18 July 2025
If you’ve recently been diagnosed with prostate cancer, this article is for you.
Being diagnosed with prostate cancer often comes as a shock, and can be overwhelming, making it hard to think about the questions you may need to ask.
We’ve put together a handy list of common questions to help you consider your options.
What are the side effects of the different treatment options?
Prostatectomy
Urinary incontinence and erectile dysfunction are two common side effects of surgery. Urinary incontinence is the involuntary leaking of urine and usually improves within one to six months, although some men experience incontinence for longer.
Surgery can also result in the loss of erectile function, and while some men regain function fairly rapidly, others will have more difficulty. This largely depends on your individual situation and whether your surgeon was able to spare the nerves that control your erections. It is common for the restoration of erectile function to take 18 to 24 months.
It's important to ask your specialist at an early point about your options for pre-habilitation and re-habilitation. You should also discuss the available treatment options, and any costs, for managing any longer-lasting side effects that concern you.
With a prostatectomy, other risks can include infection, blood clots, bleeding, and injury to nearby organs. The good news is, these types of complications are uncommon, and your specialist will be able to give you individual advice about any particular risks related to your procedure.
Radiation therapy
This may result in short term urinary frequency, urgency, a burning sensation, increased need to urinate during the night, and in some cases, blood in the urine. This usually peaks at two to four weeks after completion of radiation and improves within three to six months. Longer term, you may experience changes in urinary flow, resulting in altered stream, urgency or frequency and further blood in urine. Monitoring and identifying these changes early are key to managing these.
Other side effects can include bowel issues. Many men may experience more frequent and looser stools, bloating and increased gas. These side effects usually resolve within 3-6 months. The good news is, a lot of bowel side effects may be managed through dietary changes, stool bulking agents, or anti-diarrhoea medications.
Changes in sexual function may also occur over time after radiation therapy. Make sure you discuss options for managing these with your radiation oncologist during follow-up.
Focal therapy
Focal therapies such as High-Intensity Focused Ultrasound, NanoKnife, or focal laser therapy, may have initial urinary side effects including urgency, frequency, and blood in urine, though this usually settles within one to three months.
Hormone therapy
Men may experience urinary retention when starting certain types of hormone therapy. Treatments to manage this may include urinary catheterisation, medications, or surgery to improve urinary flow. There is also likely to be a loss of libido, genital shrinkage, and delay in getting or maintaining an erection. Hormone therapy can also alter your experience of orgasm and your ejaculate volume. The long-term impacts of these side effects will depend on the duration of your treatment and treatment response. Importantly, there are a range of options for managing these side effects.
Those prescribed hormone therapy may also experience effects including mood changes, hot flushes, fatigue, loss of muscle mass, loss of bone density, weight gain, breast enlargement and tenderness, and impaired memory or concentration and body hair loss. Not all men will experience each side effect and many experience these to varying degrees of bother.
Make sure you ask about the management options that are suitable for you and discuss these with your specialist and partner.
Chemotherapy
While chemotherapy does not typically impact your urinary or erectile function, it can damage healthy cells in the body. Men may experience altered blood cell counts, nausea, vomiting, diarrhoea, fatigue, and hair loss. Some men also experience peripheral neuropathy (damage to the nerves surrounding the brain and spinal cord) and swelling in their lower limbs. With improved chemotherapy medications, the side effects have lessened and can usually be well managed.
Check with your specialist about your individual situation and don’t be afraid to ask direct questions.
You can read more about treatment options and their side effects in PCFA’s Survivorship Toolkit, or reach out to speak with a Prostate Cancer Specialist Nurse today. They’re available to help you through each stage of treatment and beyond.
How can prostate cancer treatment affect your mental health?
While prostate cancer treatment can cause physical side effects, it may also cause psychological distress.
Compared with men in the general population, men with prostate cancer may be twice as likely to experience depression, and three times more likely to experience anxiety. Men diagnosed with prostate cancer also have an increased risk of suicide.
Maintaining vigilance through screening for distress is effective in detecting increased anxiety, depression and cancer-specific distress in men, and referring men to appropriate evidence-based psychosocial care services.
Our Prostate Cancer Specialist Nurses will screen all men for distress as part of their ongoing care and support.
Partners of those diagnosed may also experience significant distress, and can reach out to speak with a specialist nurse, or ask for a referral to PCFA’s Counselling Service, for support.
Here are some of the ways that certain treatments can impact your mental health and wellbeing.
Radiation therapy can cause you to feel low and tired or experience other mood changes. If you are also having hormone therapy, you may experience memory problems.
Chemotherapy is known for causing what is often called chemo-brain. This is also described as brain fog – where you may feel confused or have trouble paying attention, finding the right words and/or remembering new things. This may last for a short time or for many years. The type of chemotherapy you have may affect how you feel. Chemotherapy may also make you feel fatigued (very tired) or sick, which can impact your brain function and how you manage your emotions.
Hormone therapy reduces your testosterone levels and activity and so may affect your cognitive function. This includes changes to your mood, your ability to think clearly, your concentration and focus, your memory, and ability to manage your emotions and stress, increasing the risk of anxiety, depression and suicide.
There are many things you can do to improve and help manage your mental health during and after prostate cancer treatment.
Reach out to PCFA for support on 1800 22 00 99. We’re here to help. If you urgently need mental health support, you can also call Lifeline on 13 11 44.
How will you know if the treatment was successful?
Your prostate and surrounding tissue will be examined by a pathologist after your prostatectomy to determine the grade of the cancer and whether it has spread beyond the capsule of the prostate gland. If you have ‘clear margins’ it means the cancer has been completely removed. Your specialist will use this information and the result of your first PSA test after surgery to determine whether you need more treatment, and if so, what kind of treatment.
For patients undergoing radiation, your specialist will monitor your PSA level every three to six months for the first one to two years, and then annually, if your PSA falls to a low or undetectable level and remains stable. Keep in mind that it can take up to two years to drop to its lowest point (called “the nadir”) but this may occur more rapidly if you are also being treated with hormone therapy.
For those with advanced prostate cancer, monitoring may include three monthly PSA test, and in some cases scans to assess your eligibility for certain medication and your response to treatment. Your medical oncologist may also ask your GP to monitor your bone density, calcium and vitamin D levels, as well as changes in your metabolic health.
Don’t be afraid to ask your specialist what outcome they expect from your treatment.
Can you take any actions to improve your health and wellbeing prior to treatment?
Getting a good night’s sleep, eating a healthy diet, maintaining a healthy weight, and regularly participating in physical activity are important. Reducing stress and maintaining good social connections is also important.
Ask your specialist or GP about seeing a health professional who can give you expert advice in each of these areas, where necessary.
You’ll also find a range of helpful information and links to allied health professionals via PCFA’s Survivorship Toolkit.
What will the cost of treatment be?
Ask your specialist for a detailed treatment plan, with itemised costs and details of any reimbursements under Medicare or private health insurance.
You may also wish to ask if the costs are negotiable, or if a payment plan is available. If you’re insured privately, check with your health insurer to find out whether your policy will cover you for your treatment. Radical prostatectomies and radiation therapy are free of charge in the public health system, although waiting times for treatment are sometimes longer.
For more information about managing the costs of treatment, check out this article, or use the Australian government’s Medical Cost Finder, via this link: https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder.
Will you need ongoing care and who will provide it?
You should be offered follow-up appointments as part of your ongoing care, to make sure you recover well from your treatment.
If you undergo surgery, you’re likely to have a follow-up appointment with your specialist within the first six to eight weeks after the operation, as well as a PSA test. Your urologist will schedule this with you.
To assist with managing any side effects, ask your specialist for a referral to a pelvic health physiotherapist or continence nurse who can give you pelvic floor exercises to do before and after surgery.
If you decide to undergo radiation therapy, your radiation team will schedule follow-up appointments every three to six months. These appointments will give you the opportunity to ask about your PSA test results and also any side effects you may be experiencing.
If you develop any concerning side effects, don’t hesitate to contact your treatment team in the meantime for advice. You can also contact PCFA’s Telenursing Service via 180 022 00 99.
It’s important to understand what life after treatment will be like before you go ahead.
Will you be given information and support on penile rehabilitation?
Penile rehabilitation involves the use of medication and/or a medical device to encourage blood flow to the spongy cylinders in the penis towards the restoration of erectile function.
It can help to improve oxygen supply to the tissues of the penis, with the aim to try to prevent permanent damage to the tissues and potentially improve the rapid return of erectile function following treatment. Evidence suggests you are likely to get better results if you start a rehabilitation program early after your treatment.
Should you get a second opinion on treatment options?
Getting a second opinion can help you understand the range of treatment options available and is very common for men who are deciding about treatment for prostate cancer.
If you don’t feel comfortable asking your specialist for a second opinion, your GP will be able to help.
Seeking a second opinion can help you feel more confident about your treatment decision, which will underpin your emotional and psychological wellbeing afterwards. You want to know that you made the best available choice for your individual situation.
We strongly recommend talking to a PCFA Prostate Cancer Specialist Nurse for expert individual information and advice on your diagnosis and treatment options, and how to manage the side effects of treatment.
Call 1800 22 00 99 to talk to one of our team.
