Prostate Cancer

Hearing the words “prostate cancer” can stop you in your tracks. For many men and people with prostates, the first few weeks are a blur of PSA numbers, scans, opinions, and uncertainty.

This page explains how prostate cancer is typically assessed and managed in Australia, and what decisions actually matter—especially when the cancer is low risk, borderline, or detected early. The goal is not to push any one treatment. It’s to help you understand the pathway, the trade-offs, and when it’s reasonable to pause, gather more information, and choose carefully. In most cases there is time to stage properly, understand risk, and make a considered choice.

A practical overview of the prostate cancer pathway in Australia

While every case is individual, most patients move through a fairly predictable sequence:

1) PSA and risk assessment

A raised PSA is common, and prostate cancer is only one possible explanation. PSA can also rise due to benign enlargement, inflammation or infection, recent ejaculation, and urinary retention. The starting point is interpreting PSA in context—age, PSA trend, prostate size (and PSA density where available), symptoms, medications and family history.

2) MRI of the prostate

A high-quality prostate MRI is now central to modern assessment. It helps identify areas that look suspicious and guides whether a biopsy is needed, and if so, where to target. MRI does not replace biopsy in most cases, but it often reduces unnecessary biopsies and improves detection of clinically significant cancer. A reassuring MRI reduces the likelihood of significant cancer, but it doesn’t eliminate it entirely.

3) Prostate biopsy (when indicated)

If risk remains significant, a biopsy provides tissue diagnosis and grading. Biopsies may be targeted (to MRI-identified lesions), systematic, or a combination. The key output is not just “cancer yes/no”, but:

  • Gleason grade / Grade Group

  • How much cancer was found

  • Where it is located

  • Whether features suggest higher-risk behaviour

Biopsies may be performed via a transperineal or transrectal approach; your individual infection risk and anatomy help determine what is most appropriate.

4) Risk stratification and staging

Once cancer is confirmed, it is generally grouped into risk categories (low, intermediate, high) based on PSA, grade, and clinical findings. Some patients also need staging scans (for example, where there is higher risk). This step is crucial because it determines whether treatment is urgent, optional, or safely deferrable. In higher-risk situations, staging may include advanced imaging such as PSMA PET.

5) Shared decision-making

This is where judgement matters. Prostate cancer decisions are rarely about one “best” option. They are about balancing:

  • Cancer control

  • Urinary function

  • Sexual function

  • Bowel effects

  • Recovery time and long-term quality of life

  • Your values and risk tolerance

When prostate cancer does not need immediate treatment

A large proportion of prostate cancers detected today are slow-growing. For appropriately selected patients, active surveillance is not “doing nothing”—it is a structured plan with monitoring, designed to avoid (or delay) treatment side effects without compromising safety.

Active surveillance may be suitable when the cancer is low risk and appears confined, particularly if:

  • Grade and volume are low

  • MRI findings are reassuring

  • PSA kinetics are stable

  • You’re able to commit to follow-up

Surveillance protocols vary, but usually include repeat PSA tests, repeat MRI, and sometimes repeat biopsy at defined intervals. The aim is to identify the minority of cancers that begin to behave more aggressively, while allowing the majority of patients to avoid treatment they don’t need.

When treatment is recommended

Treatment is more strongly considered when the cancer has features suggesting a higher likelihood of progression or spread, such as:

  • Higher Grade Group

  • Greater tumour volume

  • Evidence of growth over time on MRI or biopsy

  • Higher-risk clinical or PSA features

For many patients, the decision is not “treat vs don’t treat,” but which treatment, and when.

Surgery vs radiation: how the decision is usually made

For prostate cancer that requires definitive treatment, the most common curative-intent options are surgery (radical prostatectomy) and radiation therapy (external beam radiation, sometimes with brachytherapy). Both are established curative-intent options. The better choice depends on cancer factors and patient priorities.

Surgery (radical prostatectomy)

Surgery removes the prostate and seminal vesicles, and may include lymph node assessment depending on risk features. It provides:

  • A complete pathology specimen (helpful for precise staging)

  • PSA should fall to an undetectable level after surgery (useful for monitoring)

  • A clear option for further treatment later if needed (e.g., radiotherapy)

Considerations include:

  • Urinary leakage during recovery (often improves, but varies)

  • Erectile dysfunction risk (highly individual; nerve-sparing suitability depends on anatomy and cancer location)

  • Recovery time from an operation

For a broader overview of robotics across urologic cancers, see Robotic Urologic Cancer Surgery.

Radiation therapy

Radiation treats the prostate in situ. It can be delivered in different schedules and sometimes combined with hormone therapy depending on risk category. It offers:

  • No major operation

  • Different side-effect profile

Considerations include:

  • Urinary irritation during and after treatment in some patients

  • Bowel effects (usually mild, occasionally significant)

  • Erectile function changes that may evolve gradually over time

  • Treatment duration and logistics

  • The complexity of surgery after radiation if surgery is needed later (not impossible, but more challenging)

The multidisciplinary reality

For many patients—particularly intermediate and high-risk disease—the best care involves coordination between urology and radiation oncology. A good decision is often the product of clear staging, careful explanation, and time to weigh trade-offs, rather than being rushed.

Referral guidance for GPs

A urology referral is appropriate when:

  • PSA is persistently elevated or rising

  • MRI suggests a suspicious lesion

  • There is an abnormal DRE

  • There is a significant family history or other high-risk features

  • There is known prostate cancer and the patient needs discussion of management options

Where possible, include PSA trend data, relevant medications, comorbidities, MRI report (if performed), and any urinary symptoms.

Accessing care in Melbourne

I consult in Melbourne and can coordinate assessment and treatment pathways across the relevant settings (public and private), depending on the clinical situation and patient preference. The right pathway varies: some patients need rapid assessment, while others benefit from time and structured decision-making.

If you are referred for prostate cancer assessment, it is often helpful to bring:

  • PSA history (dates and values)

  • MRI report and images (if available)

  • Any biopsy results

  • A list of medications

  • Your key questions and priorities (e.g., function, cancer control, recovery time)

FAQs

Does a raised PSA mean I have prostate cancer?

No. PSA is a risk marker, not a diagnosis. Many benign factors can raise PSA. The pattern over time and the broader clinical context matter.

Do I need an MRI before a biopsy?

In most modern pathways, MRI is strongly recommended before biopsy because it can better target suspicious areas and reduce unnecessary biopsy in some cases. Individual circumstances vary.

Is prostate biopsy painful? What are the risks?

Biopsy is generally well tolerated, but it is still a procedure. Risks can include bleeding, infection, urinary retention, and short-term discomfort. Your risk profile depends on the biopsy approach and your medical history.

What does “Gleason” or “Grade Group” mean?

These describe how aggressive the cancer cells look under the microscope. Higher grades are generally more likely to behave aggressively and are more likely to need treatment.

If my cancer is “low risk,” is it safe to wait?

Often, yes—if you meet criteria and can follow a structured surveillance plan. Active surveillance is a recognised and evidence-based approach for appropriately selected patients.

How do I choose between surgery and radiation?

For many patients, both are reasonable. The decision usually comes down to cancer risk category, anatomy, age, health status, and what side effects matter most to you.

Will I be incontinent after prostate surgery?

Most patients improve substantially over time, but recovery varies. Some degree of leakage early on is common. Persistent incontinence is less common but can occur.

Will surgery or radiation affect erections?

Either can affect erectile function. The pattern differs: surgery effects are often immediate with gradual recovery, while radiation-related changes may develop more gradually over time. Baseline function, age, and comorbidities matter.

Do I need a PSMA PET scan?

It depends on risk features. PSMA PET is more commonly used in higher-risk disease for staging, or where there is concern about spread. It’s not necessary for every diagnosis.

How urgent is treatment after diagnosis?

It depends on risk. Many prostate cancers are slow-growing and allow time for careful decision-making. Higher-risk cancers may need a more time-sensitive pathway, but rarely require “tomorrow” decisions.

If I choose radiation, can I still have surgery later?

Sometimes, but it is more complex and not always appropriate. This is one of the trade-offs that should be discussed early.

Do I need to see both a urologist and a radiation oncologist?

Often, yes—particularly for intermediate and high-risk disease. Hearing both perspectives can clarify trade-offs and help you choose the option that best fits your priorities.

What should I bring to my first appointment?

PSA history, MRI/biopsy reports, medication list, and your questions. If you can, bring a partner or support person—two sets of ears helps.

Clinical note
This page provides general information and is not a substitute for individual medical advice. Decisions should be made after personalised assessment, staging and discussion of options.

Last reviewed: January 2026

About the author
Dr Deanne Soares is a Melbourne-based urologist with a subspecialist focus in robotic prostate, kidney and bladder cancer surgery.