Tag Archive for: Prostate cancer screening
Active Surveillance for Prostate Cancer
Being diagnosed with prostate cancer does not always mean that treatment needs to start immediately.
Many prostate cancers grow very slowly and may never cause symptoms or threaten a man’s life. For carefully selected men, active surveillance allows the cancer to be closely monitored while avoiding, or at least delaying, treatments such as surgery or radiation therapy.
Importantly, active surveillance does not mean ignoring the cancer. It is a structured programme of PSA testing, clinical review, prostate MRI and, when appropriate, repeat prostate biopsy. If there are signs that the cancer is becoming more significant, treatment can be recommended while the disease is still potentially curable.
Current international guidelines consider active surveillance the preferred or standard management approach for most suitable men with low-risk localised prostate cancer, and it may also be considered in carefully selected men with favourable intermediate-risk disease.
What Is Active Surveillance?
Active surveillance is a management strategy for prostate cancer in which curative treatment is deliberately postponed while the cancer is carefully monitored.
The aim is simple:
Avoid unnecessary treatment and its potential side effects, without compromising the opportunity for cure if the cancer changes.
This is particularly relevant because prostate cancer behaves very differently from one man to another. Some cancers are aggressive and require treatment, while others may remain small and slow-growing for many years.
Australian patient guidance describes active surveillance as close monitoring of low-risk prostate cancer that is not causing symptoms, with treatment initiated if investigations indicate that the cancer is becoming more aggressive.
Who Qualifies for Active Surveillance?
Active surveillance is most commonly recommended for men with low-risk prostate cancer.
Typical features include:
- Cancer confined to the prostate
- Grade Group 1 / Gleason score 3+3=6
- PSA generally less than 10 ng/mL
- Clinical stage T1 to T2a
- Relatively small volume of cancer on prostate biopsy
- Favourable findings on multiparametric MRI
- A PSA density that supports low-volume disease
- No clinical or imaging evidence suggesting more aggressive cancer
The AUA/ASTRO risk classification defines low-risk disease as PSA below 10 ng/mL, Grade Group 1 and clinical stage T1–T2a. For these patients, active surveillance is recommended as the preferred management strategy.
However, no single number determines suitability. Age, general health, family history, MRI findings, PSA density, biopsy findings, life expectancy and personal preferences all contribute to the decision.
Can Men With Gleason 3+4 / Grade Group 2 Cancer Have Active Surveillance?
Sometimes.
Active surveillance is increasingly considered for carefully selected men with favourable intermediate-risk prostate cancer, particularly when there is only a small amount of Gleason pattern 4 disease.
The 2026 European Association of Urology guidelines support active surveillance for selected men with favourable Grade Group 2 cancer. Features favouring surveillance include a small amount of pattern 4 disease, PSA below 10 ng/mL, limited tumour volume on biopsy and favourable imaging.
Similarly, AUA/ASTRO guidance suggests that favourable intermediate-risk patients with low PSA density, low tumour volume and a low percentage of Gleason pattern 4 disease may be considered for active surveillance.
These men require careful counselling because their risk of progression is higher than for men with Grade Group 1 disease.
Active surveillance is generally not appropriate for Grade Group 3 or higher-risk prostate cancer in men otherwise suitable for curative treatment.
What Happens Before Starting Active Surveillance?
The first step is making sure that the cancer really is suitable for surveillance.
Assessment may include:
PSA and PSA Density
PSA is considered together with prostate volume to calculate the PSA density.
A relatively low PSA density, commonly around less than 0.15 ng/mL/cc, provides additional reassurance in men being considered for surveillance, although it should not be interpreted as an absolute cut-off in isolation.
Multiparametric MRI of the Prostate
A high-quality multiparametric MRI (mpMRI) provides important information about:
- The location of the tumour
- Tumour size
- Suspicious areas within the prostate
- Possible extension outside the prostate
- Areas that should be targeted during biopsy
MRI has become an important part of modern active surveillance, but MRI alone does not completely replace prostate biopsy.
Review or Confirmation of the Biopsy
The initial biopsy determines the Grade Group, Gleason score and volume of cancer.
Depending on how the original diagnosis was made, a confirmatory biopsy may be recommended. MRI-targeted biopsies can specifically sample suspicious lesions, while systematic or regional biopsies assess other areas of the prostate.
How Is Active Surveillance Performed?
Active surveillance is an ongoing programme rather than a single test.
The exact protocol varies according to the patient’s age, cancer characteristics, previous investigations and the treating urologist or institution.
A typical programme may include:
PSA Testing
PSA is usually measured approximately every 3–6 months initially, although intervals may become longer in men with very stable disease.
Current EAU guidance recommends PSA testing at least every six months, while Australian Cancer Council information describes PSA testing every 3–6 months.
The trend in PSA is usually more informative than one isolated reading.
An unexpected rise does not automatically mean that the cancer has progressed. PSA can fluctuate because of benign prostate enlargement, inflammation, infection and other factors.
For this reason, an unexpected PSA rise will often be repeated before further decisions are made.
Clinical Review
Regular appointments allow your urologist to review:
- PSA changes
- Urinary symptoms
- General health
- Examination findings
- MRI results
- Whether further investigation is required
A digital rectal examination may form part of surveillance, although its frequency can be individualised.
Repeat Prostate MRI
Repeat mpMRI may be performed periodically or earlier if PSA or other findings become concerning.
MRI allows comparison with previous scans to determine whether a lesion is:
- Stable
- Increasing in size
- Becoming more suspicious
- Showing features suggesting progression
Importantly, a change on MRI will often lead to a repeat biopsy rather than automatically triggering treatment. The EAU recommends confirming suspected histological progression before changing treatment strategy where appropriate.
Repeat Prostate Biopsy
Repeat biopsy remains an important component of active surveillance.
The frequency varies according to individual risk, previous MRI and biopsy findings and the surveillance protocol being followed.
The biopsy may involve:
- Targeted biopsy of an MRI abnormality
- Systematic sampling
- A combination of targeted and regional/systematic biopsies
Modern surveillance programmes increasingly tailor biopsy frequency according to the individual’s risk rather than applying exactly the same schedule to every patient.
What Are We Looking for During Surveillance?
The purpose of surveillance is to identify reclassification or progression before the cancer becomes difficult to cure.
Your urologist will be looking for several possible warning signs.
These include:
Increasing cancer grade
For example, a cancer initially classified as Grade Group 1 may subsequently demonstrate a significant amount of Gleason pattern 4 disease.
Increasing cancer volume
More biopsy samples may contain cancer, or individual samples may contain a greater amount of cancer.
Changes on MRI
An existing lesion may enlarge or become more suspicious, or a new lesion may appear.
Persistent PSA changes
A progressively increasing PSA, particularly when accompanied by increasing PSA density or concerning MRI findings, may trigger further investigation.
Clinical progression
Changes on examination or other investigations may suggest that the cancer is no longer behaving as expected.
When Should Active Surveillance Stop?
Active surveillance should generally continue for as long as the cancer remains suitable for surveillance and curative treatment remains relevant.
The decision to move to treatment should ideally be based on the overall picture rather than PSA alone.
Treatment may be recommended when there is:
- Significant upgrading of the cancer on repeat biopsy
- Increasing amounts of higher-grade cancer
- Significant increase in tumour volume
- Concerning progression on MRI confirmed by appropriate investigation
- Evidence suggesting progression beyond the original low-risk category
- A change in the patient’s preference after informed discussion
AUA/ASTRO guidance recommends that significantly higher-volume or higher-grade disease on surveillance biopsy should prompt discussion about definitive therapy.
What Happens If the Cancer Progresses?
The important concept behind active surveillance is that treatment has been postponed, not abandoned.
If investigations demonstrate clinically significant progression, curative treatment can be considered.
Depending on the man’s age, general health, cancer characteristics and preferences, options may include:
Radical Prostatectomy
Surgical removal of the prostate, increasingly performed using robotic-assisted radical prostatectomy.
Focal therapy
Nanoknife electroporation
ProFocal laser ablation
Radiation Therapy
Options may include:
- External beam radiation therapy
- Stereotactic radiation therapy in appropriate patients
- Brachytherapy in selected cases
- Radiation combined with hormonal therapy where clinically indicated
Other Selected Treatments
In carefully selected circumstances, other approaches may be discussed. The evidence for focal ablative therapies remains less mature than that for established treatments such as surgery and radiation therapy, and suitability needs individual assessment.
What Are the Benefits of Active Surveillance?
For appropriately selected men, the major advantage is avoiding treatment that may never have been necessary.
Avoiding or Delaying Treatment Side Effects
Radical treatment can potentially cause:
- Urinary incontinence
- Erectile dysfunction
- Ejaculatory changes
- Urinary symptoms
- Bowel symptoms following some forms of radiation therapy
Active surveillance allows men to maintain their existing urinary, sexual and bowel function for longer.
Maintaining Quality of Life
Many men can continue normal work, exercise, travel and sexual activity without the recovery period or functional consequences associated with immediate treatment.
Avoiding Overtreatment
Some low-risk prostate cancers may never become clinically significant during a man’s lifetime.
Treating every prostate cancer immediately would therefore expose some men to treatment complications without providing a meaningful survival advantage.
Treatment Remains Available
Active surveillance preserves the opportunity for curative treatment if the cancer subsequently demonstrates significant progression.
Long-term outcomes from well-conducted active surveillance programmes are reassuring. The EAU reports 10-year prostate cancer-specific survival rates of approximately 98–100% in active surveillance cohorts, although outcomes depend on appropriate patient selection and follow-up.
What Are the Risks of Active Surveillance?
Active surveillance is not completely risk-free.
The Cancer May Progress
Some cancers initially thought to be low risk will subsequently demonstrate more aggressive features.
In fact, a significant proportion of men are eventually reclassified during long-term surveillance and may proceed to treatment.
The Initial Biopsy May Underestimate the Cancer
A prostate biopsy samples only part of the prostate.
Occasionally, higher-grade cancer may already be present but was not captured during the original biopsy. Modern MRI and targeted biopsy techniques help reduce this risk but cannot eliminate it completely.
Small Risk of Losing the Optimal Window for Treatment
This is one of the main reasons that regular follow-up is essential.
In appropriately selected men who comply with structured surveillance, the risk is low, but surveillance must be active rather than passive.
Repeat Investigations
Active surveillance may involve:
- Repeated blood tests
- MRI scans
- Urology appointments
- Repeat prostate biopsies
Biopsies can cause discomfort, bleeding and infection, although contemporary transperineal biopsy techniques can substantially reduce the risk of serious infection.
Psychological Impact
Some men find living with untreated cancer surprisingly easy. Others find it difficult.
Anxiety may occur around:
- PSA tests
- MRI scans
- Repeat biopsies
- Waiting for results
- Concern that the cancer may be progressing
For some men, the psychological burden becomes an important factor when deciding whether to remain on surveillance.
Active Surveillance Is Not the Same as Watchful Waiting
These terms are sometimes confused, but they describe different approaches.
Active surveillance is generally used for men with potentially curable prostate cancer. The cancer is actively monitored, with the intention of offering curative treatment if clinically significant progression occurs.
Watchful waiting is more commonly used in older men or men with significant other medical conditions where prostate cancer is unlikely to affect life expectancy. Monitoring is less intensive, and treatment is generally introduced to control symptoms rather than with the intention of cure.
Does Active Surveillance Mean Doing Nothing?
No.
This is perhaps the most important misconception about active surveillance.
A better description might be:
“Treatment if and when it becomes necessary.”
The cancer is being monitored carefully so that unnecessary treatment can be avoided while retaining the opportunity to intervene if its behaviour changes.
For the right patient, this can provide an excellent balance between cancer control and preservation of quality of life.
The Bottom Line
Active surveillance has become an established standard of care for appropriately selected men with low-risk prostate cancer and can also be considered for some men with carefully selected favourable intermediate-risk disease.
The decision should take into account:
- PSA and PSA density
- Grade Group and Gleason score
- Amount of cancer found on biopsy
- MRI findings
- Clinical stage
- Age and life expectancy
- General health
- Family and genetic risk factors
- Personal preferences
Most importantly, active surveillance requires a partnership between the patient and his urologist.
The goal is not simply to avoid treatment.
The goal is to avoid treatment that is unnecessary, while identifying the point at which treatment becomes worthwhile.
This information is intended for general education and does not replace individual medical advice. Recommendations for prostate cancer management should be based on a detailed assessment of the individual patient, pathology, PSA results, imaging, general health and personal preferences.
PSA Screening for Prostate Cancer in Australia: Should You Have a PSA Test?
Prostate cancer is one of the most commonly diagnosed cancers in Australian men. One of the difficulties with prostate cancer is that early prostate cancer usually causes no symptoms. By the time symptoms develop, some cancers may already have progressed beyond the prostate.
A simple blood test called the prostate-specific antigen (PSA) test can help identify men who may be at increased risk of prostate cancer. However, PSA testing is not a perfect cancer test and deciding whether to have regular PSA testing involves balancing the potential benefits of early diagnosis against the risks of unnecessary investigation and treatment.
In Australia, there is currently no national population-based prostate cancer screening program. Instead, PSA testing is based on an informed discussion between a man and his doctor, taking into account age, family history, overall health, life expectancy and personal preferences.
What is PSA?
PSA, or prostate-specific antigen, is a protein produced by prostate cells. A small amount normally enters the bloodstream and can be measured with a simple blood test.
An elevated PSA does not automatically mean that you have prostate cancer.
PSA can rise because of:
- prostate cancer
- benign enlargement of the prostate (BPH)
- inflammation or infection of the prostate
- urinary infection
- recent ejaculation or sexual activity
- recent instrumentation of the urinary tract
- manipulation of the prostate.
Conversely, some men with prostate cancer can have a PSA within the expected range. PSA is therefore best considered a marker of prostate activity and prostate cancer risk rather than a test that diagnoses cancer.
Who Should Consider PSA Testing in Australia?
Current Australian guidance supports informed, individualized PSA testing rather than universal population screening.
For men at average risk who have been informed about the potential benefits and harms and decide to undergo regular testing, current RACGP guidance recommends offering PSA testing every two years between the ages of 50 and 69 years.
Men with a significant family history may be advised to start earlier. Depending on the strength of the family history, testing may begin from approximately 40–45 years of age and continue every two years to age 69.
A stronger family history includes having a father, brother or multiple close relatives diagnosed with prostate cancer, particularly when prostate cancer occurred at a younger age.
Other factors, including ancestry, genetic predisposition and an individual’s general health and life expectancy, may also influence the decision about when to begin testing.
Importantly, these recommendations apply to men without symptoms. Men with symptoms or clinical findings that raise concern about prostate cancer require individual assessment rather than simply entering a screening program.
What Does an Elevated PSA Mean?
An elevated PSA is not a diagnosis of prostate cancer.
For men aged 50–69 undergoing early detection testing, a PSA above 3.0 ng/mL generally prompts further assessment under current Australian guidance. An abnormal result will often be repeated because PSA levels can fluctuate and temporary elevations are common.
Depending on the PSA level, age, prostate size, family history and other risk factors, further assessment may include:
Repeat PSA → assessment of PSA trend and other risk factors → specialist review → prostate MRI → possible prostate biopsy
Modern prostate cancer assessment has changed substantially. An abnormal PSA no longer necessarily means proceeding directly to a prostate biopsy. Multiparametric MRI (mpMRI) can help identify suspicious areas within the prostate and assist the urologist in deciding whether biopsy is necessary.
The Potential Benefits of PSA Screening
The principal advantage of PSA testing is straightforward:
It may detect a significant prostate cancer while it is still curable.
Aggressive prostate cancer can spread to lymph nodes, bones and other organs. Once metastatic prostate cancer develops, treatment is generally aimed at controlling rather than curing the disease.
Regular PSA testing provides an opportunity to identify some clinically important cancers years before they would otherwise become apparent.
Large screening trials have produced differing results, which is one reason PSA screening remains controversial. European screening data have demonstrated a reduction in prostate cancer mortality associated with PSA-based screening, while other trials have shown less convincing mortality benefits.
For an individual man, therefore, the potential benefit is significant: early detection may identify an aggressive cancer at a stage when curative treatment remains possible.
What Are the Downsides of PSA Screening?
The difficulty is that prostate cancer is not one disease.
Some prostate cancers are aggressive and potentially life-threatening. Others grow extremely slowly and may never cause symptoms during a man’s lifetime.
PSA testing can detect both.
False-positive PSA results
An elevated PSA may lead to anxiety, repeat blood tests, MRI scans and sometimes biopsy even when no cancer is ultimately found.
Overdiagnosis
PSA testing can identify a prostate cancer that would never have caused illness or shortened the man’s life.
This is known as overdiagnosis.
Overtreatment
If an insignificant cancer is diagnosed and subsequently treated, the man can potentially experience treatment complications without gaining a meaningful survival benefit.
Potential consequences of prostate cancer treatment include:
- erectile dysfunction
- urinary incontinence
- urinary symptoms
- ejaculatory changes
- bowel symptoms following some forms of radiotherapy.
This is one of the major reasons Australia does not currently have a universal PSA population-screening program.
Importantly, however, diagnosing prostate cancer does not automatically mean treating it.
Many men with low-risk prostate cancer are now managed with active surveillance, involving PSA monitoring, MRI and selective repeat biopsy. Treatment is reserved for evidence that the cancer is becoming more significant.
What Are the Implications of Not Having PSA Screening?
Choosing not to undergo PSA testing is also a legitimate decision, particularly after considering the benefits and disadvantages.
The advantage is avoiding the potential cascade of:
PSA testing → abnormal result → anxiety → MRI → biopsy → diagnosis of an insignificant cancer → possible unnecessary treatment.
However, there is another side to this decision.
Because early prostate cancer frequently produces no symptoms, a man who does not undergo PSA testing may remain unaware that he has prostate cancer.
For most men who never develop clinically significant disease, this causes no harm.
For a smaller group who develop aggressive prostate cancer, however, the first indication of the disease may occur after the cancer has grown substantially or spread beyond the prostate.
At that stage, the opportunity for curative treatment may have been reduced or lost.
The decision is therefore not simply:
“Do I want to know whether I have prostate cancer?”
A more useful question is:
“Given my age, health, family history and personal priorities, do the potential benefits of finding a significant prostate cancer early outweigh the potential harms of investigating and possibly diagnosing a cancer that may never affect me?”
This is why shared decision-making with your GP or urologist is important.
What About a Digital Rectal Examination?
The digital rectal examination, or DRE, involves a doctor gently inserting a gloved, lubricated finger into the rectum to examine the back surface of the prostate.
The doctor assesses the prostate for abnormalities such as:
- unusual hardness
- nodules
- asymmetry
- irregularity
- loss of the normal contour of the gland.
Historically, DRE was routinely combined with PSA testing for prostate cancer screening.
This has changed.
DRE is no longer recommended as a routine screening test in asymptomatic men
Current Australian guidance states that DRE should not routinely be added to PSA testing for early detection in asymptomatic men in primary care.
There are several reasons.
A finger can examine only part of the prostate. Small cancers may not be palpable, and cancers in areas of the prostate that cannot be reached during examination can be missed. A normal DRE therefore does not exclude prostate cancer.
Conversely, benign prostate enlargement and other abnormalities can sometimes produce an abnormal examination.
Does DRE Still Have a Role?
Yes.
Not recommending DRE as a routine screening test does not mean that the examination has become obsolete.
A urologist may perform a DRE when assessing a man with:
- an elevated or rising PSA
- urinary symptoms
- suspected prostate disease
- an abnormal MRI
- concern about locally advanced prostate cancer
- other pelvic or rectal symptoms.
Occasionally, a prostate cancer may produce a distinctly hard or irregular prostate even when the PSA is not dramatically elevated. An abnormal DRE can therefore remain clinically important and may prompt further investigation. Cancer Council Australia notes that urologists will commonly perform DRE as part of prostate assessment even though GPs no longer routinely use it for screening asymptomatic men.
The key distinction is:
DRE has a role in clinical examination and investigation, but it is not recommended as a routine population-screening test in an otherwise well man undergoing PSA testing.
PSA Screening Is About Risk, Not Just a Number
One of the most important changes in modern prostate cancer detection is moving away from treating PSA as simply “normal” or “abnormal.”
A PSA result should be interpreted in context.
Your doctor or urologist may consider:
your age + PSA level + change in PSA over time + family history + prostate size + symptoms + examination findings + MRI findings + overall health
Together, these provide a much more meaningful assessment of prostate cancer risk than a single PSA result.
Should I Have a PSA Test?
There is no single answer that is appropriate for every man.
For a healthy man in the appropriate age group, particularly someone with a family history of prostate cancer, the potential benefit of identifying an aggressive cancer while it remains curable may be important.
For an older man with substantial medical problems or limited life expectancy, the likelihood that PSA screening will provide meaningful benefit becomes considerably smaller. Current Australian guidance advises against PSA testing in men whose life expectancy is likely to be less than approximately seven years because a mortality benefit from early detection is unlikely to occur within that period.
The decision should therefore be individual rather than automatic.
The Bottom Line
PSA testing can save lives by detecting clinically significant prostate cancer at an earlier and potentially curable stage, but it can also detect cancers that would never have caused harm.
Australia therefore does not currently operate a universal PSA screening program. Instead, men are encouraged to make an informed decision about PSA testing after discussing their individual risk and the potential benefits and harms with their doctor.
For men who choose screening, current Australian guidance generally supports PSA testing every two years from age 50–69 for men at average risk, with earlier testing considered for men with a significant family history.
A digital rectal examination is no longer recommended as a routine addition to PSA screening in asymptomatic men, but it remains an important component of specialist prostate assessment in selected circumstances.
Concerned about your prostate cancer risk?
If you are considering PSA testing, have a family history of prostate cancer, have noticed a change in your PSA, or have urinary symptoms, discuss your individual risk with your GP or urologist.
Early detection should not simply be about finding more prostate cancers. The goal is to identify the cancers that matter, at a time when something useful can still be done about them.
This information is intended for general education and does not replace individual medical advice. Recommendations may differ according to your age, family history, medical conditions and previous PSA results.
Further information
Australian patient information and guidance are available from Cancer Council Australia: Prostate cancer screening and early detection and the RACGP Guidelines for preventive activities in general practice.
How Diet & Lifestyle Can Support Prostate Health
Prostate health: food, movement and informed testing
The prostate is a small gland below the bladder that contributes fluid to semen. It surrounds the first part of the urethra, so changes in the prostate can affect urination. Prostate enlargement, inflammation and cancer are different conditions; urinary symptoms alone cannot tell us which, if any, is present.[1, 2]
A healthy diet and regular activity support overall wellbeing. They may help some people manage weight and cope with treatment, but no food or exercise programme has been shown to guarantee prevention of prostate enlargement or prostate cancer. Similarly, a “check-up” is not the same thing as screening everyone for cancer: the decision to have a PSA blood test should take account of age, individual risk, preferences and the possible harms of testing.[3, 4]
What can affect the prostate?
Benign prostate enlargement (BPH) becomes more common with age. It may cause a weak stream, hesitancy, more frequent urination or waking at night. Similar symptoms can come from bladder conditions, medicines or other causes. Treatment depends on the degree of bother and any complications, and can range from monitoring and practical changes to medicines or a procedure.[1]
Prostatitis describes inflammation of the prostate and has several forms. Pain, urinary symptoms or fever require assessment; diet alone will not diagnose or treat the cause.[1]
Prostate cancer often causes no symptoms in its early stages. Some cancers grow slowly and may never need treatment; others are more aggressive. An abnormal PSA result does not by itself establish a cancer diagnosis.[2, 4]
Is there a “prostate-friendly” diet?
It is reasonable to use this phrase for a varied, balanced eating pattern, but it should not imply that a particular menu protects the prostate. The Australian Dietary Guidelines recommend vegetables, fruit, mostly wholegrain cereals, appropriate protein foods and water as a usual drink, while limiting foods high in added salt and saturated fat.[5] Food choices should also fit a person’s other conditions and cultural preferences.
The foods often promoted for prostate health can fit into that pattern, with important limits to the evidence:
| Food | What it offers | What remains unproven |
|---|---|---|
| Tomatoes | A vegetable source of lycopene and other nutrients | Eating tomatoes or taking lycopene supplements has not been established as a way to prevent or treat prostate cancer.[3, 6] |
| Broccoli and cauliflower | Vegetables that add variety and fibre | Laboratory theories about their compounds do not prove that they prevent prostate disease in people.[3] |
| Salmon and sardines | Protein and, in oily fish, omega-3 fats | Fish is not a proven prostate cancer treatment or prevention strategy.[3, 5] |
| Green tea | A beverage some people enjoy | Antioxidant content does not establish a clinical benefit for prostate cancer; caffeine may aggravate urinary urgency in some people.[3, 7] |
| Chia and flaxseeds | Fibre and unsaturated fats | Eating these seeds is not proven to prevent BPH or prostate cancer.[3, 5] |
No supplement should be assumed to be beneficial because it is sold as “natural” or “prostate supporting.” The SELECT trial, for example, found increased prostate cancer risk among men assigned vitamin E alone. Discuss supplements with your clinician, particularly if you are receiving treatment or taking medicines.[6]
A practical meal might include vegetables, a wholegrain food and fish, beans, eggs, tofu or another suitable protein. Add fruit or unsalted nuts and seeds according to preference. The value is in the overall pattern, not a particular “superfood.” If cancer treatment is affecting appetite or weight, an accredited practising dietitian can tailor the plan.[5, 8]
Movement, weight and everyday habits
Physical activity helps cardiovascular health, strength, mood and weight management. Australia’s current adult movement recommendations encourage activity on most days, including moderate to vigorous movement for at least 30 minutes on most days, strength activities twice a week, and mobility or balance activities on several days.[9] A walk, cycling, swimming or a manageable strength routine can be a starting point; build gradually if you have been inactive.
Excess body weight is associated with some adverse health outcomes, and Cancer Council Australia reports evidence linking overweight and obesity with prostate cancer risk. That association does not mean that weight loss prevents every prostate cancer, or that a person’s weight explains an individual diagnosis.[3]
For urinary symptoms, it can help to note when and how much you drink, whether caffeine or alcohol worsens urgency, and whether constipation is present. Drinking enough is important, but forcing large volumes can make frequency worse. These measures may ease symptoms for some people; they should not delay assessment of persistent or concerning changes.[1, 7]
If you are undergoing prostate cancer treatment, exercise may support fitness and help with treatment-related effects. The safest type and intensity depend on treatment, fatigue, bone health and other conditions. Ask your treating team or an accredited exercise physiologist for an individual plan when needed.[8]
What about PSA testing and “regular check-ups”?
A PSA test measures a protein made by the prostate. PSA may rise for reasons other than cancer, and testing can find slow-growing cancers that would never have caused harm. Further investigation and treatment can carry physical and emotional burdens. Testing may also identify a cancer at a stage when treatment can help. These benefits and harms should be discussed before testing.[2, 4]
The 2026 Australian guidelines for early detection recommend, after an informed discussion, PSA testing every two years for people aged 50–69 who choose testing. Routine testing at 45–49 is generally not recommended for average-risk people, although an interested person may be offered an initial test. People at higher risk, including those with certain family histories, Black sub-Saharan ancestry or a BRCA2 mutation, may be advised to start two-yearly testing at 45. For people aged 70 or older, the decision is individualised according to health, life expectancy and preferences.[4]
These are recommendations for people without symptoms. New difficulty passing urine, blood in the urine, persistent pain or other concerning symptoms call for assessment regardless of age or a planned PSA testing schedule. A GP is a sensible first contact and can arrange testing or referral when indicated.[2, 4]
A sustainable approach
Eat a varied diet, move regularly in ways you can sustain, and talk with your GP about symptoms and whether PSA testing makes sense for your age and risk. Healthy living is valuable in its own right, while medical decisions remain individual. There is no guarantee that these steps will prevent prostate disease, and a diagnosis does not mean someone has failed to look after their health.
General information only. This article does not replace personal medical advice or a discussion of the benefits and harms of PSA testing.
References
- Healthdirect Australia. Prostate problems.
- Cancer Council Australia. Early detection of prostate cancer.
- Cancer Council Australia. Prostate cancer prevention: evidence on lifestyle and diet.
- Prostate Cancer Foundation of Australia. 2026 Guidelines for the Early Detection of Prostate Cancer in Australia.
- National Health and Medical Research Council. Australian Dietary Guidelines.
- US National Cancer Institute. Prostate cancer, nutrition and dietary supplements; SELECT trial results.
- Healthdirect Australia. Benign prostatic hypertrophy: lifestyle measures.
- Cancer Council Australia. Life during and after prostate cancer treatment.
- Australian Government Department of Health. 24-hour movement recommendations for adults.