September marks Prostate Cancer Awareness Month in Australia!
Prostate cancer is the most commonly diagnosed cancer in men in Australia with almost 20,000 diagnoses and close to 3,500 deaths each year. The Prostate Cancer Foundation of Australia (PCFA) is asking Australia to get involved and help create and raise awareness by urging men over 50 to book an appointment with their GP and get checked.
New guidelines around PSA testing have promised to transform prostate cancer outcomes in Australia. The guidelines, which recommend that men between the ages of 50-69 are offered PSA testing every two years, replaced the US Preventative Services Task Force guidelines and previous differing guidelines in Australia that some urologists blame for an increase in presentations with metastatic prostate cancer. Certainly, when screening was discouraged, adverse consequences followed, with evidence showing that mortality from prostate cancer is lower when men are screened for it. With prostate cancer the third most common cause of male cancer deaths in Australia, policies that improve early diagnosis can only help.
Better, safer biopsies
Alongside updates in PSA testing guidelines, accurate prostate cancer diagnosis is currently being transformed through a new FDA approved device, now available in Australia, PrecisionPoint™. Developed in response to the disadvantages of traditional transrectal biopsy approaches, PrecisionPoint™ has been developed and patented by the US based company Perineologic. It is the first FDA approved device that allows a free-handed transperineal biopsy of the prostate. The low-cost, disposable device represents a new approach to prostate cancer detection at an earlier stage of progression, through its ability to systematically allow access to the whole prostate gland.
The TGA approved medical device offers urologists a safer and more accurate method to diagnose potential incidents of prostate cancer. The PrecisionPoint™ system takes full advantage of the transperineal path to more thoroughly sample all regions of the prostate including those difficult to access with the traditional transrectal approach. In addition, the potential for infection is significantly reduced. Equally importantly, biopsies can be performed under local anaesthesia rather than general, which saves resources, cost and significantly improves the overall patient experience.
Early and accurate diagnosis is clearly key to better outcomes, but a major challenge for patients lies in the selection of treatment. The choice of treatment for localised prostate cancer can be complex, influenced by factors like age, cancer characteristics, treatment availability and personal preferences. And while patients can understandably be reluctant to discuss their condition, the risk is that decisions are made without fully understanding all available options, their impact on a patient’s lifestyle and their long term outcomes and side effects.
Active Surveillance is now an option for patients with early stage prostate cancer but surgery (radical prostatectomy (RP) or robotic radical prostatectomy), remains the most common primary treatment for prostate cancer. However, despite brachytherapy being an alternative for many patients – it’s an unsung option that often goes under the radar.
Low-dose rate brachytherapy (LDR-B) achieves high precision, targeted radiotherapy, using computerised treatment planning and image-guided delivery systems to deliver a tailored ablative tumour dose to the prostate whilst sparing surrounding organs. The challenge for Australian healthcare is to cement (LDR-B) as a primary consideration alongside RP.
Maximise clinical resource
A fundamental principle is for patients to be given comprehensive information and psycho-social support during the decision-making process. Whilst there are various models whereby this may be achieved, the GP plays an integral role in all of them.
The USANZ recommends giving patients the opportunity to see a radiation oncologist for an opinion on all available treatment options. The RANZCR’s Target Cancer campaign cites GPs as the best means of facilitating this at the referral stage. In addition, Optimal Care Pathways guidelines provide detailed information on the holistic approach to cancer care, whilst PCFA Prostate Cancer Support Nurses provide further resources to support patients’ decision-making. All these resources must be maximised to help patients make informed choices.
Fundamentally, it’s important to ensure patients are empowered to make informed choices. As the burden of prostate cancer increases in Australia, GPs can be much more than referrers – they can open crucial dialogue that enhances decision-making and drives better outcomes!