Prostate Cancer
Prostate cancer is the most commonly diagnosed cancer in Australian men. Many are slow-growing and never cause harm, while others need treatment. The PSA blood test helps find it early, with trade-offs worth talking through.
Many prostate cancers are the slow, lazy kind. The trick is finding out which kind you have before anyone reaches for a scalpel.
Symptoms
- Early prostate cancer usually causes no symptoms
- Urine symptoms (weak flow, getting up at night) are much more often from a benign enlarged prostate
- Blood in urine or semen, or new bone pain or weight loss, need prompt checking
The PSA test
- A blood test that can find prostate cancer early. It’s raised by cancer, but also by an enlarged prostate, infection, recent ejaculation or cycling.
- Pros: finds aggressive cancers earlier, and lowers the chance of dying of prostate cancer.
- Cons: false alarms, and finding slow cancers that would never have caused harm (overdiagnosis).
- Who: talk it over with your GP from about age 50, or 40–45 with a father or brother with prostate cancer, or a BRCA2 gene change.
- An MRI before any biopsy now spares many men an unnecessary biopsy.
Treatment
- Active surveillance: for low-risk cancers, regular PSA, MRI and sometimes biopsy, with treatment only if it changes. Avoids side effects for many men.
- Surgery (radical prostatectomy) or radiotherapy for higher-risk cancer that hasn’t spread. Both can affect erections and bladder control.
- Hormone therapy (e.g. Zoladex) lowers testosterone, often with radiotherapy or for spread cancer.
- Advanced cancer: newer hormone tablets, chemotherapy and Lu-PSMA (a radioactive treatment that targets prostate cancer cells).
The numbers
- Roughly 1 in 5 to 1 in 6 Australian men will be diagnosed by age 85.
- Five-year survival is about 96%, and most men diagnosed die of something else.
- In the UK ProtecT trial, after 15 years only about 3% of men with localised cancer died of it, whether they had monitoring, surgery or radiotherapy.
Common questions
Should I have a PSA test?
It’s a personal choice worth discussing with your GP, usually from about age 50, or 40–45 with a strong family history or BRCA2 gene change. It can find aggressive cancers early but also leads to false alarms and overdiagnosis.
What are the symptoms of prostate cancer?
Early prostate cancer usually has no symptoms. Urine symptoms are more often from a benign enlarged prostate. Blood in urine or semen, bone pain or weight loss need checking.
What is active surveillance?
For low-risk cancer, regular PSA tests, MRI and sometimes biopsy instead of immediate treatment. Treatment starts only if the cancer changes, which spares many men side effects.
Helpful resources
- Prostate Cancer Foundation of AustraliaInformation and specialist nurse support. Free.
- Cancer Council 13 11 20Information and support line. Free.
Evidence and more information
- Cancer Australia: Prostate cancer statistics
- Hamdy FC et al. Fifteen-year outcomes after monitoring, surgery or radiotherapy for prostate cancer (ProtecT, NEJM 2023)
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