Prostate Cancer

Understanding Prostate Cancer
A guide for men with cancer, their families and friends.

Understanding Prostate Cancer
A guide for men with cancer, their families and friends.
First published July 1998
Revised June 2003, April 2005, August 2007
© The Cancer Council New South Wales 2007
ISBN 9781921041600
Understanding Prostate Cancer is reviewed approximately every two years.
Check the publication date above to ensure this copy of the booklet is up to
date. To obtain a more recent copy phone The Cancer Council Helpline 13 11 20.
Acknowledgements
We thank the reviewers of this booklet: Associate Professor Phillip Stricker,
Urological Surgeon, Department of Urology, St Vincent’s Clinic, Sydney; Narelle
Hanly, Prostate Cancer Nurse, The Concord Hospital Prostate Centre; David
Smith, The Cancer Council NSW; David and Pam Sandoe, Prostate Cancer
Support Group, Sydney Adventist Hospital; Diane van deer Saag, Cancer Care
Co-ordinator, Prostate and Urology, Royal North Shore; Warren Douglass.
Sections of this book have been adapted from Sex after treatment: prostate
cancer, a publication of the Queensland Cancer Fund. For further information
see www.qldcancer.com.au.
Editors: Belinda Lee and Laura Wuellner
Cartoonist/illustrator: Greg Smith
The Cancer Council New South Wales

The Cancer Council is the leading cancer charity in NSW. It plays a unique and
important role in the fight against cancer through undertaking high-quality
research, advocating on cancer issues, providing information and services to
the public and people with cancer, and raising funds for cancer programs.
This booklet is funded through the generosity of the people of New South
Wales. To make a donation to help defeat cancer, visit The Cancer Council’s
website at www.cancercouncil.com.au or phone 1300 780 113.
Before commencing any health treatment, always consult your doctor. This
booklet is intended as a general introduction to the topic and should not be
seen as a substitute for your own doctor’s or health professional’s advice. All
care is taken to ensure that the information contained here is accurate at the
time of publication.
153 Dowling Street
Woolloomooloo NSW 2011
Cancer Council Helpline: 13 11 20
Telephone: (02) 9334 1900
Facsimile: (02) 9334 1741
Email: feedback@nswcc.org.au
Website: www.cancercouncil.com.au
Introduction
This booklet has been prepared to help you understand more
about prostate cancer.
Many men feel understandably shocked and upset when told
they have prostate cancer. We hope this booklet will help you
understand how prostate cancer is diagnosed and treated. We
also include information about support services.
We cannot advise you about the best treatment for you. You
need to discuss this with your doctors. However, we hope this
information will answer some of your questions and help you
think about questions you want to ask your doctors or other
health carers.
You may like to pass this booklet to your family and friends
for their information.
This booklet does not need
to be read from cover to If you’re reading this booklet for
cover – just read the parts someone who doesn’t
that are useful to you. understand English, tell them
about the Cancer Council Helpline
Some medical terms that which is available in different
may be unfamiliar are languages (see page 51).
explained in the glossary.
Introduction
Contents
What is cancer? ................................................................................................................ 4
The prostate ............................................................................................................................ 6
What is prostate cancer? ................................................................................ 8
How common is it? .................................................................................................................... 8
Causes of prostate cancer ................................................................................................. 8
What are the symptoms? . ............................................................................................... 10
Which health professionals will I see? .............................................................. 11
Diagnosis ................................................................................................................................... 12
Prostate specific antigen blood test ..................................................................... 12
Digital rectal examination ................................................................................................. 12
Biopsy . ................................................................................................................................................... 13
Further tests . .................................................................................................................................. 14
Stages of prostate cancer ................................................................................................ 15
Prognosis ............................................................................................................................................ 16
Treatment .................................................................................................................................. 17
Watchful waiting ........................................................................................................................ 17
Surgery .................................................................................................................................................. 18
External beam radiotherapy ........................................................................................... 21
Brachytherapy ............................................................................................................................... 23
Other treatments ....................................................................................................................... 25
Hormone treatment ................................................................................................................ 25
Palliative treatment .................................................................................................................. 26
After treatment: follow-up ............................................................................................... 27
Managing side effects ...................................................................................... 28

Impotence ......................................................................................................................................... 29
Urinary incontinence .............................................................................................................. 29
Bowel problems .......................................................................................................................... 30
Fertility problems ....................................................................................................................... 30

Making treatment decisions ................................................................. 31
Decision-making steps ........................................................................................................ 32
Talking with doctors ................................................................................................................ 33
Talking with others ................................................................................................................... 34
A second opinion ....................................................................................................................... 34
Taking part in a clinical trial . ............................................................................................ 35
Prostate cancer research .................................................................................................. 36
Life after treatment . ............................................................................................... 37

Sexuality after treatment .................................................................................................. 37
Changing body image ........................................................................................................... 45
Strengthening your relationship ................................................................................ 46
Healthy eating and exercise .......................................................................................... 47
Complementary therapies ............................................................................................... 47
Relaxation techniques .......................................................................................................... 48
Will the cancer come back? . ......................................................................................... 48
Seeking support ........................................................................................................... 49

Practical and financial help .............................................................................................. 50
The Cancer Council Helpline ......................................................................................... 51
Talk to someone who’s been there ....................................................................... 52
Understanding Cancer program ................................................................................ 52
Caring for someone with cancer .............................................................................. 53
Information on the Internet ............................................................................................ 54
Question checklist .................................................................................................... 55

Glossary . ..................................................................................................................................... 57
How you can help ..................................................................................................... 64
Regional offices ............................................................................................................ 65
Contents
What is cancer?
Cancer is a disease of the body’s cells, which are the body’s
basic building blocks. Our bodies constantly make new cells:
to help us to grow, to replace worn-out cells, or to heal
damaged cells after an injury.
Normally, cells grow and multiply in an orderly way, but
sometimes something goes wrong with this process and cells
grow in an uncontrolled way. This uncontrolled growth may
develop in to a lump called a tumour.
A tumour can be benign (not cancer) or malignant (cancer).
A benign tumour does not spread outside its normal boundary
to other parts of the body. However, if a benign tumour
continues to grow at the original site, it can cause a problem
by pressing on nearby organs.
The beginnings of cancer
Normal cells Abnormal cells Abnormal cells Malignant or

multiply invasive cancer
Boundary
Lymph
The Cancer Council Victoria ©
vessel
Blood
vessel
Some benign tumours are precancerous and may progress to cancer if left
untreated. Other benign tumours do not develop into cancer.

How cancer spreads
Primary cancer
Local invasion
Angiogenesis –
tumours grow their
own blood vessels
Lymph vessel
Boundary
Metastasis – cells
move away from the
primary tumour and
The Cancer Council Victoria ©
invade other parts of

the body via blood
vessels and lymph
vessels
Blood vessel
A malignant tumour is made up of cancer cells. When it first

develops, this malignant tumour may not have invaded nearby
tissue. This is known as a cancer in-situ (or carcinoma in-situ).
As the tumour grows, it invades surrounding tissue becoming
invasive cancer. An invasive cancer that has not spread to other
parts of the body is called primary cancer.
Sometimes cells move away from the original (primary) cancer
and invade other organs and bones. When these cells reach a
new site, they may continue to grow and form another tumour
at that site. This is called a secondary cancer or metastasis.
What is cancer?
The prostate
The prostate is a small gland found only in men. A normal
prostate is about the size of a walnut. The prostate sits below
the bladder. There is a hole in the prostate through which
urine passes. A tube called the urethra carries urine from the
bladder through the penis and out of the body.
The prostate
Ureter
Urinary bladder Spine
Vas deferens Seminal

vesicle
Prostate gland
Urethra Rectum
Penis Anus
Testes
Scrotum

Located near the prostate are the nerves, blood vessels and
muscles needed to control bladder function and to achieve an
erection.
The prostate produces most of the fluid that makes up semen.
Its removal stops ejaculation fluid from being produced and
released during orgasm.
The prostate normally gets bigger as men grow older. The
growth of the prostate depends on the male sex hormone,
testosterone, which is made by the testes.
The growing prostate makes the urethra narrower and this can
change urinary patterns. This enlargement is called benign
prostate enlargement. This is not cancer. Benign prostate
enlargement usually begins on the outer surface of the prostate.
It may cause the following symptoms:
• need to urinate more often, especially at night
• an urgent need to urinate
• difficulty starting to urinate
• leaking or dribbling after urinating.
The prostate
What is prostate cancer?
Prostate cancer develops when the cells in the prostate gland
grow more quickly than in a normal prostate, forming a
malignant lump or tumour.
Most prostate cancers grow slower than other types of cancer.
Early (or localised) prostate cancer is growth that has not
spread beyond the prostate. Some prostate cancers may spread
to other parts of the body, such as the bones and lymph nodes.
This is called advanced prostate cancer. Early prostate cancer
rarely causes symptoms.
How common is it?

Prostate cancer is the most common cancer in Australian men.
Based on 2004 figures, one in eight men in NSW will develop
prostate cancer by the age of 75.
It is uncommon in men under 50 unless you have a family
history of prostate cancer. If you have a father or brother who
has had prostate cancer, your chance of developing the disease
may be higher and it may begin at a younger age than average.
Causes of prostate cancer

While the causes of prostate cancer are unknown, the chance
of developing prostate cancer increases:
• as you get older. Its incidence increases with age
• if your father or brother has had prostate cancer.

The role of family history
Because prostate cancer is a common disease, many people
have someone in their family who has developed prostate
cancer. In about five to 10% of men with prostate cancer,
there may be an underlying inherited risk that contributed to
the cancer’s development.
Families that may have an inherited prostate cancer gene can
include:
• multiple family members with prostate cancer on the same
side of the family (on either the mother’s or father’s side)
• men diagnosed with prostate cancer at a younger age.
If you are concerned about your family history of prostate
cancer, you may wish to ask your doctor for a referral to a
family cancer clinic and/or urologist to provide information on
the most suitable screening for you and your family. For more
information call the Cancer Council Helpline on 13 11 20.
What is prostate cancer?

What are the symptoms?
Early curable prostate cancer rarely causes symptoms. This is
because the cancer is not large enough to put pressure on the
urethra.
If the cancer grows and spreads beyond the prostate (advanced
prostate cancer), it may cause the following problems:
• pain or burning when urinating
• difficulty in, or increased frequency of, urinating
• blood in the urine or semen
• pain in the lower back, hips or upper thighs.
These symptoms are common to many conditions and may
not be advanced prostate cancer. If you are concerned about
prostate cancer and/or experiencing any of these symptoms,
speak to your GP (for more about diagnostic tests, see the
Diagnosis section on page 12).
I’d never heard anyone talk about prostate cancer

before I was diagnosed – I suppose men don’t talk
about these things. I was surprised to find out that
it’s a very common cancer.
10 The Cancer Council New South Wales

Which health professionals will I see?
Health professionals who may care for you while you are being
treated for prostate cancer include:
• urologist – surgeon who specialises in treating diseases of
the urinary system
• radiation oncologist – prescribes and co-ordinates the course
of radiotherapy
• medical oncologist – prescribes chemotherapy in more
advanced cases
• nurses – give the course of treatment and support and assist
you through all stages of your treatment
• continence nurses – nurses who have special expertise in
continence issues
• cancer nurse co-ordinator – a nurse who co-ordinates the
care of a cancer patient and liaises among different specialist
providers of care
• dietitian – recommends the best diets to follow while you
are in treatment and recovery
• social worker, physiotherapist and occupational therapist –
advise you on support services and help you to get back to
normal activities.
What is prostate cancer? 11

Diagnosis
Your doctor will confirm the diagnosis with a number of tests.
You may have some or all of the following tests.
Prostate specific antigen blood test

Prostate specific antigen (PSA) is a protein made by normal
prostate cells and cancerous prostate cells. Your body makes
more PSA as you age.
The PSA is measured using a blood test. The test may tell your
doctor that there might be a problem with the prostate gland.
A high PSA does not necessarily mean you have cancer. A
number of factors can increase PSA levels in your blood.
These include inflammation in the prostate, benign prostate
enlargement or prostate cancer. Only one in three men with an
elevated PSA level will have cancer.
As the meaning of your
Some men who have prostate
PSA level is not clear cancer have normal PSA levels.
cut, this blood test is
After diagnosis, a PSA test is
normally used with
other tests to diagnose
useful for checking the growth of
prostate cancer. the prostate cancer and how it is
responding to treatment.
Digital rectal examination

The digital rectal examination involves a doctor inserting a
gloved finger into the rectum to feel the prostate gland. If your
doctor feels a hardened area or an odd shape, further tests will
be done. A digital rectal examination may be uncomfortable
but is rarely painful. It is unlikely to pick up a small cancer or
one the finger can’t reach. Doing this test together with a PSA
test improves the chance of finding early cancer.

Biopsy
A diagnosis is made by removing a small piece of tissue from
the prostate. This is called a biopsy. It is done if the PSA test
or digital rectal examination show abnormalities.
An ultrasound probe called a transrectal ultrasound or TRUS
is passed into the rectum. The probe is the size of the thumb.
It shows a picture of the shape and texture of the prostate on
a screen like a television. The ultrasound picture helps guide
the doctor in inserting a small needle from the probe through
the rectum into the prostate. Between six and 18 samples of
prostate tissue are taken from different parts of the prostate
and checked under a microscope for signs of cancer.
Most biopsies are done with some form of anaesthetic. It may
be uncomfortable and there may be some bleeding. You will
be given antibiotics to reduce the possibility of infection.
A biopsy helps tell your doctor if you have prostate cancer
and how fast it might grow (the grade). The most commonly
used biopsy grading system is called the Gleason score. The
score ranges from two to ten. A low Gleason score indicates a
slow-growing (less aggressive) cancer. A higher score indicates
a faster-growing (more aggressive) cancer.
Your doctor will consider the volume of the cancer in addition
to your Gleason score. For instance, if you have one small
cancerous spot, your doctor
would consider this a
Remember to tell your doctor if
low volume cancer. You you are on any medications –
might consider a less such as blood thinners or
aggressive treatment regime alternative medicines like ginkgo
if you have a low volume, biloba – before your biopsy.
low grade cancer.
Diagnosis 13
Further tests
If the biopsy shows you have prostate cancer, a number of
other tests may be carried out. You may have one of these
tests or a combination. The tests will estimate the extent of the
cancer in your prostate and if it has spread to other parts of
the body. This is called staging.
Blood tests
Blood samples may be taken regularly to check your health
and to see if the prostate cancer has spread.
Bone scan
A bone scan may be taken to see if the prostate cancer has
spread to your bones.
A small amount of radioactive material (called technetium) is
injected into a vein, usually in your arm. This material is
attracted to areas of bone where there is cancer. After one to
two hours the location will be viewed with a scanning machine.
A bone scan is painless and will not leave you radioactive.
CT scan
A CT (computerised tomography) scan is a type of x-ray
procedure. It uses x-ray beams to take pictures of the inside of
your body and can assess if the cancer has spread to the lymph
nodes of the pelvis and abdomen.
This painless test takes about 10-30 minutes. A special dye is
injected into a vein, probably in your arm, to help make the
pictures the scan takes clearer. This may make you feel hot all
over for a few minutes. You will lie flat on a table while the
CT scanner, which is large and round like a doughnut, rotates
around you. Most men are able to go home as soon as their
scan is done.

MRI scan
The magnetic resonance imaging (MRI) test uses a combination
of magnetism and radio waves to build up detailed cross-section
pictures of the body. The test involves lying on a couch inside a
metal cylinder – a large magnet – that is open at both ends.
In some cases of more advanced prostate cancer, an MRI can
help to confirm if the cancer is contained within the prostate.
This is sometimes performed with a probe in the rectum.
Stages of prostate cancer

If the biopsy and the results of the above tests detect prostate
cancer, the doctor will assign a stage to indicate how far it has
spread. An international staging system called TNM is used to
stage different types of cancer – including prostate cancer –
based on certain standard criteria. The T refers to the tumour,
the N to the lymph glands (or nodes) and the M to metastasis,
or how far the cancer has spread.
In the TNM system, each letter is assigned a number which
indicates how advanced the cancer is. Doctors will typically
explain the stage and grade of your cancer in plain English, but
you can ask them about your TNM score. You can also refer
to the Australian Prostate Cancer
Collaboration’s booklet,
The stage tells you how
Localised prostate cancer: a guide far the cancer has spread.
for men and their families for The grade tells you how
more information on the TNM fast the cancer is growing.
system. Call 13 11 20 for a copy.
Diagnosis 15
Prognosis
Prognosis means the expected outcome of a disease. Of course,
every man is different, so you need to discuss the prognosis of
your particular type of prostate cancer with your urologist.
Only someone who knows your individual medical history can
tell you what to expect and the treatment options that are best
for you.
Prostate cancer usually grows slowly. Even fast-growing
prostate cancer grows slower than other types of cancer.
In many cases, especially when surgery is not chosen, the cancer
does not go away after treatment but instead stops growing or
shrinks in size. Men usually return to normal or near normal
good health, which may last for months or years. Other health
issues, such as age and fitness, are an important factor in your
recovery.

Treatment
Your urologist and radiation oncologist will advise you on the
best treatment after considering your age, general health, how
fast the prostate cancer is growing (the grade) and whether it
has spread (the stage). The side effects you are prepared to
accept are also important.
The treatments for localised prostate cancer include surgery
and radiotherapy. If the cancer has spread beyond the
prostate, hormone therapy may be used. You may have one of
these treatments or a combination.
Watchful waiting
In some cases, your doctor may recommend no treatment
at all, but will instead keep an eye on you with regular
checkups. This is called watchful waiting or active
surveillance. This may seem strange to you, but having no
immediate treatment may be an option if the cancer is
small (early stage) and slow growing. Watchful waiting may
also be suggested for men over 70 years of age as the
cancer is unlikely to grow fast enough to cause any
problems during their lifetime.
Watchful waiting may be a good option if the possible

treatment side effects would have more impact on your
life than the cancer itself. You can always change your
mind and have treatment later. If the cancer grows or
spreads, other treatment may be recommended.
If living with an untreated cancer makes you feel anxious

or concerned, discuss this situation with your urologist or
radiation oncologist.
Treatment 17
Surgery
Your doctor may suggest surgery if you have early prostate
cancer, are fit for surgery and expect to live longer than 10
more years. There are several different types of surgery used to
treat prostate cancer.
Radical prostatectomy
Removal of the whole prostate and the nearby glands that store
semen, the seminal vesicles, is called a radical prostatectomy.
This surgery is usually done through a 10-12 cm cut in your
lower abdomen. After the prostate is removed, the urethra is
rejoined to the bladder.
You will need to stay in hospital for three to seven days. A
thin tube (catheter) will be used to collect urine in a bag. You
may need a catheter for six to 14 days after the surgery.
You should be able to return to work and activities such as
heavy lifting within four to six weeks depending on your type
of work.
Nerve-sparing surgery
Nerve-sparing surgery involves removal of the prostate and
preservation of the erection nerves. These nerves can only
be saved if the cancer has not spread along the nerves.
Problems with erections are common for one to three years
after nerve-sparing surgery but information, support,
medication and aids can improve the situation. Ask your
doctor or urology nurse for more information and consult
the section in this booklet on sexuality after prostate cancer
(page 37).

Keyhole surgery
For some patients, an alternative to open surgery is to remove
the prostate via keyhole surgery. This is called a laparoscopic
prostatectomy or a robot-assisted laparoscopic prostatectomy.
In this procedure, several small cuts are made in the skin, and
a small tube is passed into the abdomen. A very small
telescope, with a camera attached (the laparoscope) is passed
through it to allow the surgeon to see inside the abdomen. The
prostate is cut away and removed through the tube.
This procedure, which is not suitable for all patients, may have
some advantages over open surgery. The scar is smaller, healing
is faster, and the hospital stay is shorter. Men can often return
to work within two to three weeks, compared with four to
six weeks for open surgery. As with open surgery, the surgeon
needs to have considerable experience doing the procedure.
There is currently no long-term evidence to show if keyhole
surgery leads to fewer side effects, such as impotence and
urinary problems, than conventional prostatectomy.
Keyhole surgery using robotic technology is very expensive
technology and is unlikely to become widely available because
of the cost.
Transurethral resection
If the prostate can’t be taken out because of more extensive
cancer, symptoms such as the need to urinate more often can
be relieved by removing blockages in the urinary tract. This
operation is called transurethral resection of the prostate
(TURP). It is also used to treat benign prostate enlargement.
A telescope-like instrument is passed through the opening in
the penis and up the urethra to remove the blockage. The
operation only takes about an hour but usually requires a
couple of days in hospital.
Treatment 19
Side effects of surgery
• Nerve damage: The nerves needed to have an erection and
the muscle used to control bladder function are found near
the prostate. These may be damaged during surgery, causing
bladder control problems and erection difficulties.
• Impotence: Most men will experience problems getting and
maintaining an erection (impotence) after surgery. Recovery
of erections often takes up to two years. Impotence can
cause ongoing problems in about 30-70% of men. The
extent of the problem may depend on your age, general
health, type of surgery and quality of erections before
treatment. Fortunately, there are a number of strategies to
help you manage impotence. For more information, see
Sexuality after treatment on page 37.
• Bladder control: A radical prostatectomy may mean you have
difficulty controlling your bladder, leading to leakage and the
need for pads. This usually improves within a year of the
surgery. Advances in surgical techniques have made major
urine control problems very uncommon. You can also do
pelvic floor exercises to improve control.
Some men may notice a small
If you experience cloudy leakage of urine during
urine or notice any other
intercourse and orgasm due
changes when passing
to damage to the sphincter
urine, you speak with
your doctor. You may
muscle that controls urine flow.
have a urinary infection. See page 29 for more
information.
• Effect on fertility: Infertility will occur because the tubes
from the testicles (vas deferens) are sealed. A normal
orgasm is still possible but without the ejaculation of semen
(dry ejaculation). If you still wish to have children you
should speak with your doctor before treatment about the
possibility of storing your sperm or other options.

External beam radiotherapy
External beam radiotherapy uses high-energy x-rays to kill
cancer cells or injure them so they cannot multiply.
Radiotherapy is usually considered if you have early cancer
and are otherwise in good general health. It may be used
instead of surgery or in combination with surgery.
The x-rays are aimed at the cancer in your prostate from an
external machine. Treatment is planned to ensure as little harm
as possible to the normal tissue surrounding the prostate.
If you live close to a hospital with radiotherapy facilities, you
can usually have treatment each weekday for up to eight
weeks. You can stay at home and go to the radiotherapy
centre each day during this time. Many men continue to work
during the course of treatment.
Each treatment only takes approximately 15 minutes once
started, but it can take one to three hours to set up the
machine, see the radiation oncologist and have blood tests.
There can be unexpected delays with machine set up and
maintenance.
For more information, call the Cancer Council Helpline on
13 11 20 for a free copy of The Cancer Council’s
Understanding Radiotherapy booklet or download it from
www.cancercouncil.com.au.
Treatment 21
Side effects of radiotherapy
Radiotherapy can cause side effects, particularly to those
organs that the radiation must pass through to reach the
prostate, such as the bladder and bowel.
• Effects on erections: Problems with erections are common
after external radiotherapy (approximately 50%) because of
damage to the blood vessels needed to have an erection.
Problems may not occur immediately, but may develop over
time. Later in this booklet (page 37), we look at ways that
you can deal with this effect on your sexuality.
• Urinary problems: You may experience burning or scalding
when urinating or an increased urgency to urinate. These
side effects usually go away after treatment has finished and
your doctor can prescribe medications to reduce any
discomfort they cause. Radiation is very unlikely to cause
incontinence. You may also feel tired, although most men
remain active during treatment.
• Bowel problems: Some men may have bleeding when
passing a bowel motion. The bleeding is caused by damage
to the fine blood vessels in the lower bowel. These usually
heal quickly but treatment is available if the bleeding
continues. It is important to let your doctor know if you
experience rectal bleeding at any time. A few men may
experience difficulty holding on to their bowel motions and
feel a sense of urgency or experience diarrhoea or loose
bowel motions. Fortunately, improved radiation techniques
have made bowel problems less common.
• Tiredness: During radiotherapy your body uses a lot of
energy dealing with the effects of radiation on normal cells.
Many people find they feel tired during and after treatment.
Your weakness and weariness may build up slowly during
the course of treatment but should go away gradually after
treatment is over.

Brachytherapy
Brachytherapy is a type of targeted internal radiotherapy
where the radiation source is placed directly within a tumour.
This allows high doses of radiation to be given with minimal
effect on nearby tissues such as the rectum.
Brachytherapy can be given at either a low-dose rate, by
inserting permanent radioactive seeds, or a high-dose rate,
through temporary needle implants. Brachytherapy is not
suitable for men with significant urinary symptoms.
Permanent radioactive seeds

Low-dose radiotherapy is implanted in the prostate in the
form of tiny seeds, about the size of a rice grain. The seeds,
which release radiation that kills cancer cells, are inserted
using needles and are guided into place by ultrasound. They
lose their radiation effect over time.
This procedure takes one to two hours
Radioactive seeds
and is done under a general anaesthetic.
are used for small
It usually requires an overnight stay in
tumours with a low
hospital. The advantage of this therapy Gleason score and
is its less invasive nature, more targeted a low PSA level.
therapy and quicker convalescence.
Treatment 23
Temporary needle implants
Temporary needle implants are usually combined with
external radiotherapy for men with a high PSA level, high
Gleason scores and more advanced cancer.
Hollow needles are placed in the prostate under general
anaesthetic and high-dose radioactive wires are passed down
the needles. After a few treatments over 36 hours, these
temporary needles are removed. The implant procedure, which
is carried out using an anaesthetic, usually requires a couple of
nights in hospital. Some cancer treatment units now perform
the implant procedure as a day-only procedure, repeating the
procedure in two weeks.
Side effects of brachytherapy

Brachytherapy may cause side effects similar to external
radiotherapy.
• Impotence: Around 50% of men experience impotence
problems after temporary needle implants. Permanent
radioactive seed implant brachytherapy has the lowest chance
of causing erection problems compared with other treatments.
• Urinating problems: While inserting the radioactive seeds
causes minimal discomfort, side effects may include pain
when urinating, poor urine flow and bladder irritation. These
side effects are temporary and can be treated. They usually
start a week after treatment and last up to six months.

Other treatments
High intensity focused ultrasound (HIFU) and cryotherapy are
less established treatments for localised prostate cancer.
At this stage they are regarded as emerging options which
most centres reserve for those patients who are unsuitable for
or who refuse surgery or radiotherapy.
Hormone treatment
Prostate cancer needs the male hormone, testosterone, to
grow. Slowing the production of testosterone may also slow
the growth of the cancer or shrink it. This is called hormone
treatment.
Hormone treatment will not cure prostate cancer. It can help
with symptoms such as pain caused by the cancer spreading.
It will put the cancer into temporary remission. This treatment
is often given for several months before radiotherapy and may
be continued following radiotherapy to increase the
effectiveness of the treatment.
Hormone injections
Injections of luteinising hormone-releasing hormone (LHRH)
are used to control the production of testosterone. LHRH is
given as a monthly, three-monthly or six-monthly injection. It
will not cure the cancer but will often slow its growth for years.
Treatment 25
Hormone treatment by surgery
Two operations can reduce testosterone levels. The removal of
the testes is known as an orchidectomy. After surgery, a plastic
prosthesis can be put into the scrotum to keep its shape and
appearance. The removal of only the inner part of the testes is
called a subcapsular orchidectomy. This operation does not
require a prosthesis. Most men choose LHRH injections over
orchidectomy for psychological reasons. Surgical removal of
the testes is now uncommon.
Side effects of hormone therapy

Men receiving hormone treatment may have side effects from
the withdrawal of testosterone. These include tiredness, erection
problems, reduced sex drive, weight gain, hot flushes, breast
tenderness, depression and loss of bone strength (osteoporosis).
These side effects can significantly affect the way you function,
but your doctor can help you minimise their impact.
Palliative treatment
Palliative treatment is available for all people who have cancer
symptoms, whatever their stage of treatment. It is particularly
important for people who have advanced cancer, who cannot
be cured but want to live comfortably.
Your doctor will discuss palliative treatment for specific
problems caused by the cancer, such as pain. Treatment
can include radiotherapy, chemotherapy and pain-relieving
medications.
Palliative treatment For more information on palliative
can help with pain
treatment, call the Cancer Council
management – it is
not just for people
Helpline on 13 11 20 for a free copy
who are about to die. of the Understanding Palliative Care
information sheet.

After treatment: follow-up
After treatment, you will need regular checkups with your
doctor. This will involve testing your PSA level. The meaning
of your PSA levels will vary depending on whether you have
had surgery or radiotherapy.
After surgery, your PSA level should drop quickly to zero, as
there are no prostate cells left to produce it.
After radiotherapy, your PSA level will gradually drop. It may
take two to three years for your PSA to reach its lowest level.
Your doctor will decide how often you need checkups and a
PSA test. Checkups will become less frequent if you have no
further problems.
What if the prostate cancer comes back?

If your PSA levels start to rise and the cancer has not spread
beyond the prostate, this may mean you still have cancer cells
in the prostate area. If this happens, you may be given more
treatment. This is called salvage treatment. If you have had
surgery, radiotherapy may be offered. If you have had
radiotherapy you may be offered surgery, brachytherapy,
cryotherapy or ultrasound treatment (HIFU).
If the cancer has spread beyond the prostate, hormone treatment
is the usual treatment option.
Treatment 27
Managing side effects
Treatment for prostate cancer may damage nerves and muscles
near the prostate and the bowel and this may cause side effects.
The side effects of treatment include impotence, urinary
incontinence, changes in bowel habits, infertility and loss of
interest in sex.
Side effects will vary from person to person. Some men will
have no side effects; others may experience a few. Side effects
may last from a few weeks to
three years. Fortunately, there
After treatment for prostate
cancer, most men lead
are many ways to reduce or
active lives by managing manage the discomfort that side
the side effects. effects cause, and most go away
in time.

Impotence
The quality of erections usually changes as men get older.
Erections may be short-lived or difficult to achieve. Erection
problems are also common in men who have had surgery and
radiotherapy for prostate cancer because these treatments can
damage nearby nerves and blood flow.
In Sexuality after treatment on page 37, we discuss how you
can deal with these changes.
Urinary incontinence
Not being able to control the flow of urine is called urinary
incontinence. It is a common temporary side effect of surgery,
but for a few men it is permanent.
The effects of incontinence vary. Some men may lose a few
drops when they cough, sneeze, strain or lift. Others have
more severe problems requiring the use of incontinence pads.
It is usually worse after treatment, and better within a year.
Bladder problems can be managed in a variety of ways. You can:
• Use aids to help cope with any urine loss and protect your
skin. Some available aids include absorbent pads, sheets and
chair covers.
• Ask a doctor or nurse about Don’t restrict your intake of
‘training’ your bladder. This fluids because you are
can help you to go to the toilet afraid of leakage. It’s
less often and to pass more important to drink plenty of
urine when you go to the toilet. water as concentrated urine
can irritate the bladder,
• Exercise the muscles in your cause constipation and may
pelvis (pelvic floor muscles) to lead to urinary infections.
help stop or reduce leakage.
Managing side effects 29

If incontinence lasts longer than a year, it is unlikely to improve.
You should then talk to your urologist about other treatments to
fix the incontinence. Two
successful options include slings or
an artificial sphincter.
For more information on pelvic
floor exercises and bladder
training programs, contact the
continence nurse or
physiotherapist at your hospital or
call the Continence Foundation of
Australia on 1800 330 066, which
can provide a free brochure, Pelvic
floor muscle exercises for men.
Bowel problems
Rarely, radiotherapy may damage the lower bowel (rectum),
leading to bleeding, diarrhoea or loss of bowel control. A
bowel specialist (colorectal surgeon) will treat these side effects
with suppositories or treatments applied to the bowel. Ask
your radiation oncologist for more information.
Fertility problems
After surgery, radiotherapy or hormone therapy for prostate
cancer, most men become infertile. Loss of fertility may not be a
problem for many men diagnosed with prostate cancer as they
are usually older and have finished having children. If you want
to have children, it is best for you and your partner to talk
about these issues with your doctor before treatment
commences. You may be able to store sperm before treatment
starts for use at a later date. Ask your doctor about the options.

Making treatment decisions
Sometimes it is difficult to decide on the right treatment for
you. You may feel that everything is happening so fast that
you don’t have time to think things through. There is usually
time for you to consider what sort of treatment you want.
Prostate cancer is typically a slow-growing disease and there is
usually plenty of time to decide on treatment. Don’t feel rushed.
Take time to talk to others and find out more information.
Waiting for test results and for treatment to begin can be
difficult. While some people feel overwhelmed with
information, others feel they don’t have enough. You need to
make sure you understand enough about your illness, the
treatment and side effects to make your own decisions.
If you are offered a choice of treatments, you will need to weigh
the advantages and disadvantages of each treatment. If only one
type of treatment is recommended, ask your doctor to explain
why other treatment choices have not been offered.
Some people with more advanced cancer will choose treatment,
even if it only offers a small chance of cure. Others want to
make sure the benefits of treatment outweigh any side effects.
Still others will choose the
treatment they consider offers
You always have the right
them the best quality of life. Some
to find out what a
may choose not to have treatment, suggested treatment
but instead choose to have means for you, and the
symptoms managed to maintain right to accept or refuse it.
the best possible quality of life.
Making treatment decisions 31

Decision-making steps
1. Take the time to consider all treatment options.
2. Weigh up the advantages and disadvantages of each
treatment.
3. Consider how important each side effect is to you –
particularly those that affect your lifestyle. If you have a
partner, discuss the side effects with them.
4. If only one type of treatment is recommended, ask your
doctor if other treatment choices are available.
5. Find out more about the treatment choices offered to
you – speak to your doctor, get a second opinion, look at
the recommended Internet sites on page 54, talk to your
family and friends and to other people who have
received these treatments.
6. Consider the cost and availability of treatment when
making your treatment decision. Some treatments, such
as brachytherapy, are more costly and are available only
in some locations. Ask about the ease of accessing
treatment, whether it is available at public or private
hospitals, as an in- or out-patient treatment, and whether
Medicare or your
health fund covers
the costs.
7. If you are not happy
with the information
you are given – or
how it is given – tell
the doctor about your
concerns, or seek a
second opinion.

Talking with doctors
When you doctor first tells you that you have cancer, it is
obviously very stressful and you may not remember very
much. It is often difficult to take everything in, so you may
want to see the doctor a few times before deciding on
treatment. Your doctor may use medical terms you don’t
understand; it’s okay to ask your doctor to explain something
again, or you can check a word’s meaning in the glossary at
the end of this booklet.
Before you see the doctor, it may
help to write down your questions
– see the list of questions on
page 55. Taking notes during the
session or tape-recording the
discussion can also 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.
Initially I didn’t understand my diagnosis and the

treatments sounded pretty bad. This made it hard
to make a decision but it helped to talk about the
different options with my doctor and family.

Talking with others
Once you have discussed treatment options with your doctor,
you may want to talk them over with family or friends,
nursing staff, the hospital social worker or chaplain, your own
religious or spiritual adviser, a cancer support group or the
Cancer Council Helpline on 13 11 20. Talking it over can help
sort out the right course of action for you.
A second opinion
You may want to get a second opinion from another specialist.
Some people feel uncomfortable asking their doctor for a
second opinion, but specialists are used to patients doing this.
A second opinion can be a valuable part of your decision-
making process. It can confirm or suggest changes to your
doctor’s recommended treatment plan, reassure you that you
have explored all of your options, and answer any questions
you may have.
Your specialist or family doctor can refer you to another
specialist and you can ask for your results to be sent to the
second-opinion doctor.
You may later decide you prefer to be treated by the doctor
who provided the second opinion, and this is your right.
You can ask for a second opinion even if you have already
started treatment or still want to be treated by your first doctor.

Taking part in a clinical trial
Your doctor may suggest you consider taking part in a clinical
trial. Clinical trials help find better cancer treatments.
Doctors conduct clinical trials to test new or modified
treatments and see if they are better than current treatments.
Before deciding whether or not to join the trial, you may wish
to ask your doctor:
• What treatments are being tested and why?
• What tests are involved?
• What are the possible risks or side effects?
• How long will the trial last?
• Will I need to go into hospital for treatment?
• What will I do if problems occur while I am in the trial?
• Has an independent ethics committee approved the trial?
If you are unsure about joining the trial, ask for a second
opinion from an independent specialist.
If you decide to join a randomised clinical trial, you will be
given either the best existing treatment or a promising new
treatment. You will be chosen at random to receive one
treatment or the other.
Being in a trial gives you important rights. You have the right
to withdraw at any time. Doing so will not jeopardise your
treatment for cancer.
For more information about
clinical trials – and how to It is always your decision to
take part in a clinical trial. If
find a trial that may be
you don’t want to take part in
suitable for you – call the
the trial, your doctor will
Cancer Council Helpline on provide the best current
13 11 20 for a free copy of treatment choices for you.
Understanding Clinical Trials.

Prostate cancer research
Extensive research is being done on prostate cancer treatment.
One example is The Cancer Council’s Prostate Cancer
Outcomes Study, which began in 2000. It is looking at the
long-term benefits and side effects of the treatment options for
prostate cancer.
The study is surveying 2,000 men with prostate cancer each
year for five years after their diagnosis. This research will
provide information on the expected quality of life and the
type and the severity of side effects after treatment for
Australian men with prostate cancer. The data collection is
scheduled for completion in late 2007.
For details on other research being conducted, ask your doctor.

Life after treatment
Sexuality after treatment
The role that sexuality and intimacy play in people’s lives is
ever changing and depends on one’s age, environment, health,
relationships, culture, beliefs and interest. As individuals,
people not only have different ways of expressing and defining
sexuality and intimacy, but they also place their own
importance on these needs.
Having cancer can affect your sexuality in both physical and
emotional ways. The impact of these changes depends on
many factors, such as your treatment and its side effects, the
way you and your partner communicate, and your self-
confidence. Knowing the potential challenges and addressing
them if they affect you personally will help you overcome or
adjust to these changes.
I don’t feel less a man because I have prostate

cancer and the treatment has affected my sex drive.
My partner and I have found ways to be loving in the
most intimate, private ways. She almost always
initiates the foreplay that gets me interested. Love,
discussion and setting out to make things happen is
what has helped us find our way through this.
Life after treatment 37

Prostate cancer and erectile function
While the prostate doesn’t contribute to a man’s ability to
have an erection, it lies close to structures that are important
to erectile function and these can be damaged when prostate
cancer is treated.
A series of fine nerves lie in bundles against the prostatic
capsule and these contribute to having an erection. Prostate
cancer treatments – such as radiation and surgery – can
damage both the nerves and the blood vessels that are
important for strong erections.
When a man has trouble getting or keeping an erection firm
enough for intercourse, this condition is called ‘erectile
dysfunction’. This is the technical name for the condition that
affects many men at different stages in their lives, and which,
despite being relatively common, can still be very distressing.
Prostate cancer treatment may then have an additional impact
on your ability to have an erection. This may be a long-term
effect or only a short-term effect, and there is a range of ways
to work around these difficulties.
A man’s sexual activity can be affected by many things and
one of these can be simply getting older. Other contributing
factors include:
• diseases such as diabetes
• certain medications, such as those used to treat blood
pressure or depression
• surgery to the bowel or abdomen
• a history of smoking and/or a high alcohol intake
• emotional or mental distress.

Radical prostatectomy and your sex life
Radical prostatectomy removes the entire prostate gland, part
of the urethra and the seminal vesicles. See the area enclosed
by the dotted line in the diagram below.
While the surgeon will try to minimise the risk of nerve
damage by using a ‘nerve-sparing’ technique, most men will
lose the capacity to have erections in the short term. The body
needs time to heal after surgery. There is generally gradual
improvement, with some men noticing continued improvement
up to four years after surgery.
Radical prostatectomy
to remove the prostate
(as indicated by the dotted line)

Improving the quality of your erections
There are things you can do and techniques you can try to
improve the quality of your erection, both ‘artificial’ aids
(listed below) and changes to the way you and your partner
approach foreplay and sex.
There is a range of different aids, including:
• Tablets that increase the blood flow to the penis, such as
Viagra. These medications can cause headaches, nausea,
blurry vision and facial flushing. Men with heart problems
should check with their doctor before taking this medication.
• Penile injection therapy – an injection to the penis, which you
can learn to do yourself, causes the blood vessels to expand
and the penis to become erect. This treatment works well in
most men but a few may experience some pain and scarring.
• A pump device that
uses suction to draw
blood into the penis.
This may be an option
if injections or tablets
have not worked.
• Implants surgically
placed in the penis. A
pump is positioned in
the scrotum and is
turned on when an
erection is needed.
Implants are usually
performed about one to
two years after surgery.

Erectile dysfunction therapies
Erectile dysfunction is a common problem. It is not unusual to
see large advertisements in newspaper and magazines or on the
Internet for products and services offering treatment for this
condition. These treatments range from herbal preparations
and natural therapies to nasal sprays and lozenges. After a
diagnosis of prostate cancer, a man needs to be very cautious
about using testosterone or natural products that may act like
testosterone in the body. It is strongly recommended that men
talk with their doctor before taking any additional medication
to improve erections.
Other changes that might occur

Dry orgasm or ejaculation: Following surgery, you will
experience ‘dry ejaculation’ as you will not produce semen in
the prostate and seminal vesicles. You will feel the same
rhythmic muscular spasms and pleasure that accompany
orgasm, but no semen comes out of the penis. Some men may
notice a small leakage of urine during intercourse and orgasm
due to damage to the sphincter muscle that controls urine flow.
Though this can be upsetting to some men or their partners,
urine is normally sterile and should not be harmful. If this is a
problem for you, empty your bladder before having sex. You
can also speak with your doctor about how to manage this.
Even if you have radiotherapy instead of surgery, the production
of semen will be reduced.
Men sometimes worry that dry ejaculation will be less
pleasurable for their partner. However, many partners report
that they do not feel the release of semen during intercourse
and that dry ejaculation is actually ‘less messy’ for them
during both oral and penetrative sex.

Loss of libido: Reduced interest in sex is common during
cancer treatment. This lowered level of desire is known as loss
of libido. Quite often it occurs due to anxiety, worry and
fatigue, rather than the treatment itself. However, hormone
treatment to reduce testosterone levels and impotence caused
by radiotherapy or surgery can impact heavily on libido levels.
Most men notice that their sex drive returns when treatment
has finished, but for some men it is an ongoing concern.
The emphasis a man placed on his sexual activities before he
had prostate cancer will influence how much his lowered
libido affects him and/or his partner. As men often identify
their sense of masculinity with their sex drive, loss of libido
can represent much more than the end of sexual intimacy.
Some men might feel they have lost a part of themselves, while
others may question their self-worth.

Adjusting to changes in sex drive can be emotionally and
physically challenging for men and partners. Discussing your
feelings and concerns with your partner and doctor or
counsellor will help you work through your individual sexual
needs and desires. This is especially important if your situation
is causing depression or relationship difficulties. Some men
also find it useful to talk to other men who have been through
a similar experience. See page 52 for information on support
groups and Cancer Connect.
Restoring your sex life

• After treatment for prostate cancer the way you have sex
may need to change. Patience, practice and the following
suggestions will help you manage impotence. Even if your
erections improve, continuing these approaches to your sex
life can have lasting benefits and improve the quality of
your sexual relationships.
• If you have a partner, it will help to talk about it. You are
both affected by the changes. Discuss what works and
doesn’t work for you. Talking will also help reassure both
of you of your need and affection for each other.
• Take it slowly the first few times you have sex after cancer
treatment. Start by touching each other. Tell your partner
where you like to be touched or guide them with your hand.
When you feel relaxed, include some genital touching. Ask
your partner to be gentle because your genital area may be
tender. Practise reaching an orgasm through stroking with a
hand or through oral sex.
• Try different positions with your partner to find out what
feels comfortable and is suitable for both of you.
• Touching, holding, hugging and caressing are other ways of
reassuring your partner that you love them.

• Explore your own ability to enjoy sex through
masturbation. Touching your genitals and bringing yourself
to orgasm can help you find out if cancer treatment has
changed your sexual response.
• Even if you have a partial erection, you can still attempt
intercourse – it can be surprisingly satisfying for you and
your partner and the stimulation may encourage further
and better quality erections.
• Personal lubricants, especially the silicone-based products,
can be helpful if prolonged stimulation is necessary.
• If you have difficulty continuing your usual sexual activities,
talk with your doctor or a counsellor.
For more information, call the Cancer Council Helpline on
13 11 20 for a free copy of The Cancer Council’s booklet
Sexuality for Men with Cancer or download it from
www.cancercouncil.com.au.
I always thought you needed an erection to have

an orgasm. Once I realised you didn’t, maintaining
my sex life wasn’t the issue I originally imagined.

Changing body image
Cancer can change how you feel about yourself. Treatment
or side effects such as impotence or incontinence may
make you feel embarrassed or insecure.
While treatment side effects such as incontinence or

impotence are often temporary and can be managed, they
may make you feel less masculine.
The physical changes don’t change who you are. Your

intelligence, sense of humour and personality remain
the same.
Take time to get used to body changes. Look at yourself

naked in the mirror and, if you feel comfortable, touch your
genitals to find out what is different and what feels sore or
numb. Show your partner any body changes so you can
get used to how that makes you feel.
Talking about your experience with men who have had a

similar experience can be helpful. For information on
joining a prostate cancer support group, see page 52.

Strengthening your relationship
Most relationships have to deal with the normal challenges of
individual differences and the issues of how, where and when
couples will have sex. Some of these things may need to be
discussed again after treatment for prostate cancer.
For many couples, a relationship based on trust and mutual
understanding is an important part of a satisfying sexual
experience. Keeping a relationship happy, intimate and
satisfying takes time and effort on both sides. To develop
intimacy, a couple needs to practise spending time together
talking, relaxing and having fun. Sexual intercourse may not
always be possible, but closeness and sharing are vital to a
healthy relationship. Cuddling, massage, touching and kissing
are special ways to be together without the need to have sex.
Sex and the single man

Single men may avoid dating for fear of rejection or being seen
as an undesirable sexual partner. Deciding when to tell a new
date about your cancer experience isn’t easy. While the timing
will be different for each person, it can be helpful to wait until
you and your new partner have developed a mutual level of
trust and caring. There is no ‘perfect time’ to talk about
sexuality issues; however, it is best to talk with a new partner
about your concerns before becoming sexually intimate. By
communicating openly, you may find that your partner is very
understanding and accepting of your changes, which will
make subsequent sexual activity easier for you both.

Healthy eating and exercise
Eating nutritious food will help you keep as well as possible
and cope with the cancer and treatment side effects. Depending
on the kind of treatment you have had, you may have special
dietary needs. A dietitian can help to plan the best foods for
your situation – ones that you find tempting, easy to eat and
nutritious.
The Cancer Council’s booklet, Food and Cancer, has practical
tips on diet during and after cancer treatment. Call 13 11 20
for a copy or download it from The Cancer Council’s website.
You will probably find it beneficial to your overall health to
stay active and to exercise regularly if you can. The amount
and type of exercise will depend on what you are used to and
how well you feel. If you want to do more vigorous exercise,
ask your doctor what is best for you.
Complementary therapies
Complementary therapies may help you cope better with side
effects and feel as well as possible. They may also increase
your sense of control over what is happening to you, reduce
your feelings of helplessness, decrease your stress and anxiety
and improve your mood. Some complementary therapies may
reduce the amount of medication needed for pain control.
There are many different types of complementary therapies,
including acupuncture, massage, hypnotherapy, relaxation
and yoga.
Some cancer treatment centres offer complementary therapies
such as counselling and massage as part of their services. Ask
what’s available at your hospital.

Relaxation techniques
Some men find relaxation or meditation helps them feel better
by releasing tension and anxiety. The hospital social worker or
nurse will know whether the hospital runs any programs, or
may know about local community programs. Your community
health centre or prostate cancer support group may also be
able to help.
Will the cancer come back?

After treatment finishes, you might feel pressure to get back to
‘normal life’. Many people feel that life will never be the same
after an experience with cancer – indeed, some people have
even reported that they have a new perspective on life and that
they see things with a new clarity.
Still, fear of cancer returning can feel like a shadow on your
life. You might worry about every ache and pain and wonder
if it is the cancer coming back. It might help to talk to your
doctor and ask about what to expect if the cancer were to
return. This might reassure you.
This is a difficult time and it will take time to readjust. If you
have continued feelings of sadness, have trouble getting up in
the morning or have lost motivation for things that previously
gave you pleasure, talk to your doctor. You might be clinically
depressed and there are ways that your doctor can help you.

Seeking support
When you are first diagnosed
with cancer, it is normal to
experience a range of
emotions, such as fear,
sadness, depression, anger or
frustration. If anxiety or
depression is ongoing or
severe, tell your doctor about
it as counselling or
medication can help.
It may help to talk about
your feelings with others.
Your partner, family
members and friends are a
good source of support or
you might prefer to talk to:
• members of your treatment team
• a hospital counsellor, social worker or psychologist
• your religious or spiritual adviser
• a support group – see page 52
• the Cancer Council Helpline on 13 11 20.
If you have children, the prospect of telling them you have
cancer can be frightening and unsettling. The Cancer Council
booklet When a parent has cancer: how to talk to your kids
can help you prepare for this difficult conversation.
You may find that your friends and family don’t know what
to say to you. They may have difficulty with their feelings as
well. You may feel able to approach your friends directly and
tell them what you need or you may prefer to ask a close
family member or a friend to talk with other people for you,
and coordinate practical support and offers of help.
Seeking support 49
Some people may feel so uncomfortable that they avoid you.
They may expect you to ‘lead the way’ and tell them what
you need. This can be difficult to handle and can make you
feel lonely.
The Cancer Council’s booklet Emotions and Cancer may help at
this stressful time. Call 13 11 20 for a copy or download it from
the Cancer Council’s website at www.cancercouncil.com.au.
Practical and financial help

A serious illness often causes practical and financial difficulties.
You don’t need to face these alone.
Many services are available to help:
• Financial assistance, through benefits and pensions, can help
pay for the cost of prescription medicines and for travel to
medical appointments.
• Home nursing care is available through community nursing
services, or through the local palliative care service.
• Meals on Wheels, home care services and aids and appliances
can make life easier.
Contact the hospital social worker, occupational therapist or
physiotherapist, or the Cancer Council Helpline for information.

The Cancer Council Helpline 13 11 20
Monday to Friday 9am to 5pm
The Cancer Council Helpline is a service of The Cancer

Council NSW. There is no charge for this service except for
the cost of a local call. The Cancer Council Helpline is a
telephone information and support service for people
affected by cancer. You can talk about your concerns and
needs confidentially with specialised oncology health
professionals. They can send you written information and
put you in touch with appropriate services in your own
area. If calling outside business hours, you can leave a
message on an answering machine and your call will be
returned the next business day.
You can call the Cancer Council Helpline, Monday to Friday,

9am to 5pm, for the cost of a local call.
Cancer Council Helpline .................................................................. 13 11 20
Cantonese and Mandarin ..................................................... 1300 300 935

Greek . ......................................................................................................... 1300 301 449
Italian ........................................................................................................... 1300 301 431
Arabic ......................................................................................................... 1300 301 625
Tele-typewriter (TTY) for deaf or
hearing-impaired people ................................................... (02) 9334 1865
Seeking support 51
Talk to someone who’s been there
Cancer support groups offer mutual support and information
to men with cancer and their families. It can help to talk with
others who have gone through the same experience.
The Cancer Council Connect Prostate Cancer Peer Support
puts you and your family in touch with trained volunteers
who have had prostate cancer and are now in good health.
They can offer support during or after treatment and in the
recovery period.
It is an opportunity to talk about your fears and concerns
with someone who understands. Peer support can also offer
the chance to share experiences and ways of coping.
For more information call the Cancer Council Helpline on
13 11 20.
Understanding Cancer program

If you want to find out more about cancer and how to cope
with it, you may find the Cancer Council’s Understanding
Cancer program helpful. The program offers practical
information about many of the issues people experience after
a diagnosis of cancer, including: what is cancer, cancer
symptoms and side effects, palliative care and diet, exercise
and complementary therapies. Groups are small, with plenty
of time for discussion. Courses are held frequently at hospitals
and community organisations throughout NSW. Call the
Cancer Council Helpline on 13 11 20 to find out more.

Caring for someone with cancer
Looking after someone with cancer can be very stressful,
particularly when it is someone you care about. Try to look
after yourself during this time. Give yourself some time out,
and share your worries and concerns with someone.
You may have to make many decisions. You will probably
have to attend many appointments with doctors, support
services and hospitals. Many people find it helpful to take
another member of the family or a close friend with them.
Cancer support group membership is generally open to people
with cancer and carers. A support group can offer the chance
to share experiences and ways of coping for all the family.
No-one has to cope alone.
There are a variety of support services that can help you cope
with treatment at home. Call the Cancer Council Helpline on
13 11 20 to find out about services in your area. Carers NSW
also offers support and information, call 1800 242 636.
For a free copy of the Cancer Council’s Caring for someone
with cancer booklet call the Cancer Council Helpline or log
onto www.cancercouncil.com.au.
Seeking support 53
Information on the Internet
The Internet can be a useful source of information, although
not all websites are reliable. The websites listed below are good
sources of reliable information.
Australian
The Cancer Council NSW ...................... www.cancercouncil.com.au
The Cancer Council Australia ................................... www.cancer.org.au
St Vincent’s Prostate Cancer Centre ............ www.prostate.com.au
Prostate Cancer Foundation of Australia ..... www.prostate.org.au
Australian Prostate Cancer Collaboration (APCC) Inc.
................................................................................................... www.prostatehealth.org.au
International
Cancerbackup ......................................................... www.cancerbackup.org.uk
National Cancer Institute ..... www.cancer.gov/cancer_information
American Cancer Society ......................................................... www.cancer.org
Canadian Cancer Society ............................................................. www.cancer.ca

Question checklist
You may find this checklist helpful when thinking about the
questions you want to ask your doctor about your illness and
treatment. If there are answers you don’t understand, it is
okay to ask your doctor to explain again.
1 What type of prostate cancer do I have?

2 What is the stage and grade of my cancer and what does
that mean?
3 What treatment do you recommend and why?
4 What happens if I do nothing?
5 Are there other treatment choices for me? If not, why not?
6 What are the side effects of each treatment?
7 How can the side effects be managed?
8 Will I have problems with sex and fertility?
9 Will I have to stay in hospital?
10 How long will the treatment take? Will it affect what I
can do?
11 Where will I have the treatment? In a public or private
facility? As an in- or out-patient?
12 How much will it cost?
13 How will I know if the treatment is working?
14 If I need further treatment, what will it be like and when
will it begin?
Question checklist 55
15 After treatment, will I need checkups? What will they
involve?
16 I would like to have a second opinion. Can you refer me
to someone else?
17 Is my cancer hereditary? If, so what do you recommend?
18 How many patients with prostate cancer similar to mine
do you see each year?

Glossary
advanced prostate cancer
Prostate cancer that has spread to other parts of the body.
anaesthetic
A drug that stops a person feeling pain during a medical
procedure. A local anaesthetic numbs only a part of the
body. A general anaesthetic puts a person to sleep for a
period of time.
androgens
Male sex hormones. They produce male physical
characteristics such as facial hair or a deep voice. The main
androgen hormone, testosterone, is produced by the testicles.
benign
Not cancer. Not malignant.
benign prostate enlargement

A non-cancerous enlargement of the prostate that pushes
against the urethra and the bladder, blocking the flow of
urine.
biopsy
The removal of a small sample of tissue from the body, for
examination under a microscope, to diagnose a disease.
bladder
A sac with an elastic wall of muscle, which is in the lower
part of the abdomen. The bladder stores urine until it is
passed from the body.
Glossary 57
brachytherapy
A type of radiotherapy treatment that implants radioactive
material sealed in needles or seeds into or near the tumour.
cells
The building blocks of the body. A human is made of
millions of cells, which are adapted for different functions.
Cells can reproduce themselves exactly, unless they are
abnormal or damaged, as are cancer cells.
chemotherapy
The use of drugs to treat cancer by killing cancer cells or
slowing their growth.
CT (computerised tomography) scan

A technique that uses x-rays to build a picture of the body.
digital rectal examination

An examination of the prostate through the rectum wall.
The doctor inserts a gloved finger into the rectum to feel the
shape of the prostate.
dry orgasm
Sexual climax without the release of semen from the penis.
external beam radiotherapy

The use of high-energy x-rays to kill cancer cells or injure
them so they cannot multiply.
Gleason score
A way of grading prostate cancer biopsies. A low Gleason
score indicates a slow-growing (less aggressive) cancer and
a higher score indicates a faster-growing (more aggressive)
cancer.

grade
A score that describes how quickly the tumour is likely to
grow. It is commonly measured by the Gleason score.
High Intensity Focused Ultrasound (HIFU)

A less established treatment for localised prostate cancer
which may be used for those patients who are unsuitable
for surgery or radiotherapy.
hormone
A substance that affects how your body works. Some
hormones control growth, others control reproduction. They
are distributed around the body through the bloodstream.
hormone treatment/therapy
A treatment that blocks the body’s natural hormones that
help cancer grow.
impotence
Inability to have an erection firm enough for penetration.
incontinence
Inability to hold or control the loss of urine or faeces.
libido
Sex drive.
localised prostate cancer

Early-stage prostate cancer that has not spread beyond the
prostate gland.
Glossary 59
lymph nodes
Small rounded masses that make up the body’s lymphatic
system. Lymph nodes collect and destroy bacteria and viruses.
lymphatic system
A network of tissues, capillaries, vessels, ducts and nodes
that removes excess fluid from tissues, absorbs fatty acids
and transports fat, and produces immune cells.
magnetic resonance imaging (MRI) scan

A scan that uses both magnetism and radiowaves to take
detailed cross-sectional pictures of the body.
malignant
Cancer. Malignant cells can spread (metastasise) and
eventually cause death if they cannot be treated.
magnetic resonance imaging (MRI)

Similar to a CT scan, but this test uses magnetism instead of
x-rays to build up cross-sectional pictures of the body.
metastasis
Also known as a secondary cancer. A cancer that has spread
from another part of the body.
orchidectomy
Also called orchiectomy. An operation to remove one or
both testicles.
palliative treatment
Treatment to relieve symptoms without trying to cure the
disease.

primary cancer
The original cancer. Cells from the primary cancer may
break away and be carried to other parts of the body, where
secondary cancers form.
prognosis
The likely outcome of a person’s disease.
prostate
A gland about the size of a walnut found only in men. It
produces part of the fluid that makes up semen.
prostate specific antigen (PSA)

A protein produced by prostate cells. It can be used to test
for prostate cancer or to monitor its recurrence.
prostatectomy
An operation to remove all or part of the prostate.
radiotherapy
The use of radiation, usually x-rays or gamma rays, to kill
cancer cells or injure them so they cannot grow and multiply.
radiation oncologist
A doctor who specialises in treating cancer with radiotherapy.
radical prostatectomy
An operation to remove the entire prostate and some of the
tissue around it.
rectum
The last part of the bowel, leading to the anus, through
which stool passes.
Glossary 61
scrotum
The external pouch of skin behind the penis containing
the testes.
semen
The fluid, containing sperm and secretions from the
testicles and seminal vesicles, ejaculated from the penis
during sexual climax.
seminal vesicles
Glands that lie very close to the prostate and produce
secretions that form part of the semen.
side effect
Unintended effects of a drug or treatment.
sperm
The male sex cell. It is made in the testes.
staging
Tests to find out how far a cancer has spread.
testes
Also called testicles. Two egg-shaped glands that produce
sperm and the male sex hormone, testosterone. They are
found in the scrotum.
testosterone
The major male sex hormone produced by the testes. It
promotes the development of male sex characteristics.

TNM system
An international staging system used to stage different types
of cancer – including prostate cancer – based on certain
standard criteria.
transurethral resection of the prostate

Also called TURP. A surgical procedure to remove tissue
from the prostate that is restricting urinary flow. It uses an
instrument inserted through the urethra.
tumour
A new or abnormal growth of tissue on or in the body.
urethra
The tube that carries urine from the bladder out through
the penis and to the outside of the body.
urologist
A surgeon who specialises in treating diseases of the urinary
system.
watchful waiting
Also called active surveillance. When you receive no
treatment at all, but instead regularly monitor your cancer.
Glossary 63
How you can help
At The Cancer Council NSW we’re dedicated to defeating
cancer. As well as funding more cancer research than any other
charity in the state, we advocate for the highest quality of care
for cancer patients and their families, and create cancer smart
communities by empowering people with knowledge about
cancer, its prevention and early detection. We also offer direct
financial assistance for those people in hardship as a result
of having cancer. These achievements would not be possible
without community support, great and small.
Join a Cancer Council event: join one of our community

fundraising events like Daffodil Day, Australia’s Biggest Morning
Tea, Relay For Life, Girls Night In, Pink Ribbon Day, hold your
own fundraiser or become a volunteer.
Make a donation: any donation whether large or small will

make a meaningful contribution to our fight to defeat cancer.
Buy your sun protection products from our website or our

retail stores: every purchase contributes to our work.
Help us speak out and create a cancer-smart community:

The Cancer Council is a leading advocate for cancer prevention
and improved patient services. You can help us speak out on
important cancer issues and help us defeat cancer by living and
promoting a cancer smart lifestyle.
To find out more about how you or your family and friends can
help, please call 1300 780 113.

Regional offices
Central Coast Region South West Region
127 Erina Street 1/ 37 Tompson Street
Gosford NSW 2250 Wagga Wagga NSW 2650
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Regional offices 65
Cancer Council Helpline 13 11 20
For support and information on cancer and cancer-related issues, call the
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CAN728 Date: 08/07 ABN: 51 116 463 846

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Prostate Cancer

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Understanding Prostate Cancer

A guide for men with cancer, their families and friends.

The Cancer Council New South Wales

Managing side effects ...................................................................................... 28

 The Cancer Council New South Wales

Life after treatment . ............................................................................................... 37

Seeking support ........................................................................................................... 49

Question checklist .................................................................................................... 55

The beginnings of cancer

Normal cells Abnormal cells Abnormal cells Malignant or

 The Cancer Council New South Wales

invade other parts of

A malignant tumour is made up of cancer cells. When it first

Urinary bladder Spine

Vas deferens Seminal

 The Cancer Council New South Wales

How common is it?

Causes of prostate cancer

 The Cancer Council New South Wales

What is prostate cancer? 

I’d never heard anyone talk about prostate cancer

10 The Cancer Council New South Wales

What is prostate cancer? 11

Prostate specific antigen blood test

Digital rectal examination

12 The Cancer Council New South Wales

14 The Cancer Council New South Wales

Stages of prostate cancer

16 The Cancer Council New South Wales

Watchful waiting may be a good option if the possible

If living with an untreated cancer makes you feel anxious

18 The Cancer Council New South Wales

20 The Cancer Council New South Wales

22 The Cancer Council New South Wales

Permanent radioactive seeds

Side effects of brachytherapy

24 The Cancer Council New South Wales

Side effects of hormone therapy

26 The Cancer Council New South Wales

What if the prostate cancer comes back?

28 The Cancer Council New South Wales

Managing side effects 29

30 The Cancer Council New South Wales

Making treatment decisions 31

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Initially I didn’t understand my diagnosis and the

Making treatment decisions 33

34 The Cancer Council New South Wales

Making treatment decisions 35

36 The Cancer Council New South Wales

I don’t feel less a man because I have prostate

Life after treatment 37

38 The Cancer Council New South Wales

Life after treatment 39

40 The Cancer Council New South Wales

Other changes that might occur

Life after treatment 41

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Restoring your sex life

Life after treatment 43

I always thought you needed an erection to have

44 The Cancer Council New South Wales

While treatment side effects such as incontinence or

The Cancer Council New South Wales

The Cancer Council New South Wales

The Cancer Council New South Wales

The Cancer Council New South Wales

What is prostate cancer?