Prostate cancer is the second commonest cause of male cancer death and in Australia, nearly 3000 men die from the disease annually. Urologists and GPs use the PSA blood test, Prostate Specific Antigen level to assess a man’s risk of prostate cancer. In addition, any family history of prostate cancer is relevant. Digital rectal examination is helpful in the diagnosis, and the Urologist performs this simple finger examination in the consulting rooms. Prostate MRI (magnetic resonance imaging) prior to prostate needle biopsy, is now the standard of care. MRI – Ultrasound fusion biopsies allows for accurate biopsy targeting of an abnormal area seen on prostate MRI.
Treatment choices for prostate cancer include; Active Surveillance of low grade low volume disease, Radical Prostatectomy – most commonly Robotic Assisted Surgery, with nerve sparing (where possible, dependent upon MRI assessment of extra-prostatic extension and NVB neurovascular bundle involvement), or radiotherapy in older men with other medical problems that make them less suitable for robotic surgery.
Much reading information is available through The Urological Society of Australia and NZ, or The Prostate Cancer Foundation of Australia.
Systemic treatment of metastatic disease includes, often in combination; Androgen deprivation therapy (ADT), chemotherapy, anti-androgens, immunotherapy, and clinical trial drugs. The involvement of a medical and or radiation oncologist is recommended as multi-disciplinary care in this advanced setting tends to improve clinical outcomes.
After primary treatment, the Urologist will check the PSA levels to exclude recurrence of cancer, and rehabilitate continence and erectile outcomes.