostate-specific antigen (PSA) blood tests.

Treatment options for prostate cancer include:

• Active surveillance and watchful waiting – Recommended when the cancer is small and considered low risk and unlikely to spread or impact quality of life. May include regular scans and biopsies to track the cancer’s progression.
• External beam radiation therapy – A highly targeted form of radiation therapy that treats the tumour area only, avoiding adjacent tissue. 
• Brachytherapy – A form of radiation therapy in which a source of radiation is put inside the body, close to the cancer.
• Radical prostatectomy – A procedure where the whole prostate gland is removed. 
• Stereotactic body radiation therapy (SBRT) – A type of radiation therapy where the cancer site is targeted, and healthy surrounding tissue is not impacted.

The type of treatment your doctor recommends will depend on the stage of your cancer, risk factors relating to your age, and how each treatment might impact your quality of life.³

As with any cancer treatment, prostate cancer treatment can have positive and negative impacts on the patient. For example, while major complications are uncommon with radical prostatectomy, up to 87% of patients have reported erectile dysfunction and urinary incontinence after surgery, with many men experiencing these side effects long-term.⁴

Similarly, external beam radiation therapy has a good long-term success rate³, but can adversely affect sexual function and urinary continence. Patients may also experience bowel urgency and haemorrhoids.^3,5 In addition, external beam radiation therapy has been associated with a slight increase in the risk of subsequent secondary cancer, predominantly in the bladder and rectum.⁶

Because of these negative impacts, doctors have been researching alternative lower-risk treatments, including SBRT.

SBRT is a relatively new treatment for prostate cancer that targets tumours with high-dose, high-precision radiation.⁷ It is also known as stereotactic ablative radiation therapy. It has also been used to treat other cancers, including lung, liver and kidney, and cancers that have spread from the original site.⁷

Research into SBRT’s effectiveness at treating localised prostate cancer has shown promising results in low- and intermediate-risk groups after 10-year follow-up. Importantly, treatment-related toxicity rates are also low.⁸

SBRT for prostate cancer has shown several advantages over other treatments, including:

• It may retain greater sexual and urinary continence function compared with surgery⁹
• It has a low long-term impact on health-related quality-of-life scores⁹
• It is non-invasive and better able to spare healthy adjacent tissue compared with conventional radiation therapy^8,10
• Fewer treatment sessions are needed than with conventional radiation therapy⁸
• It is cost-effective, potentially improving patient access⁸

While further research is taking place and the type of treatment most suitable for individual patients depends on their specific needs and circumstances, SBRT is increasingly considered an acceptable treatment option for appropriate patients with localised or oligometastatic prostate cancer.^10,11

_{Disclaimer: Any procedure including treatments involving radiation carry risks, including skin irritation and associated pain. Before proceeding with a referral for treatment, patients should be advised to seek a second opinion from an appropriately qualified health practitioner. As in any medical procedure, patient experiences and outcomes will vary.}

1. Rawla P. World J Oncol 2019;10(2):63-89.
   
2. Australian Government Cancer Australia: Prostate cancer symptoms. www.canceraustralia.gov.au/cancer-types/prostate-cancer/symptoms-and-diagnosis
3. Dearnaley D, et al. Lancet 2016; 17(8):1047-1060.
4. Kesch C, et al. Front Surg 2021.684088.
5. Potosky A, et al. JNCI 2004; 96(18):1358-1367.
6. Bostrom P, et al. Europ Urol 2007;52(4):973-982.
7. Lo S, et al. Nat Rev Clin Oncol 2010;7:44-54.
8. Kothari G, et al. Technol Cancer Res Treat 2018;17:1533033818789633.
9. King C, et al. Int J Rad Onc Biol Phys.2013; 87(5):939-945.
10. Phillips R, et al. JAMA Oncol 2020; 6(5):650-659.
11. Ahmed K, et al. Front Oncol 2013;2.