Prostate Cancer

The most common treatment options for prostate cancer include watchful waiting, active surveillance, surgery, radiation therapy and hormone therapy, however other treatments such as chemotherapy, cryotherapy and theranostics are also used. The type of treatment you receive will depend on several different considerations, such as the type of prostate cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how prostate cancer treatment works in the private health system.

Watchful waiting is an option for men with small, early-stage prostate cancer which is slow-growing and isn’t causing symptoms. It is typically used for older people who are diagnosed with prostate cancer which isn’t expected to require treatment during their lifetime or for men with serious pre-existing health conditions. In some cases, it may also be offered as an alternative to active cancer treatments such as surgery or radiation therapy. Watchful waiting involves monitoring the prostate cancer through regular PSA tests, with treatment only occurring if the cancer progresses to help manage symptoms.

Active surveillance focuses on avoiding or delaying progression to active cancer treatment by monitoring the growth and spread of low-risk prostate cancer which isn’t causing symptoms. It typically involves additional tests to monitor the prostate cancer compared to watchful waiting, including PSA tests, digital rectal exams, MRI scans and biopsies. If the results show that your prostate cancer has begun growing and spreading, your doctor may recommend that you begin active treatment.

During surgery, surrounding lymph nodes may also be removed in a procedure known as a pelvic lymph node dissection. They will then be analysed for the presence of prostate cancer under a microscope to detect if your cancer has spread from the prostate.

Image guided radiation therapy (IGRT) is used to ensure EBRT is delivered as accurately as possible to your prostate cancer. This involves the use of advanced imaging equipment and computer software such as MRI, CT and x-ray.

Ensuring your radiation therapy treatment is highly-accurate

As part of your external beam radiation therapy treatment, you may have Calypso® radiofrequency transponders surgically placed in your prostate tumours to track and adjust the radiation beams due to natural movements of the body, such as breathing. Fiducial markers (gold seeds) may also be used, which help to more accurately locate the prostate gland during your radiation therapy treatment.

If your treatment is being delivered using the Varian TrueBeam linear accelerator (radiation therapy machine), triggered imaging technology may be used. This helps identify that a tumour is being accurately and precisely targeted by radiation and is specifically used for prostate cancers. Using markers implanted in the prostate, radiation therapists can visualise your tumour throughout treatment using low dose x-ray images, which allow the machine to automatically detect the position of the markers.

Reducing your risk of side effects

Your doctor may talk to you about having a prostate spacer such as SpaceOAR Hydrogel implanted by a urologist ahead of your treatment. A prostate spacer is a gel-like substance that is implanted between the prostate and rectum to reduce side effects during radiation therapy treatment.

Stereotactic radiation therapy

Stereotactic radiation therapy is an advanced technique used to treat small tumours with well-defined edges and can be used for both primary and metastatic (advanced) prostate cancer. It is different to conventional radiation therapy for prostate cancer, where the whole prostate is generally treated. Stereotactic radiation therapy reduces the overall treatment time for prostate cancer to one and a half weeks, delivering high doses of radiation in less than 15 minutes, and monitors the patient’s prostate motion using small gold markers to ensure the radiation is delivered accurately. Stereotactic radiation therapy for primary prostate cancer is available at Icon Cancer Centre Midland, Icon Cancer Centre Gold Coast Private, Icon Cancer Centre Greenslopes, Icon Cancer Centre Maroochydore, Icon Cancer Centre Noarlunga, Icon Cancer Centre North Lakes and Icon Cancer Centre Redland.

Stereotactic radiation therapy can also be used to treat advanced prostate cancer where the disease has started to spread to other parts of the body. Traditionally patients would be treated with hormone therapy and chemotherapy, which are often associated with negative side effects. Icon Group’s TRANSFORM study, published in the International Journal of Cancer, found that stereotactic radiation therapy can delay progression to these treatments for more than two years.

Icon is proud to offer access to this treatment approach at centres in New South Wales, ACT, Queensland, Victoria, Tasmania and Western Australia. If you would like to enquire about stereotactic radiation therapy treatment, please contact your local Icon team or send us a message.

Learn more about the latest in treatment for advanced prostate cancer.

Seed brachytherapy

Brachytherapy is a special form of internal radiation therapy where radioactive seeds are placed in the prostate to treat your cancer. Focal brachytherapy uses the same technique, however the radioactive seeds are placed into the tumour to directly target your cancer instead of the whole prostate, preserving the rest of the prostate gland and reducing side effects.

Men with prostate cancer can now access new precision focal brachytherapy at Icon Cancer Centre through the LIBERATE clinical registry, which aims to support the use of this cutting-edge prostate cancer treatment and reduce side effects to preserve men’s quality of life. As part of the LIBERATE clinical registry, focal brachytherapy treatment is available at Icon Cancer Centre Geelong, Icon Cancer Centre Richmond, Icon Cancer Centre Freemasons, Icon Cancer Centre Midland and Icon Cancer Centre Rockingham.

Cryotherapy (also known as cryosurgery or cryoablation) is a less common treatment for prostate cancer which uses a needle-thin probe and low temperature gases to destroy prostate cancer tumours by freezing them. It may be used if your prostate cancer has come back following radiation therapy treatment, or as an alternative to surgery or radiation therapy for men with low-risk, early-stage prostate cancer.

When you are diagnosed with prostate cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer.

Common treatment options for each stage of prostate cancer include:

Localised prostate cancer (Stage I and II) 

Surgery to remove the prostate gland (radical prostatectomy), radiation therapy with or without hormone therapy and active surveillance are the most common treatment options for early-stage prostate cancer, alongside cryotherapy. Radiation therapy may involve external beam radiation therapy or brachytherapy. With recent advances in prostate cancer treatment, you may also have the option of focal brachytherapy treatment. 

Locally advanced prostate cancer (Stage III) 

Locally advanced prostate cancer requires a combination of treatments, which usually begins with radiation therapy combined with hormone therapy or surgery. If you receive surgery, radiation therapy is often recommended as your second line of treatment. 

Metastatic or advanced prostate cancer (Stage IV) 

Treatment for stage IV prostate cancer commonly includes hormone therapy, which may be delivered in combination with chemotherapy. If hormone therapy is no longer effective, further treatments may include chemotherapy, immunotherapy, or targeted therapy or theranostics. Clinical trials may also offer new treatment options for advanced prostate cancer patients.