Prostate cancer

What to expect -

Prostate cancer

The following information describes the optimal care that should be provided at each step of the cancer pathway.

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Prostate cancer support

For information about prostate cancer or where to go for support call 1800 22 00 99 or visit Prostate Cancer Foundation of Australia www.prostate.org.au.

Also, qualified cancer nurses at Cancer Council can answer your questions about the effects of cancer, explain what will happen during treatment and link you to support groups and other community resources. Call Cancer Council 13 11 20.

Translating and Interpreting Service LogoIf you need an interpreter, call TIS (the Translating and Interpreting Service) on 1314 50. For support and advice for carers, call the Carers Association on 1800 242 636.

Other resources include:

Click here to view additional resources.

Andrology Australia
Information on male reproductive health
• Telephone: 1300 303 878
• Website: www.andrologyaustralia.org

Australian Cancer Survivorship Centre
Has general and tumour-specific information, primarily focused on the post-treatment survivorship phase
• Telephone: (03) 9656 5207
• Website: www.petermac.org
/cancersurvivorship

Continence Foundation of Australia
Provides advocacy and support for those affected by bladder or bowel control issues
• Telephone: 1800 33 00 66
• Website: www.continence.org.au

National Health Services Directory
A directory providing information on local hospital and community services
• Website: www.nhsd.com.au

beyondblue: the national depression initiative
Information on depression, anxiety and related disorders, available treatment and support services
• Telephone: 1300 22 4636
• Website: www.beyondblue.org.au

Cancer Australia
Information on cancer prevention, screening, diagnosis, treatment and supportive care for Australians affected by cancer, and their families and carers
• Telephone: 1800 624 973
• Website: www.canceraustralia.gov.au

Pathfinder – Prostate Cancer Research Register
A national online register for participating in research into improving the health and lives of people post-prostate cancer treatment.
• Website: pathfinderregister.com.au

Cancer Council (operated by Cancer Council Victoria)
A confidential telephone support services for people affected by cancer.
• Telephone: 13 11 20 (Monday to Friday, 8.30am – 5.30pm)
• Website: www.cancervic.org.au

Care Search: Palliative Care Knowledge network
Information for patients and carers on living with illness, practical advice on how to care, and finding services
• Telephone: (08) 7221 8233
• Website: www.caresearch.com.au

Prostate Cancer Foundation of Australia
Information about prostate cancer and where to go for support and help, including state and territory support groups
• Telephone: 1800 22 00 99
• Website: www.prostate.org.au

Clinical versions of the optimal care pathways have been developed for clinicians and general practitioners www.cancer.org.au/OCP

Phone

1. Initial investigations and referral

DoctorIf you have a family history of prostate cancer, your GP should discuss the option for annual PSA testing. If you do not have a family history of prostate cancer, you may still wish to consider tests for early detection after discussing the risks and benefits with your GP.

Your general practitioner (GP) will assess your symptoms, conduct a physical examination and arrange blood tests if needed. Your GP should also discuss your needs (including physical, psychological, social and information needs) and recommend sources of reliable information and support.

Investigations

It can be helpful to bring a family member or friend with you to your appointments.

If prostate cancer is suspected, you will be referred to a specialist (likely to be a urologist) for further testing. Your GP will provide the specialist with information about your medical history, whether there is a history of cancer in your family, and your test results. Tests you may have:

  • Prostate specific antigen (PSA) testing: The PSA blood test looks for the presence in the blood of a protein that is produced specifically by prostate cells.
  • Measurement of PSA free to total ratio: Most PSA In the blood is attached to proteins but some is free (unattached). Measuring the proportion of free PSA in the blood can assist in identifying the likely causes of an elevated PSA.

2. Diagnosis and staging

The specialist should discuss your test results and options for further testing. This is to find out whether cancer is present, and if it is, its stage of development and if it is confined to the prostate.

Your specialist should also explain the risks and benefits of having a prostate biopsy and give you time to decide if you want to undergo further testing.

It can be helpful to contact prostate cancer peer support groups, carer support groups, and special interest groups.

Further tests you may have:

  • Digital Rectal Examination (DRE)
  • Biopsy
  • MRI scan
  • Computed tomography (CT) or bone scan

Digital Rectal Examination (DRE)

The doctor inserts a gloved finger in the anus and examines the surface of the prostate, looking for irregularities.

Biopsy

Small samples are removed from your prostate gland to be examined under a microscope.

MRI Scan

Magnetic fields and radio waves are used to take pictures of inside the body.

CT Scan

Computer technology and x-rays are used to create cross­-section views of the body.

It can be helpful to contact prostate cancer peer support groups, carer support groups, and special interest groups.

For a list of questions to ask your doctor visit http://www.cancer.org.au/about-cancer/after-a-diagnosis/questions-to-ask-your-doctor.html

3. Treatment

To ensure you receive the best care, your specialist will arrange for a team of health professionals to plan your treatment based on your preferences and needs.

The team will be made up of health professionals who have experience managing and supporting a person with prostate cancer. Your specialist will tell you when the team will be discussing your case.

Your team should discuss the different treatment options with you including the likely outcomes, expected timeframes, possible side effects, and the risks and benefits. Your doctor may also suggest you consider taking part in a clinical trial.

Let your team know about any complementary therapies you are using or thinking about trying. Some therapies may not be appropriate, depending on your medical treatment.

You might want to ask for more time before deciding on your treatment, and you should be offered an opportunity for a second opinion by a radiation oncologist and a urologist in order to have a balanced view about the treatment options.

There are a number of ways to treat prostate cancer. In some cases, more than one type of treatment could be used to get the best outcome.

Treatment options for early prostate cancer:

Chemotherapy or drug therapy

Active surveillance

No treatment is given or treatment is postponed but the cancer is closely monitored.

Watchful waiting

Watchful waiting

Less strict monitoring than active surveillance. Often suitable for older patients or patients who have other health issues.

Surgery

Surgery (prostatectomy)

Surgery to remove the prostate may benefit those with early prostate cancer. It is important that this surgery is performed by a surgeon who is very experienced in performing prostatectomies and performs several operations every year.

Radiation therapy

Radiation therapy

(also called radiotherapy) can be given with or without surgery and may be external or internal (brachytherapy). Brachytherapy involves delivering the radiation using an implant placed into your body through or near the tumour.

Your doctor should discuss your needs with you during and after treatment (including physical, psychological, social and information needs) and may refer you to another service or health professional for different aspects of your care.

Treatment options for advanced prostate cancer
(i.e. affecting other organs or bone):

Surgery

Androgen deprivation therapy (ADT)

ADT is an injection and/or tablet based hormone treatment. Your specialist will discuss possible side effects.

Chemotherapy or drug therapy

Chemotherapy and other drug therapy

May be given in conjunction with ADT.

For more information about treatment and treatment side effects ask your doctor or visit www.cancer.org.au/about-cancer/treatment

4. After treatment

After Treatment

After treatment is completed, your doctor should provide you with  a treatment summary which details the care you received, including:

  • diagnostic tests performed and their results
  • types of treatment used and when they were performed
  • treatment plans from other health professionals
  • support services provided to you


To monitor your health, and make sure the cancer has not returned, you will need regular check-ups.

You and your GP should receive a follow-up care plan that tells you about:

  • the type of follow-up that is best for you
  • care plans for managing any side effects of treatment, should they occur
  • how to get specialist medical help quickly if required

Your doctor should:

Discuss

discuss your needs with you and refer you to appropriate health professionals and/or community organisations, if support is required

Thermometer


provide information on the signs and symptoms to look out for that might mean a return of the cancer

Healthy eating


provide information on prevention and healthy living

Treatment for prostate cancer sometimes damages nerves and muscles near the prostate and the bowel.

This can lead to side effects such as incontinence, erectile dysfunction, infertility and loss of interest in sex. Fortunately, there are many ways to reduce or manage these, and most men are able to continue to lead active lives after their treatment.

5. If cancer returns

CalendarSometimes prostate cancer can come back after treatment. This is why it is important that you have regular check-ups. Usually this will be detected at your routine follow-up appointments or if you notice symptoms are coming back.



6. Living with cancer

Sife Effects
Side effects: Some people experience side effects (for example tiredness) that continue beyond the end of treatment. Side effects sometimes might not begin until months after treatment has finished.For more information about side effects ask your doctor or visit www.cancervic.org.au/about-cancer/survivors/long-term-side-effects

Palliative care
Advance care plan: Your doctor may discuss with you the option of developing an advance care plan. An advance care plan is a formal way of setting out your wishes for future medical care. For more information about advance care planning ask your doctor or visit www.advancecareplanning.org.au

Advanced care
Palliative care: This type of treatment could be used at different stages to help you with pain relief, to reduce symptoms or to help improve your quality of life. For more information about palliative care ask your doctor or visit www.palliativecare.org.au

7. Questions of cost

There can be cost implications at each stage of the cancer care pathway, including costs of treatment, accommodation and travel. There can be substantial out-of-pocket costs if you are having treatment in a private health service, even if you have private health insurance. You can discuss these costs with your doctor and/or private health insurer for each type of treatment you may have. If you are experiencing financial difficulties due to your cancer treatment you can contact the social worker at your local hospital.

CostFor more information about cost of treatment ask your doctor or visit http://canceraustralia.gov.au/affected-cancer/living-cancer/dealing-practical-aspects-cancer/costs-treatment

TravelFor more information about accommodation and travel costs ask your doctor or visit http://www.cancercouncil.com.au/get-support/practical-support-services/