Early detection and treatment critical

RISK FACTORS: Age and family history are factors that are most strongly linked to an increased chance of developing prostate cancer.
RISK FACTORS: Age and family history are factors that are most strongly linked to an increased chance of developing prostate cancer.

Early diagnosis and treatment are critical to effectively managing prostate cancer.

Prostate cancer affects men and is the most common cancer diagnosed in Australia.

It develops when abnormal cells in the prostate gland grow more quickly than normal cells, forming a malignant tumour.

NSW  Cancer Institute statistics from up to 2012, reveal the incidence and mortality rates for prostate cancer in the Hunter-New England region is significantly higher than the NSW state average.

“It is not known whether this was related to delayed diagnosis or delayed treatment,” according to urologist Dr Paul Ainsworth, from Hunter Urology, 

PSA testing is still the best (albeit imperfect) screening test for prostate cancer in conjunction with digital rectal examination.

“Multiparametric (MRI) scans are further helping decide who needs to proceed to biopsy sooner and who can be observed longer,” Dr Ainsworth said. 

A range of treatments are available in the Hunter, according to Dr Anne Capp, from Genesis Cancer Care Newcastle at Lake Macquarie Private Hospital.

“Treatment is  based around men’s age, prostate symptoms, general fitness, pre-existing illnesses, and taking into account their personal preferences and  how advanced the prostate cancer is.

“For men with early prostate cancer, there are several options available. Active surveillance allows men with limited low grade cancer to defer treatment, but does require regular review, repeated imaging and scheduled prostate rebiopsies.

“For men who would like immediate treatment, the options lie between radical prostatectomy [removal of the prostate gland] and radical radiation therapy.

“For early prostate cancer, the cure rates for both forms of treatment are similar.”

Low Dose Rate brachytherapy seeds are another form of radiation therapy for early low grade prostate cancer available in the Hunter.

“For men with more locally advanced prostate cancer, hormone therapy is often combined with prostate and pelvic radiation therapy and is given as curative treatment,” Dr Capp said. “For men with metastatic prostate cancer, hormone therapy is the mainstay of treatment, and radiation therapy is used to treat cancer deposits which are causing pain or other symptoms. If their cancer is not controlled by the hormone therapy, there are several chemotherapy options available now.”

The risks and benefits of surgery and radiation therapy must be discussed with each patient and it is recommended that any man with localised prostate cancer see both a surgeon and radiation oncologist before deciding what treatment they are going to undergo.

Patients should expect a clear outline of options of treatment, based on the  extent and grade of prostate cancer, and allowing for their age, fitness and pre-existing illnesses.

“This will involve an individualised discussion of risks to sexual function, urinary continence, and damage to other organs such as the rectum and bladder,” Dr Ainsworth said.

“A patient should expect that their specialist would be a part of a broader multidisciplinary prostate cancer care group including surgical, radiation oncology, medical oncology, pathology, radiology and nuclear medicine specialists.

“Your specialist should be able to give you information regarding any prostate cancer related clinical trials being run locally and should always keep the patients’ GP informed and engaged.”

Access to equipment and services are critical. They include:

  • Diagnostic services – imaging including bone scans, CT scans, multiparametric diagnostic MRI (Magnetic Resonance Imaging), PSMA (Prostate Specific Membrane Antigen) scans. Pathology assessment of biopsies.
  • Supportive services such as exercise physiologists (specially designed exercise programs have been shown to help limit the effects of hormone treatment and improve the outcomes for prostate cancer), pelvic floor rehabilitation physiotherapists, psychologists, sexual health advisors, palliative/supportive care, and community support groups.
  • Good quality web based patient information, such as the Prostate Cancer Foundation of Australia (www.pcfa.org.au).

Most people with PSA detected prostate cancer are cured at ten years after diagnosis. For more information visit  www.hunterurology.com.au and www.genesiscare.com.au.

Dr Paul Ainsworth has 20 years surgical experience with a particular interest in prostate cancer management and patient recovery after treatment.

Dr Anne Capp is a radiation oncologist at Genesis Cancer Care Newcastle.