Who this is for
Prostate cancer treatment in Melbourne has changed significantly over the last decade.
If you have recently been diagnosed with prostate cancer, are living with advanced prostate cancer, or are seeking a prostate cancer second opinion in Melbourne, Colombo, Kandy, the Maldives, Indonesia or the Philippines, this article explains the three changes that are quietly transforming how prostate cancer is diagnosed and treated.
Clinical Observation
One of the most common things I hear from men with prostate cancer is:
“Doctor, I just want to understand what is actually happening.”
This is especially true when the cancer has returned, spread, or stopped responding to earlier treatment.
Patients often arrive with several unfamiliar terms in front of them.
PSA.
Gleason score.
PSMA PET.
Hormone therapy.
Castration-resistant prostate cancer.
ctDNA.
For many patients and families, the problem is not only the diagnosis. It is the language surrounding the diagnosis.
Over the last decade, prostate cancer treatment has changed dramatically.
However, some of the most important changes are not only new drugs.
They are changes in how we explain the disease, how we see the disease, and how we measure the disease.
Many people assume that the biggest advances in prostate cancer have been new drugs.
That is only partly true.
The biggest changes I discuss with patients in my Melbourne prostate cancer clinic are actually changes in how we talk about prostate cancer, how we see prostate cancer, and how we measure prostate cancer.
These changes are making treatment more personalised, more accurate, and hopefully less frightening for patients and their families.
We are moving away from frightening labels and focusing on the biology
One of the most confronting phrases patients hear is:
“Your prostate cancer is now castration-resistant.”
I have never liked how that term sounds from a patient perspective.
Historically, the term was medically important because it described prostate cancer that continued to grow despite treatments that lowered testosterone levels.
The problem is that many patients hear the word “castration” and immediately feel overwhelmed, frightened, or confused.
What we now understand much better is that prostate cancer growth is often driven by the androgen receptor pathway.
This pathway acts like a communication system that prostate cancer cells use to receive growth signals.
Modern treatments increasingly target different parts of this pathway.
These include:
- Abiraterone
- Enzalutamide
- Apalutamide
- Darolutamide
These medicines are commonly called androgen receptor pathway inhibitors (ARPIs) or androgen receptor signalling inhibitors (ARSIs).
For patients, this change matters because it shifts the conversation away from an emotionally loaded label and towards understanding the biology of the disease.
Increasingly, the question is not:
“Has my cancer become castration-resistant?”
Instead, it is:
“What is driving my cancer, and which pathway should we target next?”
That is a much more useful conversation.
PSMA PET scans have changed what we can see
Ten years ago, most of the major prostate cancer studies used:
- CT scans
- Bone scans
Those studies remain incredibly important and continue to guide treatment today.
The challenge is that we now have much better imaging.
PSMA PET imaging has transformed prostate cancer care in Australia and is now widely available.
For many patients with prostate cancer in Melbourne, PSMA PET has become one of the most important tests performed during diagnosis, recurrence assessment, and treatment planning.
The reason is simple.
PSMA PET can detect cancer deposits that older scans simply could not see.
This has created an important dilemma.
Many of the definitions we still use today—including “high-volume metastatic disease”—were originally developed using CT and bone scan technology.
Historically, high-volume disease generally meant:
- Four or more bone metastases, particularly outside the spine and pelvis, or
- Spread to organs such as the liver or lungs.
When a modern PSMA PET scan identifies additional disease sites that older scans would have missed, doctors must carefully interpret how those findings fit into historical clinical trial evidence.
For patients, this explains why treatment recommendations sometimes appear more complex than expected.
The good news is that we are making decisions with far more information than ever before.
And in medicine, seeing the disease more clearly is usually a good thing.
ctDNA may become one of the most important blood tests in prostate cancer
The third major change is something many patients have never heard of.
It is called circulating tumour DNA or ctDNA.
Every cancer cell contains genetic material.
As cancer cells die, tiny fragments of DNA can enter the bloodstream.
Modern technology can now detect and analyse these fragments through a simple blood test.
This is exciting because ctDNA may eventually help doctors understand prostate cancer in ways that PSA and scans cannot fully explain.
In advanced prostate cancer, research suggests that ctDNA may provide additional information alongside PSA testing.
This may help doctors monitor treatment response and understand whether a treatment is working.
However, ctDNA is still evolving in prostate cancer.
It is not yet a routine test for every patient.
For now, I see ctDNA as one of the most important areas to watch over the next decade.
Researchers hope it may eventually help us:
- Monitor treatment effectiveness more accurately
- Detect resistance earlier
- Personalise treatment choices
- Identify patients who may need a different treatment approach
- Better understand the biology of advanced prostate cancer
Prostate Cancer Treatment in Melbourne: Why These Changes Matter
When patients ask me what has genuinely changed in prostate cancer treatment, my answer is increasingly:
We are becoming more precise.
Doctors are also using more patient-friendly language.
Better imaging, especially PSMA PET, is helping us see the disease more clearly.
We are using increasingly sophisticated biomarkers.
The result is that treatment decisions are becoming more personalised than ever before.
Whether you are seeking prostate cancer treatment in Melbourne, looking for a prostate cancer specialist in Melbourne, or obtaining a second opinion from Sri Lanka, Indonesia, the Philippines or the Maldives, understanding these developments can help make sense of why modern prostate cancer management often looks very different from what it did even a few years ago.
Key Takeaways
- Prostate cancer treatment is becoming more personalised
Doctors are increasingly looking at the biology of the cancer, not just broad labels. - PSMA PET has changed how prostate cancer is seen
It can detect disease that older CT and bone scans may miss, which can make treatment planning more accurate. - ctDNA is an important area to watch
It may eventually help doctors monitor treatment response and personalise care, although it is still evolving in prostate cancer. - The language we use matters
Clearer, less frightening explanations can help patients better understand their diagnosis and treatment options.
Overall, prostate cancer treatment in Melbourne is becoming more precise, more personalised and more focused on helping patients understand their options clearly.
Key Evidence
- Scher HI, Morris MJ, Stadler WM, et al. Trial design and objectives for castration-resistant prostate cancer: updated recommendations from the Prostate Cancer Clinical Trials Working Group 3. J Clin Oncol. 2016;34(12):1402-1418. doi:10.1200/JCO.2015.64.2702
- Sweeney CJ, Petry R, Xu C, et al. Circulating tumor DNA assessment for treatment monitoring adds value to PSA in metastatic castration-resistant prostate cancer. Clin Cancer Res. 2024;30(18):4115-4122. doi:10.1158/1078-0432.CCR-24-1096.
- Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395(10231):1208-1216. doi:10.1016/S0140-6736(20)30314-7
- Gillessen S, Tombal B, Davis ID, et al. Management of patients with advanced prostate cancer. Report from the 2024 Advanced Prostate Cancer Consensus Conference. Eur Urol. 2025;87(2):157-216. doi:10.1016/j.eururo.2024.09.017
Dr Dilanka De Silva
MBBS, MRCP(UK), MRCP(UK SCE Oncology), FRACP, PhD
Medical Oncologist & Cancer Genetics Physician
Memorial Sloan Kettering Cancer Center Fellow (New York, USA)