Unlike many other health issues that can be treated or managed with a simple operation or generic form of treatment, many men are faced with a daunting prospect after receiving a prostate cancer diagnosis.
One in seven men will be diagnosed with prostate cancer in their lifetime, with 21,000 to be diagnosed by the end of this year. And, while there’s a big debate over how vigorously doctors should be testing or trying to diagnose the cancer, many men are unsure what actually happens when they’ve had a biopsy and they are diagnosed.
Speaking to Starts at 60, urologist Joseph Ischia explains that a number of factors determine what happens next for a man.
“Once you have a diagnosis of prostate cancer, it really depends a lot on what that biopsy showed and what their PSA [prostate-specific antigen] is, what age they are and how fit they are,” Ischia explains. “All those things go into us deciding what we do next. The reason there are so many factors is not all prostate cancers are the same.”
Prostate cancer can vary in how aggressive it is and it’s not uncommon for patients with low-grade or low-risk cancers to be told they don’t need to undergo treatment. Then there are those that, if left untreated, can cause major health problems or even death.
However it can take years for aggressive cancers to cause death or serious harm, which is why some older patients choose not to seek treatment.
“You don’t want to put him through all the rigmarole of cancer treatment if it’s not going to give him the benefit long term,” Ischia says, using an example of someone at the age of 80 who has been diagnosed. “It’s got its side effects associated with it and the like. So that’s another factor that comes in.”
Another factor surgeons consider is whether the cancer has spread beyond the prostate. For those with no spread, it’s common to receive surgery or radiation as treatment. In cases where it has spread, patients are likely to receive hormone treatments, possible combined with therapy.
“I think that confusion is what makes it so difficult for men to just get an idea of what to do,” Ischia says. “With prostate cancer, there’s such a wide variety, there’s no cookie-cutter solution for everybody.”
In addition to the treatment, there are a number of problems and challenges patients face, but depending on the cancer characteristics, it can vary from man to man. While age and the specifics of the cancer is one factor, a man’s attitude can also play a role.
“The treatments for prostate cancer and the side effects of the treatments affect two of the most important things that men consider themselves manly,” Ischia says. “Their erections can be affected or their continence can be affected, so they can leak urine. It’s a very real problem for some people.”
There’s also the psychological side effects that come with being told you have cancer or have a cancer that doesn’t need to be treated if it’s not aggressive. Thankfully, there are many services available to help men and their partners through a cancer diagnosis. A man’s treating doctor, urologist, medical oncologist or radiologist is a great starting point, although a good GP is also vital.
“Then there’s other resources. I’d point people to the Cancer Council of Victoria or the Prostate Cancer Foundation of Australia,” Ischia notes. “You’ve also got Movember and the Movember services. There’s a particularly good service at the moment called TrueNTH.
“It’s trying to cover all the aspects that go into a man living with prostate cancer. It will look at the cancer, his incontinence, his erections, his sexual function and relationship, the mental side, physiotherapy, nursing.”
It’s best to keep away from websites that try to sell miracle cures and instead address any issues directly with a GP. It’s also good to discuss overall prostate health with your GP and to raise any concerns with them.