Page last updated: August 2026
The information on this webpage was adapted from Understanding Prostate Cancer - A guide for people with cancer, their families and friends (2026 edition). This webpage was last updated in August 2026.
Expert content reviewers:
This information was developed based on Australian and international clinical practice guidelines, and with the help of a range of health professionals and people affected by prostate cancer:
- Prof Declan Murphy, Consultant Urologist, Director – Genitourinary Oncology, Peter MacCallum Cancer Centre and The University of Melbourne, VIC
- Alan Barlee, Consumer
- Dr Patrick Bowden, Radiation Oncologist, Epworth Hospital, Richmond, VIC
- Bob Carnaby, Consumer
- Dr Megan Crumbaker, Medical Oncologist, St Vincent’s Hospital Sydney, NSW
- Henry McGregor, Health Physiotherapist, Adelaide Men’s Health Physio, SA
- Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital and Headway Health, NSW
- Dr Gary Morrison, Shine a Light (LGBTQIA+ Cancer Support Group)
- Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA;
- Graham Rees, Consumer
- Kerry Santoro, Prostate Cancer Specialist Nurse Consultant, Southern Adelaide Local Health Network, SA
- Prof Phillip Stricker, Chairman, Department of Urology, St Vincent’s Private Hospital, NSW
- Dr Sylvia van Dyk, Brachytherapy Lead, Peter MacCallum Cancer Centre, VIC.
This edition is based on the previous edition, reviewed by the above panel. All updated content has been clinically reviewed by Prof Declan Murphy (see above).
There are different options for managing and treating prostate cancer, and more than one treatment may be suitable for you. Your specialists will let you know your options and discuss them with you, so you can make an informed decision.
This is called shared decision-making. You can ask about other options and what they would mean for you. For example, if surgery is suggested, you could ask if radiation therapy is an option.
Treatment recommended by your doctors will depend on the stage and grade of the cancer, your general health, age and preferences.
Options by stage
Localised (early)
- active surveillance
- surgery and/or radiation therapy
- watchful waiting
Locally advanced
- surgery and/or radiation therapy
- androgen deprivation therapy (ADT) may also be suggested
- watchful waiting
Advanced (metastatic)
- usually androgen deprivation therapy (ADT)
- additional hormone therapy, newer drug therapy or targeted therapy is often combined with ADT
- sometimes chemotherapy or radiation therapy
- watchful waiting may be an option
- newer treatments as part of a clinical trial
Active surveillance
This is close monitoring of low-risk prostate cancer that isn’t causing symptoms. The aim is to avoid treatment that’s not yet needed, while watching for any changes that mean treatment should start.
Active surveillance is usually suggested for prostate cancers with a PSA level under 10 ng/mL, stage T1–2, and Gleason 6 or less (Grade Group 1).
It may also be suggested for certain cancers with a PSA level between 10 and 20, and some Grade Group 2 cancers. About 80% of Australians with low-risk prostate cancer choose active surveillance. It involves:
- PSA tests every 3–6 months
- mpMRI scans
- possible digital rectal examinations, and
- biopsies if advised by your urologist.
If results show the cancer is growing faster or more aggressively, your specialist may suggest starting active treatment.
Watchful waiting
Watchful waiting may be suggested if you are older and the cancer is unlikely to cause a problem in your lifetime.
It may be an alternative to active treatment if the cancer is advanced at diagnosis, or if other health problems would make it hard to handle surgery or radiation therapy.
The aim of watchful waiting is to maintain quality of life rather than to treat the cancer. If the cancer spreads or causes symptoms, you will have treatment to relieve symptoms or slow the growth of the cancer, rather than to cure it.
Watchful waiting may involve fewer tests than active surveillance. You will have regular PSA tests and your doctor may suggest an mpMRI if your PSA is of concern. They may discuss whether to have a biopsy.
“I’d recommend that anyone join a group as early as possible after diagnosis.” Tony
Explore prostate cancer support groups
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for prostate cancer can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Surgery
For many people, surgery will be a suggested treatment option. It is worth discussing with your urologist or treating doctor whether there are other options, such as radiation therapy, available to you.
The main surgery for localised and locally advanced prostate cancer is a radical prostatectomy. It removes all the prostate, part of the urethra and the seminal vesicles.
The urethra is rejoined to the bladder, and the vas deferens (that carry sperm from the testicles to the penis) will be sealed.
Some people have a nerve-sparing radical prostatectomy, to avoid damaging the nerves that control erections.
This is only for lower-grade cancers where the cancer isn’t close to these nerves, and it works best for those who had strong erections before diagnosis. Problems with erections are common even with nerve-sparing surgery.
Cancer cells can spread from the prostate to nearby lymph nodes. For intermediate-risk or high-risk prostate cancer, nearby lymph nodes may also be removed (pelvic lymph node dissection).
How the surgery is done
There are different surgery methods to remove the prostate:
- open radical prostatectomy – usually done through one long cut in the lower abdomen (belly)
- laparoscopic radical prostatectomy (keyhole surgery) – small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen as a guide
- robotic-assisted radical prostatectomy – laparoscopic surgery performed with help from a robotic system. The surgeon uses a 3D picture and control panel to move robotic arms holding instruments
Making decisions about surgery
Talk to your surgeon about whether surgery or another treatment such as radiation therapy is the best option for you.
Also ask what surgical methods are available to you. Ask about the advantages and disadvantages of each option.
There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery.
The surgeon’s experience and skill are more important than the type of surgery offered.
Compared with open surgery, both standard laparoscopic and robotic-assisted surgery usually mean a shorter stay in hospital, less bleeding, a smaller scar and a faster recovery.
Current evidence suggests that the different approaches have a similar risk of side effects. Take the time you need to make the right decision for you.
What to expect after surgery
- Recovery time – No matter which surgical method is used, a radical prostatectomy is major surgery and you will need time to recover. You can expect to return to your usual activities within about 6 weeks of the surgery. Usually you can start driving again in a couple of weeks, but heavy lifting should be avoided for 6 weeks.
- Managing pain and discomfort – It’s common to have pain after the surgery, so you may need pain relief for a few days.
- Having a catheter – A thin, flexible tube (catheter) drains urine from your bladder into a bag. The catheter will be removed after 1–2 weeks once the wound has healed. Some people find this uncomfortable.
For more information about preparing for surgery and what to expect during and after, see Understanding Surgery or call Cancer Connect on 13 11 20.
Side effects of prostate cancer surgery
You may experience some or all of the following side effects:
- Nerve damage – The nerves needed for erections and the muscle that controls the flow of urine (sphincter) are both close to the prostate. It may be very difficult to avoid these during surgery, and any damage can cause problems with erections and bladder control. Sometimes the nerves will need to be removed to try to ensure all cancer is removed.
- Loss of bladder control – You can expect to have some light dribbling or trouble controlling your bladder for some weeks to months after a radical prostatectomy. This is known as urinary incontinence or urinary leakage. You can use continence pads to manage urinary leakage. Bladder control usually improves in a few weeks and will continue to get better for up to a year after the surgery. In the long term, you might continue to have some light dribbling. Some people may consider having an operation to fix urinary incontinence. In rare cases, people have no control over their bladder.
- Changes in erections – Problems getting and keeping erections after prostate surgery are common. This is often called erectile dysfunction (ED) or impotence. Erections may improve over months to a few years. It’s more likely you won’t get strong erections again if erections were already difficult before the operation.
- Changes in ejaculation – During a radical prostatectomy, the tubes from the testicles (vas deferens) are sealed and the prostate and seminal vesicles are removed. This means semen is no longer ejaculated during orgasm (a dry orgasm). Your orgasm may feel different – in some cases it may be uncomfortable or, rarely, painful. A small amount of urine may leak during orgasm (which isn’t harmful to your partner).
- Infertility – A radical prostatectomy will cause infertility and you will not be able to conceive a child without medical assistance. If you wish to have children, talk to your doctor before treatment about freezing sperm for future use (sperm banking) and other options.
- Change in penis size – You may notice that your penis gradually becomes a little shorter after surgery. Talk to your doctor about whether vacuum erection devices and prescription medicines may help. A change to the size of your penis can be difficult to deal with.
Managing side effects.
Focal therapy
Focal therapy, also sometimes called ablation or focused therapy, uses high-intensity sound waves or targeted laser beams to target and destroy cancer cells.
This therapy is not a standard part of approved treatment guidelines and it’s not proven whether it works. Focal therapy may sometimes be offered as part of a clinical trial.
Although this is not a new therapy, there have not been enough randomised clinical trials to confirm how well focal therapy works.
You can still usually have other treatments afterwards if focal therapy does not work.
Radiation therapy
Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill or damage cancer cells so they cannot grow, multiply or spread. Radiation therapy may be used:
- for localised or locally advanced prostate cancer – it has similar rates of success to surgery in controlling prostate cancer that has spread to the lymph nodes
- if you are not well enough for surgery or are older
- after a radical prostatectomy for locally advanced disease, if there are signs of cancer left behind or the cancer has returned where the prostate used to be
- for prostate cancer that has spread to other parts of the body
- for intermediate and high-risk prostate cancer, it is often combined with androgen deprivation therapy (ADT).
There are two main ways of delivering radiation therapy: from outside the body (external beam radiation therapy) or from inside the body (brachytherapy).
You may have one of these types of radiation therapy, or you may have a combination of both.
The Prostate Cancer Foundation of Australia has a resource on radiation therapy for prostate cancer. For more about how radiation therapy works, visit Targeting Cancer.
External beam radiation therapy (EBRT)
In EBRT, a machine precisely directs radiation beams to the prostate. Each treatment session takes about 15 minutes. You will lie on the treatment table under the radiation machine.
The machine doesn’t touch you but may rotate around you. You can’t see or feel the radiation. There are different types of EBRT. Your radiation oncologist will talk to you about the most suitable type for your situation.
Usually, EBRT for prostate cancer is given Monday to Friday for 4–9 weeks. Some newer forms of EBRT are given in 5–7 treatments over two weeks. EBRT does not make you radioactive and there is no danger to people near you.
Most people feel well enough to work and do their normal activities, though fatigue may increase as your treatment continues.
Reducing the risk of bowel side effects
Radiation therapy can cause bowel changes.
- To move the bowel away from the prostate and help prevent side effects, the radiation oncologist may suggest a spacer. Before treatment begins, a temporary gel or balloon is injected between the prostate and bowel. This is done by a urologist as a day procedure under a light anaesthetic. The cost of a spacer is not subsidised by Medicare. Ask your doctors what you will have to pay and the benefits for your situation.
- The radiation therapist may advise you to drink fluids before each treatment session so you have a full bladder. This will expand your bladder and push the bowel higher up into the abdomen, away from the radiation.
- The radiation team may also advise you to go to the toilet to empty your bowels before each treatment. This can help to ensure the prostate is in the same position every time.
Internal radiation therapy (brachytherapy)
Brachytherapy is a type of targeted internal radiation therapy where the radiation source is placed inside the body near the prostate.
Giving doses of radiation directly into the prostate can lower the amount of unwanted radiation going into areas such as the rectum and bladder. There are two different types of brachytherapy: permanent and temporary.
If you already have significant urinary symptoms or a large prostate, brachytherapy may not be suitable.
Safety precautions after brachytherapy
If you have permanent brachytherapy your body may give off some radiation for a period of time. The levels will gradually fall over a number of months.
This radiation only travels a short distance, which means there is little radiation outside your body.
You will still need to take care spending time in close contact with pregnant women and young children for a few weeks or months after the seeds are inserted. Your treatment team will explain the precautions to you.
You should use a condom during sex (intercourse and oral) for this precaution time in case a seed comes out (this is rare).
If you have temporary brachytherapy, you will not be radioactive once the wires are removed after treatment, and there is no risk to other people and no special precautions are needed during sex.
How brachytherapy is done
Permanent brachytherapy (seeds)
- Also called low-dose-rate (LDR) brachytherapy.
- Most suitable for people with few urinary symptoms, and small cancers with a low PSA level (less than 10) and a low to intermediate Gleason score or Grade Group.
- Multiple radioactive metal “seeds”, each about the size of a grain of rice, are put into the prostate under a general anaesthetic.
- The radiation oncologist uses needles to insert the seeds through the skin between the scrotum and anus (perineum). Ultrasound is used to guide the seeds into place.
- The procedure takes 1–2 hours and you can usually go home the same or next day.
- The seeds slowly release radiation into the area of the prostate to kill cancer cells.
- There are safety issues for patients and others.
- The seeds lose their radioactivity after about a year. They are not removed from the prostate.
Temporary brachytherapy
- Also called high-dose-rate (HDR) brachytherapy.
- May be offered to people with a higher PSA level and a higher Gleason score or Grade Group. It is often given with a short course of EBRT.
- The radiation is delivered through hollow needles that are inserted into the prostate while you are under anaesthetic.
- The needle implants stay in place for several hours or, in some cases, overnight. You usually will have 1–3 brachytherapy treatments during this time.
- For each treatment, radioactive wires will be inserted into the needles to deliver a high dose of radiation to the prostate in a few minutes.
- The needle implants are taken out after the final radiation dose is delivered. You will have no radiation left in your body.
- There are no safety issues.
- In some cases, the implant procedure is repeated 1–2 weeks later.
Side effects of radiation therapy
The side effects you experience will vary depending on the type and dose of radiation, and the areas treated. You may experience some of the following side effects.
Most side effects are temporary and tend to improve gradually in the weeks after treatment ends, though some may continue for longer.
Some side effects may not show up until many months or years after treatment. These are known as late effects.
Talk to your doctor or treatment team about ways to manage any side effects you have.
Short-term side effects
- Fatigue – The effects of radiation on your body may mean you become tired during treatment. Fatigue may build up during treatment and usually improves 1–2 months after treatment ends, but occasionally can last up to 3 months.
- Urinary problems – Radiation therapy can irritate the lining of the bladder and the urethra. This is known as radiation cystitis. You may pass urine more often or with more urgency, have a burning feeling when urinating or a slower flow of urine. If you had urinary issues before treatment, you may be more likely to have issues with urine flow. If you see blood in the urine, tell your doctor as this may need treatment. If you are unable to empty your bladder (urinate) right after brachytherapy, you may need a catheter for a few days or weeks.
- Bowel changes – Radiation therapy can irritate the lining of the bowel and rectum. You may have smaller and more frequent bowel movements, need to go to the toilet quickly, or feel that you can’t completely empty the bowel. Less commonly, there may be some blood in the faeces (poo or stools). If this happens, let your doctor know as there are treatments that can stop the bleeding.
- Ejaculation changes – You may notice that you feel the sensation of orgasm but ejaculate less or no semen after radiation therapy. This is known as dry orgasm, which may be a short-term or permanent side effect. In some rare cases, you may experience pain when ejaculating. The pain usually eases over a few months.
Long-term or late effects
- Infertility – Radiation therapy to the prostate usually causes infertility. If you might want to have children, speak to your doctor before treatment about sperm banking or other options.
- Urinary problems – Bladder changes, such as frequent or painful urination, can appear months or years after treatment. After brachytherapy, scarring can develop around the urethra, which can block the flow of urine. This can usually be repaired. It is important to let your doctor know if you have any problems with urinating or notice any bleeding.
- Bowel changes – Bowel changes, such as diarrhoea, wind or constipation, can appear months or years after treatment. Bleeding from the rectum can also occur. In rare cases, there may be loss of bowel control (faecal incontinence) or blockage of the bowel. It is important to let your doctor know about any bleeding, or if you have pain in the abdomen and difficulty opening your bowels.
- Erection problems – Radiation may damage the nerves and blood vessels that control erections. This can make it difficult to get and keep an erection, especially if you have had problems before treatment. Having ADT can also cause problems with erections. Erection problems may take time to appear and can be ongoing or permanent.
Androgen deprivation therapy (ADT)
Prostate cancer needs testosterone to grow. Reducing how much testosterone your body makes may slow the cancer’s growth or shrink the cancer temporarily.
Testosterone is an androgen (male sex hormone made by the testicles), so this treatment is called androgen deprivation therapy (ADT). It is also known as hormone therapy.
ADT for locally advanced cancer may be used after a radical prostatectomy or with radiation therapy. It may also be given to help control advanced prostate cancer.
Types of ADT
There are different types of ADT:
- ADT injections – The most common form of ADT involves injecting a drug to block the production of testosterone. Your GP or specialist can give the injections. How often you have injections depends on the type of ADT. They may be given monthly, every 3 months or every 6 months. ADT injections can help slow the cancer’s growth for years. ADT injections may also be used before, during and after radiation therapy to increase the chance of getting rid of the cancer. They are sometimes combined with chemotherapy.
- Intermittent ADT – Occasionally ADT injections are given in cycles and continue until your PSA level is low. Injections can be restarted if your PSA rises again. This is known as intermittent ADT. In some cases, this can reduce side effects. It is not suitable for everyone.
- Anti-androgen tablets – Often called hormone tablets, anti-androgen tablets may be given in combination with ADT injections.
- Removing the testicle/s (orchidectomy) – This surgery is an uncommon way to lower how much testosterone your body makes. If you have advanced prostate cancer, you may choose to have surgery rather than regular ADT injections or tablets. Surgery to remove both testicles is called a bilateral orchidectomy. It is possible to have a silicone prosthesis put into the scrotum to keep its shape. Removing only the inner part of the testicles (subcapsular orchidectomy) also lowers testosterone and does not need a prosthesis.
Side effects of ADT
ADT may cause side effects because of the lower levels of testosterone in the body. Side effects may include:
- tiredness that doesn’t go away with rest (fatigue)
- reduced sex drive (low libido)
- difficulty getting an erection (impotence)
- shrinking of the testicles and penis
- loss of muscle strength
- hot flushes and sweating
- weight gain, especially around the middle
- breast swelling and tenderness
- mood swings, depression, trouble with thinking and memory
- loss of bone density (osteoporosis) – calcium and vitamin D supplements and regular exercise help reduce the risk of osteoporosis
- higher risk of diabetes, high cholesterol and heart disease. These are more likely the longer you have ADT, so ask your doctor about them.
Adjusting to changes in your testosterone levels takes time. For ways to manage side effects, talk to your treatment team and see Managing side effects.
To find out more about ADT, contact the Prostate Cancer Foundation of Australia. For information about erectile and other sexual health issues, visit Healthy Male.
Advanced prostate cancer treatment
If prostate cancer has spread (metastasised) to other parts of the body, you may have a combination of drug therapies, EBRT, ADT or chemotherapy.
Drug therapies
Newer drug therapies may be used to treat advanced prostate cancer that has come back while having ADT.
These drugs are often hormone therapy tablets that can be combined with ADT to help control the cancer and reduce symptoms. They are usually taken daily.
These new drugs are usually available for advanced prostate cancer through the PBS. Treatment usually aims to relieve symptoms or keep the cancer under control for years.
Hormone-sensitive prostate cancer may be treated with ADT alongside the treatments below.
Drug therapies, chemotherapy and hormone therapies used together is called triple therapy.
Other drug therapies include drugs that target specific features of cancer cells, called targeted therapy.
These drugs (e.g. olaparib) are used for cancer with gene changes (such as BRCA) linked to prostate cancer.
Radiation therapy
You may be offered radiation therapy to slow the growth of the cancer.
Radiation therapy may be given to the areas where the cancer has spread, such as the lymph nodes or bones.
You may also have radiation therapy to the prostate if you have not previously had any radiation treatment.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells or slow their growth.
If the prostate cancer continues to spread despite using ADT and other drug therapies, chemotherapy may be suitable.
Chemotherapy may also be offered as part of initial treatment in combination with ADT. Generally, chemotherapy is given through a drip (infusion) into a vein (intravenously).
For prostate cancer, chemotherapy is usually given once every three weeks for 4–6 months and you do not stay in hospital. Side effects of chemotherapy may include:
- fatigue
- hair loss
- changes in blood counts increasing the risk of bleeding or infections
- numbness or tingling in the hands or feet (peripheral neuropathy)
- changes in nails
- watery eyes and runny nose, and
- rare side effects, such as allergic reactions or blocked tear ducts.
Transurethral resection of the prostate
This surgical procedure is used to treat problems passing urine.
It helps with symptoms of more advanced prostate cancer, such as the need to pass urine more often and a slow flow of urine.
If you have localised cancer, TURP may be used before radiation therapy to relieve symptoms of urinary blockage. TURP is also used to treat benign prostate hyperplasia.
You will be given a general or spinal anaesthetic. A narrow tube-like instrument is passed through the opening of the penis and up the urethra to remove the blockage.
The surgery takes about an hour, and you will usually stay in hospital for a couple of days. Side effects may include blood in urine or problems urinating for a few days.
Bone therapies
If the prostate cancer has spread to the bones (bone metastases), your doctor may suggest treatments to manage the effect on the bones.
Drugs can be used to prevent or minimise bone pain and reduce the risk of fractures and pressure on the spinal cord.
Radiation therapy can also be used to control bone pain, to prevent fractures or help them heal, and to treat pressure on spinal nerves (spinal cord compression) from cancer that has spread to the spine.
Learn more about advanced cancer
Palliative treatment
Palliative treatment helps to improve quality of life by managing the symptoms of cancer without trying to cure the disease. It is about living for as long as possible in the most satisfying way you can.
As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include:
- radiation therapy to control pain if the cancer has spread to the bones
- pain medicines (analgesics)
- radionuclide therapy to control pain and improve quality of life. This involves swallowing or being injected with radioactive material which spreads through the body and targets cancer cells. The high doses of radiation kill cancer cells with little damage to normal tissues.
Palliative treatment is part of palliative care, in which a team of health professionals aims to meet your physical, emotional, practical, cultural, social and spiritual needs. They also support families and carers.
“For me, the hardest part was the shock of the initial diagnosis.” Derek
Prostate cancer clinical trials
Cancer clinical trials are research studies that test whether a new approach to prevention, screening, diagnosis, or treatment works better than current methods and is safe.
There are clinical trials for prostate cancer open to recruitment in Victoria. This list shows the most recently updated prostate cancer studies on the Victorian Cancer Trials Link (VCTL).
Visit the VCTL to find more prostate cancer clinical trials.