Management or treatment of prostate cancer

Prostate cancer is typically slow-growing, giving men time to make decisions about their management or treatment options.

Sometimes it is difficult to decide on the type of management or treatment that is right for you. You may feel that everything is happening too fast. Check with your doctor how soon you need to make a decision and take as much time as you can. Understanding the disease, treatment options and possible side effects can help you make an informed decision that’s based on your personal values.

If you are offered a choice of management or treatment, you will need to:

• weigh up the pros and cons
• consider how important any possible side effects are to you
• think about the cost and availability of treatment (some treatments, such as brachytherapy and robotic-assisted surgery, are only available in some locations and may cost more).

If you have a partner, you may want to talk about treatment options with them. You can also talk to friends and family or men you know who have had prostate cancer. If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been offered. You also have the right to accept or refuse any treatment offered.

Some men with more advanced prostate cancer may choose treatment even if it only offers a small benefit for a short period of time. Such options often won’t cure the cancer but may slow its progress and improve quality of life.

The treatment you have will depend on a number of factors including the stage of the cancer, your general health and your preferences.

Localised 

Active surveillance, surgery or radiation therapy are usually offered. Watchful waiting may be an option.

Locally advanced

Active surveillance is not recommended and you will be offered surgery and/or radiation therapy. Androgen deprivation therapy (ADT) may also be suggested.

Advanced/metastic (at diagnosis)

Usually offered androgen deprivation therapy (ADT), sometimes chemotherapy or radiation therapy. Watchful waiting may be an option. Newer treatments may be available as part of a clinical trial.

It important to feel that your sexuality is respected when discussing how cancer treatment will affect you. Your medical team should be able to openly discuss your needs and support you through treatment. Try to find a doctor who helps you feel at ease talking about sexual issues and relationships.

If you have a partner, encourage him to come to medical appointments with you. This will show your doctor who’s important to you and will enable your partner to be included in discussions and treatment plans.

You can contact the Prostate Cancer Foundation of Australia (PCFA) on 1800 22 00 99 or at prostate.org.au to request a free copy of the Prostate Cancer Pack: Information for Gay and Bisexual Men. PCFA also have support groups for gay and bisexual men.

When your doctor first tells you that you have cancer, you may not remember the details about what you are told. Taking notes or recording the discussion may help. Many people like to have a family member or friend go with them to take part in the discussion, take notes or simply listen.

If you are confused or want clarification, you can ask questions – see Questions for your doctor for a list of suggested questions. If you have several questions, you may want to talk to a nurse, such as a prostate cancer specialist nurse or cancer care coordinator, or ask the office manager if it is possible to book a longer appointment.

You may want to get a second opinion from another specialist to confirm or clarify your doctor’s recommendations or reassure you that you have explored all of your options. Specialists are used to people doing this.

Your doctor can refer you to another specialist and send your initial results to that person. You can get a second opinion even if you have started treatment or still want to be treated by your first doctor. You might decide you would prefer to be treated by the doctor who provided the second opinion.

Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment.

Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.

It may be helpful to talk to your specialist or clinical trials nurse, or get a second opinion. If you decide to take part, you can withdraw at any time. For more information, call Cancer Council 13 11 20, or visit australiancancertrials.gov.au.