Prostate Cancer Melbourne — Screening, Diagnosis & Robotic Prostatectomy Guide

Prostate cancer is the most commonly diagnosed cancer in Australian men, with approximately 18,000 new cases each year. While the diagnosis can be confronting, the outlook for most men is excellent — particularly when the cancer is detected early. Understanding the screening process, diagnostic pathway, and the full range of treatment options empowers you to make informed decisions about your care.

This comprehensive guide explains the journey from screening through to treatment, covering the latest evidence-based approaches available with Dr Brendan Dias in Melbourne.

What Is Prostate Cancer?

The prostate is a walnut-sized gland located below the bladder and in front of the rectum. It produces seminal fluid that nourishes and transports sperm. Prostate cancer develops when cells in the prostate gland begin to grow abnormally and uncontrollably.

Prostate cancer is unique among cancers in its extremely variable behaviour. Some prostate cancers are slow-growing and may never cause symptoms or threaten life (indolent disease), while others are aggressive and can spread beyond the prostate if not treated promptly. Distinguishing between these two extremes is central to modern prostate cancer management.

Risk Factors

Several factors increase a man's risk of developing prostate cancer:

• Age — risk increases significantly after age 50, with the majority of cases diagnosed in men over 65
• Family history — having a first-degree relative (father or brother) with prostate cancer doubles your risk; two or more affected relatives increases risk further
• Ethnicity — men of African descent have a higher incidence and are more likely to develop aggressive disease
• Genetics — mutations in BRCA1 and particularly BRCA2 genes are associated with increased prostate cancer risk and more aggressive disease
• Diet and lifestyle — obesity, a diet high in processed meat, and low physical activity may contribute to increased risk

Screening: PSA Testing and When to Start

Prostate-Specific Antigen (PSA) is a protein produced by the prostate gland. A simple blood test can measure PSA levels, which may be elevated in the presence of prostate cancer — but also in benign conditions such as an enlarged prostate (BPH) or prostatitis.

In Australia, the current consensus recommends a baseline PSA test at age 50 for men at average risk, with earlier testing (from age 40–45) for those with a family history or other risk factors. The decision to undergo PSA testing should be a shared one between you and your doctor, understanding both the potential benefits of early detection and the risks of over-diagnosis and unnecessary treatment.

What PSA Levels Mean

• PSA below 1.0 ng/mL at age 40–50 — low risk; retest in 2–4 years
• PSA 1.0–3.0 ng/mL — moderate range; frequency of monitoring depends on age and trend
• PSA above 3.0 ng/mL — further investigation recommended (MRI and possible biopsy)
• Rapidly rising PSA (velocity) — an increase of more than 0.75 ng/mL per year is concerning regardless of absolute level

It is important to note that there is no single "normal" PSA value. The interpretation of PSA requires consideration of age, prostate size, medications (such as finasteride, which halves PSA), and trends over time.

Diagnosis: MRI and Prostate Biopsy

Multiparametric MRI (mpMRI)

If PSA levels are elevated or rising, the next step is usually a multiparametric MRI of the prostate. This non-invasive imaging study uses multiple MRI sequences to identify suspicious areas within the prostate, graded using the PI-RADS scoring system (1–5):

• PI-RADS 1–2 — clinically significant cancer is unlikely; biopsy may be deferred
• PI-RADS 3 — equivocal; biopsy may be recommended depending on clinical context
• PI-RADS 4–5 — clinically significant cancer is likely; biopsy is strongly recommended

The introduction of MRI before biopsy has been one of the most significant advances in prostate cancer diagnosis. It reduces unnecessary biopsies by approximately 25% and increases the detection of clinically significant cancers.

Transperineal Prostate Biopsy

When biopsy is indicated, Dr Dias performs MRI-targeted transperineal prostate biopsy. This approach involves taking tissue samples through the perineum (the skin between the scrotum and anus) using MRI-ultrasound fusion technology to precisely target suspicious areas identified on the MRI.

The transperineal approach has largely replaced the older transrectal method due to its significantly lower infection risk (less than 1% compared to 2–4% for transrectal biopsy) and improved sampling accuracy. The procedure is performed under general or local anaesthesia and is typically a day case.

Understanding Your Biopsy Results: The Gleason Score

If cancer is found, the pathologist assigns a Gleason score, which grades how aggressive the cancer cells appear under the microscope. This is now expressed as a Grade Group (1–5):

Treatment Options

The optimal treatment for prostate cancer depends on the cancer's grade and stage, PSA level, your age and general health, and your personal preferences. Dr Dias will guide you through the options, ensuring you understand the benefits, risks, and expected outcomes of each approach.

Active Surveillance

For men with low-risk prostate cancer (Grade Group 1), active surveillance is the recommended approach. Rather than treating immediately, the cancer is closely monitored with regular PSA tests, MRI scans, and repeat biopsies. Treatment is only initiated if the cancer shows signs of progression.

Active surveillance avoids the side effects of treatment in men whose cancer may never become life-threatening. Research shows that approximately 50–70% of men on active surveillance avoid treatment at 10 years, without compromising long-term cancer outcomes.

Robotic Radical Prostatectomy

Robotic radical prostatectomy is the surgical removal of the entire prostate gland and seminal vesicles using the da Vinci robotic surgical system. It is the most common curative treatment for localised prostate cancer in younger, fit men.

The robotic approach offers significant advantages over traditional open surgery:

• Enhanced precision — magnified 3D vision and wristed instruments allow meticulous dissection around critical structures
• Nerve preservation — improved ability to spare the neurovascular bundles responsible for erectile function
• Reduced blood loss — the procedure is virtually bloodless for most patients
• Faster recovery — most men are discharged within 1–2 days and return to normal activities within 2–4 weeks
• Excellent cancer control — long-term cancer-free rates of 85–95% for organ-confined disease

Dr Dias performs robotic radical prostatectomy regularly and is experienced in nerve-sparing techniques to optimise functional outcomes. He will discuss the likelihood of continence and potency preservation based on your specific cancer characteristics and anatomy.

Radiation Therapy

External beam radiation therapy (EBRT) and brachytherapy (internal radiation) are alternative curative treatments for localised prostate cancer. Radiation is typically delivered over several weeks and can achieve cancer control rates comparable to surgery in many cases.

Radiation may be preferred for older men, those with significant comorbidities, or those who wish to avoid surgery. Dr Dias works closely with radiation oncologists and can facilitate referral and discussion of radiation options as part of a multidisciplinary approach.

Other Treatments

Additional treatment modalities include:

• Hormone therapy (androgen deprivation therapy) — used in combination with radiation for intermediate and high-risk cancers, or as primary treatment for advanced disease
• Focal therapy — emerging treatments such as HIFU (high-intensity focused ultrasound) that target only the cancerous area of the prostate, currently offered in select centres
• Chemotherapy — reserved for advanced prostate cancer that has become resistant to hormone therapy

Comparing Treatment Approaches

Life After Prostate Cancer Treatment

Following treatment, regular follow-up is essential. After surgery, PSA should fall to undetectable levels (below 0.03 ng/mL). After radiation, PSA falls gradually over 12–18 months. Regular PSA monitoring, typically every 3–6 months initially and then annually, ensures any recurrence is detected early.

Recovery of urinary continence after robotic prostatectomy is progressive — most men achieve good continence within 3–6 months, with continued improvement up to 12 months. Erectile function recovery depends on nerve preservation, age, and pre-operative function, and can take 12–24 months. Dr Dias provides comprehensive post-operative support including pelvic floor physiotherapy referral and erectile rehabilitation programs.

Dr Dias' Approach to Prostate Cancer

Dr Brendan Dias provides a complete prostate cancer service from screening through to surgical treatment and long-term follow-up. His approach emphasises:

• Thorough assessment — comprehensive evaluation including PSA trends, MRI review, and risk stratification
• Precise diagnosis — MRI-targeted transperineal biopsy for accurate cancer detection
• Individualised treatment — treatment recommendations tailored to your cancer, anatomy, and personal priorities
• Surgical excellence — regular robotic prostatectomy practice with focus on cancer control and functional outcomes
• Multidisciplinary care — collaboration with radiation oncologists, medical oncologists, and allied health professionals
• Ongoing support — structured follow-up and rehabilitation to optimise recovery

Consulting across multiple locations in Melbourne's western and northern suburbs, Dr Dias ensures convenient access to expert prostate cancer care. Early consultation allows the full range of options to be explored and the best treatment pathway to be determined.

Frequently Asked Questions

The Bottom Line

Prostate cancer is the most common cancer in Australian men, but with modern screening, accurate diagnosis, and advanced treatment options including robotic surgery, outcomes have never been better. The key is appropriate screening, timely specialist referral, and a personalised treatment plan. If you have concerns about your prostate health or have been diagnosed with prostate cancer, consulting an experienced urologist is the most important step toward effective management and peace of mind.