1. Prostate cancer is the most common cancer in Australian men

The prostate gland sits beneath the base of the bladder in men.

It is comprised of glandular tissue encased in a fibrous shell and its role is to produce alkaline fluid that is added to semen. 

Due to its location, this small and important organ can be a source of pelvic symptoms.

Common conditions affecting the prostate include benign prostatic hyperplasia and prostate cancer (PCa).

In 2024 there were an estimated 26,400 diagnoses of prostate cancer in Australia (AIHW 2024), comprising 28 per cent of cancer diagnoses in men.

PCa is an agerelated condition and has a 96 per cent fiveyear survival rate.

Men and other people with prostates who have a primary relative with PCa are at an increased risk of diagnosis. 

2. PSA testing is not a diagnostic test for prostate cancer

Despite the prevalence of PCa, many people are unaware of the function of the prostate or the tests used to detect change within it.

Prostate-specific antigen (PSA) is a protein produced by prostate cells.

Changes to PSA levels are indicative of change within the prostate and are not diagnostic of cancer.

PSA levels can be increased in the presence of benign prostatic hyperplasia, prostate or urinary tract infection; after ejaculation (up to 48 hours later); following long periods of pressure to the perineal area (eg, bike riding); and in the presence of prostate cancer. PSA levels are measured in nanograms per millilitre.

In Australia, guidelines recommend that men only have PSA tested after they have been educated on the harms versus the benefits of testing (PCFA 2016).

People with prostates can be tested every two years from the age of 45 if they have a family history of PCa.

Otherwise, testing is recommended every two years from 50 to 69. PSA testing is not recommended in men over the age of 70 because the harms may be greater than the benefits.

Population screening is not recommended due to the potential for over-diagnosis and over-treatment of prostate cancers.

Prostate cancer can only be diagnosed through prostate biopsy.

3. Treatment for prostate cancer can cause long-term side effects

Common treatment options for people diagnosed with PCa, including radical prostatectomy, radiation therapy and hormone therapy, can have both shortand long-term side effects.

Side effects of PCa treatment may have a significant impact on the emotional health of patients and their families. 

Radical prostatectomy involves surgical excision of the prostate gland.

Common side effects include urinary incontinence (UI) and erectile dysfunction.

Over 90 per cent of men will experience UI following radical prostatectomy; approximately three to 30 per cent will have UI persisting at 12 months (Gacci et al 2023).

UI seems to worsen in the long term, with 24 per cent experiencing UI requiring pad usage 12 years after treatment (Donovan et al 2023).

Erectile dysfunction also persists long term and at seven years, only 18 per cent of men reported erectile function sufficient for sexual intercourse (Donovan et al 2023).

In radiation therapy, radiation is delivered either locally or externally to the prostate. This can negatively affect bladder, bowel and erectile function in the long term.

Hormonal treatment involves administering medications to block testosterone.

It is often used in conjunction with radiation therapy. Common side effects include fatigue, sexual dysfunction, weight gain and mood changes.

A new treatment option for lowand intermediate-grade localised cancers, NanoKnife, delivers nonthermal, high-voltage, short-duration electrical pulses (focal irreversible electroporation) to PCa tumours.

This new technology appears to have positive short-term outcomes with minimal side effects.

To date, there are no long-term controlled trials published to support its effectiveness.

NanoKnife is not available in the public health system and therefore confers a high cost to the patient.

4. Active surveillance is an option for low-grade prostate cancers

Active surveillance is a recognised treatment option for men with low-grade localised PCa or those wishing to avoid the side effects of PCa treatment.

Men with low-grade cancer who undertake active surveillance do not have an increased risk of dying from PCa in 10 years compared with other treatment options (Hamdy et al 2016).

These patients typically experience minimal reduction in quality of life.

Active surveillance involves monitoring change over time via PSA testing, scans and repeat biopsy while actively improving physical and emotional health.

Active surveillance can include optimising physical activity, lowering oxidative stress and inflammation, reducing weight and abdominal girth, ceasing smoking, improving nutrition, reducing or eliminating alcohol consumption and improving emotional health.

5. Pelvic health physiotherapists support people with prostate cancer

Pelvic health physiotherapists have postgraduate training and typically have extended consultations, spending time improving pelvic health from a biopsychosocial perspective.

We are ideally placed to be proactive in educating men and other people with prostates early in life as well as those who have received a diagnosis and are pondering their treatment options.

Our resources are already well utilised in supporting people undergoing treatment, particularly rehabilitation postoperatively.

We educate men on the anatomy of the pelvis, the role of the prostate gland and pelvic floor muscles and the side effects of treatments.

We provide individual pelvic floor muscle assessment and training using a range of biofeedback techniques.

Following comprehensive assessment, pelvic health physiotherapists instruct patients in bladder retraining, fluid optimisation, bowel education and support, and advice for erectile dysfunction and UI—optimising pelvic functions pre- and post-treatment.

Pelvic health physiotherapists can also play an important role in active surveillance.

A prostate cancer diagnosis is often the first time that a man has focused on his pelvic health.

It may also be the first time a man has seriously considered making changes to improve his general health and wellbeing.

Pelvic health physiotherapists can educate men to aid in the process of making informed choices about their treatment.

Practical support can be given to make lifestyle changes in line with patients’ individual goals.

The side effects of treatment for prostate cancer can have a significant effect on quality of life.

It is imperative that people with prostates are well educated and informed along their journey.

>>Malina Kelly MACP is a senior physiotherapist at Consano Pelvic Health Centre in Perth, Western Australia. Malina has a Master of Clinical Physiotherapy in Continence and Women’s Health from Curtin University and a particular interest in pelvic pain, complex pelvic presentations and male pelvic health, especially the management of prostate conditions. Malina is an APA Titled Women’s, Men’s and Pelvic Health Physiotherapist and a member of the APA Women’s, Men’s and Pelvic Health national group.

>>Alison Wroth MACP is the principal physiotherapist and founding director of Consano Pelvic Health Centre. Alison has a Master of Clinical Physiotherapy in Continence and Women’s Health from Curtin University. She has a deep interest in understanding how the inner world of humans, particularly emotions, impacts physiology, physical function, movement and behaviour. Alison is an APA Titled Women’s, Men’s and Pelvic Health Physiotherapist and the chair of the Western Australian branch of the Women’s, Men’s and Pelvic Health group.  

• References
• Infographic