Prostate cancer is the second commonest cause of male cancer death and in Australia, nearly 3000 men die from the disease annually. Its diagnosis relates to the patient’s PSA level, digital rectal examination and more recently, the use of prostate multi-parametric MRI.
A prostate biopsy is required, either by way of the traditional transrectal ultrasound route or transperineal through the skin, to confirm the grade of the cancer.
Not all prostate cancers require definitive treatment and some of them are suitable for an active surveillance program, where over several years, the patient requires repeat PSA testing, repeat rectal examination, repeat MRI scan and repeat prostate biopsies.
This surveillance allows the man to retain continence and erectile abilities until a state where the disease has progressed and definitive treatment, either by way of surgical excision or radiotherapy, in one of its various forms, is applied with a curative intent.
Intermediate and high grade prostate cancers, based on prostate biopsy results and imaging based staging of the disease, require definitive treatment, either by way of surgery to remove the prostate gland and surrounding tissues, including a pelvic lymph node dissection, or definitive external beam radio therapy.
The operation can be performed using the robotic assisted approach, or traditionally via the open retropubic lower pelvic incision.
Any diagnosis of prostate cancer requires a full assessment of the patient’s medical conditions and life expectancy, in order to determine whether definitive treatment is suitable and in the elderly population, even more aggressive cancers may simply be watched, due to competing health risks.
Staging includes CT scans of the abdomen, pelvis and a bone scan and also a pelvic MRI scan, to make sure the cancer has not spread elsewhere beyond the organ of origin.
A newer scan called a PSMA PET scan is very accurate at picking up prostate cells and is available to patients for staging. An assessment of voiding function and continence and erections is imperative in each patient diagnosed with prostate cancer.
There is significant information available and provided through the Prostate Cancer Foundation of Australia, and handed on to the patient by his urologist in the rooms. Often several consultations are required, as well as possible referral to a medical oncologist and/or radiation oncologist, before a final decision can come to light.
Several studies have confirmed that the ongoing use of PSA testing and the early detection of intermediate and high grade prostate cancers has saved lives and has reduced the number of patients presenting with metastatic wide spread disease.
More complex and difficult prostate cancers require hormonal treatments in the form of either tablets or injections and may also require short periods of chemotherapy. There are newer secondary and tertiary hormonal manipulative strategies that are best left in the hands of the medical oncologist.
Certain hormonal treatments reduce bone mineral density and calcium supplementations and weight bearing exercises, as well as referral to a male exercise rehabilitative program may be required.
Careful ongoing monitoring of blood tests including liver function, with PSA and testosterone levels are performed by your specialist.
In this practice, low grade, intermediate grade and high grade prostate cancers are successfully managed by robotic surgical excision, however a full discussion is first required with your urologist.