Prostate cancerYour guide to best cancer care

It can be overwhelming after being told that you have or may have prostate cancer. A lot can happen quickly, and you might have lots of questions, like 'what happens next after a diagnosis?'

This support resource can help to guide you, your family, and friends through this experience.

Information and support

If you need additional information or would like support, you can visit the prostate cancer page or call Cancer Council on 13 11 20 to talk to an experienced healthcare professional.

For information about prostate cancer and patient support, visit the Prostate Cancer Foundation of Australia page.

If you need a translator, call TIS on 13 14 50 or visit the TIS National website.

Symptoms

Most people with prostate cancer don’t have any symptoms.

Prostate cancer may be suspected in men who have a blood test (see PSA testing) and show an abnormal result.

Less commonly, prostate cancer may be suspected because of symptoms you might be having such as bone pain, problems peeing or leg weakness.

Initial tests you may have

Referrals

If your general practitioner (GP) has concerns, you will be referred to a specialist (urologist) at a public hospital or in private practice for more tests. Urologists are doctors who are highly trained in prostate cancer.

You can bring a family member or friend with you to your appointments.

Timeframes

Your specialist appointment should happen urgently if you have symptoms and an abnormal PSA test result.

If you don’t have symptoms but your GP is concerned about your repeat PSA test results, your specialist appointment should happen within four weeks of your GP referral.

If you can’t get an appointment within this time, follow up with your GP.

A specialist will do more tests to see if you have prostate cancer. This process of working out if you have a medical problem is called making a diagnosis. You might have one test or a mix of tests:

These tests will give the specialist more information about the cancer, such as where exactly it is in your body, if the cancer is growing or has spread, and what stage it is at. This is called staging, which helps to work out the best treatment for you.

These further tests used may be based on the type of cancer found:

Timeframes

Results should be available within two weeks from when you have the tests.

There are several ways to treat prostate cancer. Your specialist will talk to you about your treatment options.

You will be treated by a team of experts, and you may need more than one treatment type to get the best results. The team will work with you and your family or carer to plan your treatment.

Many prostate cancers are slow growing, so sometimes your specialist will recommend that you don’t have treatment straight away:

Active surveillance is where the specialist believes there is a low risk of growth and spread but monitors the cancer carefully to see if it changes over time. No treatment is given straightaway, but regular checks are done to look for changes or growth in the cancer. Treatment may be recommended if the cancer changes or grows.

Watchful waiting is also where no treatment is given, or the treatment is not given straightaway. Your team will check the cancer like they would in active surveillance, but it is not as often. This is used if you are older, or if you have other health issues.

If treatment is recommended you might have one treatment or a mix of treatments:

Prostatectomy is a type of surgery to cut the prostate out. It is used if you have early prostate cancer, or if the cancer hasn’t spread.

Radiation therapy uses x-rays to kill cancer cells and stop the cancer growing. It is used with or without androgen deprivation therapy. It is used if you have early prostate cancer, or if the cancer hasn’t spread. For some men, radiation therapy may be used following surgery.

Brachytherapy is where a radioactive implant is put inside your body close to or near the cancer. The implant will send out radiation to the nearby cancer, with the aim of killing the cancer cells.

If the cancer has spread outside the prostate gland, various medications may be used to slow its growth:

Androgen deprivation therapy (ADT) is a type of hormone treatment. Hormone therapy stops your body from making certain hormones or blocks the way the hormones work in your body. It helps to reduce the size and slow down the spread of the cancer. Your team should talk with you about what will happen and what might happen during your ADT.

Although ADT is used if your prostate cancer has spread to other parts of your body, it is also given in combination with radiation therapy in some people who do not have any spread.

Chemotherapy or drug therapy is where drugs are used to kill cancer cells and stop the cancer growing. It might be used at the same time as ADT. It is used if your prostate cancer has spread to other parts of your body.

For more information, visit Cancer Treatment. Supportive care (treatment or services that support you through a cancer experience) are also available.

Timeframes

If treatment is recommended, it should start within three months of diagnosis or within four weeks if you are having significant symptoms.

You can ask your GP for a referral to another specialist for a second opinion.

Recovery

Cancer treatment can cause a range of physical and emotional changes.

Follow-up care plan

Your healthcare team will work with you to make a plan for you and your GP. This plan will explain:

• who your main contact person is after treatment
• how often you should have check-ups and what tests this will include
• understanding and dealing with side effects of treatment
• how to get help quickly if you think the cancer has returned or is worse

Many people worry that the cancer will return. Your specialist and healthcare team will talk with you about your needs and can refer you to other healthcare professionals and community support services.

Other information you may get:

• signs and symptoms to look out for if the cancer returns
• late effects of treatment and the specialists you may need to see
• how to make healthy lifestyle choices to give you the best chance of recovery and staying well

For more information, visit After Cancer Treatment.

Sometimes cancer can come back after treatment. It can come back in the same place or can appear somewhere different in your body.

If cancer returns, you may be referred to the specialist or the hospital where you were first treated, or to a different specialist.

Treatment will depend on how far the cancer has spread, how fast-growing it might be, and the symptoms you are experiencing.

Advance care planning

Your GP or healthcare team may talk with you, your family, and carer about your future treatment and medical needs.

Advance care directive

Sometimes known as a living will, an advance care directive is a legally binding document that you prepare to let your family and healthcare team know about the treatment and care you might want or not want in case you become too unwell to make those decisions yourself.

For more information, visit Advance Care Planning Australia.

Palliative care

Your specialist may refer you to palliative care services, but this doesn’t always mean end-of-life care. Today, people can be referred to these services much earlier if they’re living with cancer or if their cancer returns. Palliative care can help you to live as well as you can, including managing pain and symptoms. This care may be at home, in a hospital or at another location you choose.

Speak to your GP or specialist or visit Palliative Care Australia.

Making treatment decisions

You may decide not to have treatment at all, or to only have some treatment to reduce pain and discomfort. You may want to discuss your decision with your healthcare team, GP, family and carer.

For more information, visit Advanced Cancer Treatment.

Decisions about cost

You may have to pay for some appointments, tests, medications, accommodation, travel or parking. Speak with your GP, specialist or private health insurer (if you have one) to understand what is covered and what your out-of-pocket costs may be.

If you have concerns about costs, talk to your healthcare team or a social worker about:

• being bulk-billed or being treated in the public system
• help with accommodation during treatment
• the possible financial impact of your treatment

You can call Cancer Council on 13 11 20 to speak to a healthcare professional about financial support. For more information about costs, visit Practical and financial assistance and What will I have to pay for treatment.