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Prostate cancer

This fact sheet is to help MBF members and their families be better prepared for the healthcare experience after a diagnosis of prostate cancer.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and perhaps with other healthcare professionals in the team caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading (see 'More about prostate cancer and its treatment') will also help you make more informed decisions about your treatment.

About prostate cancer  

The prostate is a small gland, normally about the size of a walnut that is found in men just below the bladder and behind the scrotum. Its' functions are to produce seminal fluid and to help control urinary flow.

Over the course of a man's life, the prostate enlarges, but unlike other growth in the body, for some reason the prostate gland seems to continue this enlargement into very old age. This growth also seems to make it susceptible to the development of cancerous cells. Cancer of the prostate occurs when its cells begin to reproduce abnormally to form a (cancerous) lump or tumour. Although prostate cancer is generally considered to be slower growing than many, it may still spread to other parts of the body (known medically as "metastasising"), especially the bones and liver.

While its causes are not known, men aged greater than 60 and/or have a family history of the condition (father or brother), have an increased risk of prostate cancer. After skin cancer, prostate cancer is the most common form of cancer in Australian men, with around one in 11 men likely to be diagnosed with the condition by age 75.

It is important to understand that not all prostate cancers are the same. In many cases, the growth is quite slow compared to other cancers and may not necessarily threaten your life. In fewer cases, the prostate cancers grow very quickly and aggressively.

Doctors often use three factors--stage, grade and PSA levels--to describe the extent of prostate cancer.

"Stage" refers to whether the cancer has spread and if so, where, often using what's known as the Tumour-Node-Metastasis (TNM) classification system.

  • T refers to the tumour size and location, rated from one (the smallest and most localised) through to 4 (where the tumour may have spread outside the prostate region to the pelvic region).
  • N refers to whether the tumour has invaded the lymph nodes (glands) in the pelvis, from 1 through to 3.
  • M refers to whether the cancer has spread and whether there are tumour cells present in other parts of the body (such as the bones).

"Grade" refers to the aggressiveness of the tumour - how quickly it is likely to grow or spread - and is often measured by what's known as the "Gleason" score, which ranges from 2 to 10. To establish the Gleason score, a pathologist needs to examine a sample of the tumour that has been extracted during surgery or biopsy: the higher the Gleason score, the more aggressive the cancer.

PSA levels are also used to help detect or monitor the extent of prostate cancer. PSA or "prostate specific antigen" is a protein that is created with assistance from the prostate gland. A high PSA level may sometimes be a sign of cancer. What is considered a "normal" PSA level will vary according to your age and other factors, and can fluctuate quite considerably from day to day. Although PSA levels can be raised for other reasons unrelated to cancer, where a diagnosis of prostate cancer has been made, it is likely that PSA levels will be measured before and after treatment as one way of assessing whether, or how many, cancer is still present, or more correctly, how the cancer has responded to treatment.

The combination of these three factors - grade, stage and PSA levels - can help with estimates about the type of cancer you have, and the likelihood of its spreading. If you already know the stage and grade of your condition, try to keep this in mind when you talk to your doctor and/or conduct your own research. This will help you focus on information that's most relevant to you.

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Your Treatment Options  

After prostate cancer has been diagnosed, you will probably have to undergo some further testing to determine more exactly the size and location of the cancer and whether it has spread. This is likely to include a rectal examination by the doctor, blood testing and medical imaging.

Once the size and location are determined, you and your doctor will be better placed to make a decision about the treatment that is best for you. There are more treatment options for prostate cancer than treatment for some other cancers, so it's especially important to work closely with your doctor and preferably to do plenty of research and ask plenty of questions.

In general, the advisable course of treatment will be determined depending on several factors, including:

  • cancer stage;
  • cancer grade;
  • PSA levels;
  • tumor size;
  • if it has spread and if it has, to what other parts of the body;
  • your general health and age; and
  • in particular, how you feel about the different options available and the likely effects they may have on your future wellbeing and quality of life.

Treatment for prostate cancer commonly includes a combination of some or all of the following:

  • surgery;
  • radiotherapy (radiation therapy) - external or internal;
  • chemotherapy;
  • hormone therapy; or
  • watchful waiting (as prostate cancer can be very slow growing this implies doing nothing immediately, but monitoring the cancer closely).

If possible, when choosing your doctor (see below), try to choose one who is associated with the dedicated cancer treatment centre of a major hospital and who regularly works with the other specialists from whom you can receive all the types of treatment you may need.

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Watchful waiting

There are still many doctors who consider that for many men, especially where prostate cancer is found to be very low grade and slow growing, or if there are other factors to take into account - in particular your general health status, whether you are suffering from any other health conditions, and age - no treatment or conservative management of any symptoms may be recommended, at least until something should change in the symptoms or the monitoring of your condition.

It is almost as though some of the less aggressive presentations of this condition can be managed by watching them growing old with the patient.

However, very regular monitoring of the tumour and its growth and other factors such as your PSA level, will take place. If there are changes, or depending on how you feel, the advice you receive may change if you and your doctor decide on more active treatment.

Again, full discussion and plenty of research about your own unique case will help you make this decision.

Emotional Support

A diagnosis of cancer and going through treatment is usually enormously distressing to everyone involved. It can affect not only you, but also your partner and others around you. There are many prostate cancer support and information organisations and websites that offer a wide variety of practical help and information to both you and your family. You should also discuss with your doctor whether you might benefit from the assistance of a community organisation, counsellor or social worker.

Men sometimes find that seeking emotional support, or acknowledging that there may be psychological effects of their health condition is difficult for them. Despite this, many men gain enormously from contacting the support groups that have commonly been established by other men who have gone through this same disease. These men have learned through their own experiences of some of the non-medical needs as well as the medical treatment options and their effects, and form groups to help others through some of the difficult decisions that can make real differences in your ongoing quality of life.

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Questions to ask your doctors 

Your treatment and ongoing care for prostate cancer will involve a number of different doctors, including your GP, who will refer you to the specialists and help coordinate your care; a specialist urologist (or occasionally a general surgeon) who has specialised in prostate care to perform your surgery; and a radiation and/or medical oncologist to take care of radiation therapy or chemotherapy. Ideally, try to find doctors who work as a coordinated team or as part of a comprehensive cancer care program, often out of one major hospital or centre to reduce your travelling time and also to help with effective communication between doctors about your ongoing treatment and care.

Every person and every case of prostate cancer is different, so the treatment options that are right for you differ too. Your treatment decisions may depend on the answers to many questions. Here are a few that might help at the start.

To the GP/Referring Doctor:

  • Why have you chosen to refer me to this particular doctor?
  • Is this doctor associated with a comprehensive cancer care centre?
  • Do you know anything about the radiotherapists and oncologists that may be involved if I go to this doctor?
  • Do you know if they charge a gap that Medicare or my health fund won't cover for my inpatient procedures? Or is there someone just as suitable that is more likely not to charge a 'gap' over the medical fee? Even so, choose your doctor first on the outcomes you can expect and their experience and expertise.

To the Specialist Doctor:

  • Why do you think this is the best treatment option for me? What other options are there?
  • Will you explain the treatment I am going to have, starting in simple terms, please?
  • What are the likely outcomes of my treatment?
    • What are the chances that the outcomes will be good, with this treatment or with the alternative options? Why are you recommending (either/or) more conservative / (or) more radical treatment in my case?
  • What are the possible complications and/or side effects associated with my surgery? What would it be for any other treatment options that might be appropriate for me and the stage and type of cancer I have? How can I reduce the risks?
  • How many of these procedures have you done? How does this compare to a doctor who has a specific interest and practice in prostate cancer surgery?
  • Are you associated with a comprehensive cancer care centre?
  • Do you know anything about the outcomes for the radiotherapists and oncologists that may be involved?
  • Are you and your team the right ones to be seeing at this stage or should I be thinking of seeing someone who may be even more specialised in this area or in any other particular treatment that might be appropriate for me? Is there any time when we should reconsider that?
  • What is the likelihood that I could be incontinent or have erectile impairment after my treatment? Is there anything else you can tell me about this aspect of my treatment, or any other support agencies that I could refer to help me adjust to this? If I am concerned about that risk, are there alternative treatment plans that I should consider where the risks, and of course the possible benefits, may be different? Is there any way I can treat these effects if they occur?

Each of the following questions may or may not be relevant to you:

  • How long after the operation will you be able to tell me the result and how will I be able to contact you?
  • Do you charge a gap that Medicare or my health fund won't cover for inpatient services? Even so, choose your doctor first on the outcomes you can expect and their experience and expertise.
  • Does the anaesthetist who usually works with you charge a gap? If so, how much should I expect that to be?
  • How long do you expect me to be in hospital? Who do I call if anything happens?
  • What is my expected recovery time?
  • What can I do, prior to hospital, to reduce my risk for complications?
  • Should I stop taking any of my medications prior to going to hospital? If so, how long before?
  • What restrictions will I have regarding my everyday activities when I go home (i.e. driving, lifting heavy objects, sexual activity)? If so, how long will I need assistance (or need to avoid)?
  • If I am to have chemotherapy or radiotherapy or hormone therapy, can you tell me: how long is the treatment likely to last? How will I expect to feel? What are the possible side effects and complications of these treatments? How can I reduce these?
  • If I need radiotherapy or drugs, where would I be going for that treatment? Are the outcomes of treatment at that centre as good or better than those at other large centres near here?
  • Are there any clinical trials or new treatments I should know about?
  • What sort of monitoring and follow-up treatment should I expect once my initial treatment is over?
  • I understand that some people and their families benefit from counselling and being able to discuss any issues. Do you work with anyone that counsels in this area? If not, can you tell me who to access? Do you have a booklet on this?

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What does MBF pay toward my treatment?  

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect during prostate cancer treatment. Always check with MBF before you go to hospital.

Your hospital costs  

All levels of MBF hospital cover help pay for in-patient treatments provided that:

  • they are provided to you while you are formally admitted to a hospital;
  • they are treatments for which Medicare pays a benefit;
  • they are not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

Your MBF hospital cover will help pay for the following treatments and services so long as you are formally admitted to the hospital and the above conditions are met:

  • shared accommodation (or private room if available)
  • surgery related expenses including operating theatre, and intensive care if needed
  • chemotherapy
  • certain drugs supplied as part of your inpatient hospital treatment, and
  • certain therapies such as physiotherapy, occupational therapy and speech therapy when provided by the hospital and associated with your hospital treatment.

Please note that Medicare pays a Medicare benefit toward the cost of radiation therapy.

The costs of participating in clinical trials and experimental drugs are paid by the sponsor of the trial and are not covered by private health insurance or by the patient.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that surgeon's and other doctors' charges will be part of your medical costs.

Your medical (doctors') costs  

If your doctor thinks you may need to go to hospital for care, ask your doctor to explain the costs of your inpatient care including their own fees, any fees that other doctors might charge, and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'. Obtaining this information is extremely important before any planned hospital admission.

Remember, there may be more than one doctor involved in your care. You may not meet them all in person.

Each doctor will charge separately for his or her services and may or may not charge a gap.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

Your extras costs  

If you have MBF extras cover, MBF may also help with the cost of a number of other healthcare services that may assist with the treatment and recovery from prostate cancer.

Depending on your level of MBF extras cover, limits of your cover and waiting periods these may include:

  • occupational therapy, to help you re-establish your usual living or working routine;
  • psychology, such as counselling for you and family members included on your cover;
  • pharmacy (for drugs not listed on the Pharmaceutical Benefits Scheme);
  • physiotherapy, to help restore movement and function following surgery; and
  • complementary therapies such as remedial massage.

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

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More about prostate cancer and its treatment  

More about going to hospital, MBF Network hospitals, no-gap doctors, and MBF MemberCare providers 

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 05-06-07

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