Prostate cancer treatment at GenesisCare

What you can expect as a patient

Our team of medical professionals will design a comprehensive prostate cancer treatment plan focused on you, the individual, not just the condition.

Chapter 01

What is prostate cancer?

Prostate cancer is the most common cancer in men. In Australia, the risk of getting prostate cancer by the age of 75 is 1 in 7 men. By the age of 85, this increases to 1 in 5.¹ Early diagnosis and treatment can mean a positive outcome for many.

What is the prostate?

Only men have a prostate gland. The prostate is a small gland below the bladder and near the rectum in men. It surrounds the urethra, the passage to the penis through which urine and semen pass.

The prostate gland is part of the reproductive system. It makes prostate fluid, one of the components of semen, and a protein called prostate specific antigen (PSA). To grow and develop, the prostate relies on the male hormone testosterone, which is made by the testicles.

The prostate is often described as being the size of a walnut, and it is common for it to grow as men age.

Common symptoms of prostate cancer

Prostate cancer happens when abnormal cells in the prostate multiply, causing a tumour. In men diagnosed with early or localised prostate cancer due to an elevated PSA blood test result, the majority have no symptoms.2 This is because early prostate cancer often starts in the outer edge of the prostate, away from the urethra, and not does not cause any symptoms.3

These cancerous cells sometimes grow throughout the prostate and through the capsule surrounding the prostate. There may be spread to the adjacent seminal gland, and they can spread to other areas including bone and lymph nodes. This is known as advanced or secondary prostate cancer.3

Advanced prostate cancer symptoms can include:4

  • The frequent or sudden feeling to urinate
  • Difficulty and/or discomfort when urinating
  • Discovering blood in semen or urine
  • Pain in the lower back, upper thighs, or hips.

Some symptoms of advanced prostate cancer can be symptoms of other common conditions, for example benign prostatic hyperplasia (BPH) – a non-cancerous enlargement of the prostate causing some of the above symptoms.3 It is therefore important to seek medical advice for any symptoms you are experiencing.

If prostate cancer is found before it has spread, there are a broader range of treatments available, with greater expectation that treatment will achieve better outcomes. Depending on the type and stage of cancer, you may be offered one, or a combination of treatments including surgery, radiation therapy and hormone therapy.3

How quickly does prostate cancer progress?

Prostate cancer is usually slow growing, and many men with low-volume prostate cancer have no symptoms and generally live many years without the cancer spreading.3 Early detection is key to deciding which men require active treatment for a more active tumour that is classed as higher-grade or volume.3

What causes prostate cancer?

The exact cause of prostate cancer is not known. However, some factors are known to increase the risk. Prostate cancer is rare before the age of 40, and the risk increases after the age of 50.4

Risk factors can also include:4

  • Diet and lifestyle
  • A strong family history of prostate cancer
  • Specific genetic conditions, which are also associated with breast cancer and ovarian cancer in women (BRCA mutations)
Chapter 02

Diagnosing your prostate cancer

For anyone concerned about prostate cancer symptoms, we recommend you make an appointment to see your GP who can assess your symptoms.

Checking for prostate cancer generally involves a couple of different tests to check the health of the prostate. A blood test called a prostate specific antigen (PSA) test

can give an idea of whether it is likely or unlikely that you have prostate cancer. Many factors can affect the PSA, so it needs to be interpreted by an expert. You would normally be referred to a urologist for further investigation of an abnormal PSA result. A digital rectal examination (DRE) can help to confirm if your prostate feels benign or malignant, however in most instances an MRI will give a much clearer picture of whether your prostate has changes suspicious of cancer or not. The only way to confirm whether you have prostate cancer is with a prostate biopsy.4

Biopsy: During a prostate biopsy, a urologist will take small amounts of tissue from the prostate using needles guided by an ultrasound or video scope. After the biopsy, the tissue obtained is sent to a pathologist to confirm whether the cells are cancerous (malignant) or non-cancerous (benign). There are two types of prostate biopsy.4

  • Transperineal (TPUS) biopsy – the needle is inserted through the skin between the anus and the scrotum. This is the most common biopsy, and generally done under
  • Transrectal (TRUS) biopsy – the needle is inserted through the rectum, again generally done under

What to expect

We know that hearing the words, ‘you have cancer’ and coming to terms with a cancer diagnosis can be incredibly challenging – for you and your loved ones.

At GenesisCare we believe care should be focused on you, the individual, and not just the condition. Our belief is that care be available when and where you need it most and be designed to help give you the best life outcomes possible.

John's battle with prostate cancer
Chapter 03

How is cancer treated?

If you are diagnosed with prostate cancer the specialist leading your treatment may be a urologist, radiation oncologist or perhaps a medical oncologist. The group of specialists supporting your care may discuss your treatment options with other health professionals within a multidisciplinary team (MDT) meeting.

Different factors influence what treatment may be recommended for your cancer. These include:

  • The type of cancer
  • Tumour location
  • Speed of growth
  • How advanced the cancer is
  • Your age and general

At GenesisCare we are constantly challenging ourselves to design better care. We personalise care for you and your condition so treatment can involve a combination of therapies such as surgery, radiotherapy, chemotherapy, hormonal therapy, dietary changes, and other holistic care.

Deciding on your treatment

Making the decision about what cancer treatment to have can be difficult. We recommend you discuss all your options (including those suggested by your multidisciplinary team) with your specialist before starting any treatment. Further important considerations may include the location of the treatment centre, duration of treatment(s), potential side-effects, and any extra costs.

Your treatment with GenesisCare

At GenesisCare we not only focus on treating your cancer, we also take a holistic approach that cares for you as a person.

Our oncologists work with a team of medical professionals to design a personalised treatment plan that is tailored for you. Our centres are staffed with caring and highly qualified teams to provide you with the highest level of care throughout your treatment. Each step of your treatment will be closely monitored, and each member of your team will be fully informed and up to date with your treatment progress.

We provide each of the following to you:

  • Rapid access to treatment – no waiting list
  • A personalised prostate care plan, including preference of appointment times to fit your schedule
  • One oncologist managing your treatment from start to finish
  • A GenesisCare nurse will coordinate your care and offer personalised support throughout your

State of the art technology and innovative treatments

We work closely with other healthcare professionals to deliver comprehensive care to you.

Treatments we offer

Chapter 04

Radiation therapy

Radiation therapy – Radiation therapy, also called radiotherapy, kills cancer cells. It can also be used to relieve pain and discomfort from cancer that has spread.

There are many ways to have radiation therapy, but they all work in a similar way. Carefully controlled high-energy X-rays destroy or damage cancer cells. This stops them growing or spreading. Radiation therapy is usually delivered in daily intervals called ‘fractions’. This allows time between treatments for the healthy cells to repair and the cancer cells to die off.

Our prostate cancer radiation therapy treatments

Intensity Modulated Radiotherapy (IMRT): IMRT delivery enables high doses of radiation to be precisely delivered to the tumour whilst protecting normal tissues, resulting in fewer side effects.

Volumetric Modulated Arc Therapy (VMAT): This form of IMRT involves a quicker treatment delivery process resulting in each treatment being significantly shorter.

Image Guided Radiation Therapy (IGRT): IGRT uses X-rays and scans before, and during your treatment. It is used to check your position before the treatment machine is turned on. The scans show the exact shape, size, and location of the tumour. We can then make tiny adjustments to precisely target the tumour.

Stereotactic Body Radiation Therapy (SBRT): SBRT is an effective technique, enabling a high dose of radiation to be delivered to small tumours. SBRT is also delivered over a shorter period, meaning fewer sessions and treatment duration (within clinics, not necessarily in hospitals).

Low Dose Rate Brachytherapy (LDR): LDR brachytherapy is often used to treat prostate cancer. It involves permanently placing brachytherapy seeds in, or near, the tumour. The seeds continually release low-dose radiation over several months.

High Dose Rate Brachytherapy (HDR): HDR brachytherapy is given by placing temporary needles or rods into the prostate under anaesthetic, and then delivering internal radiation, avoiding dose to the surrounding tissues.

Supporting radiation therapy with spacers

Some patients may be offered the use of gel spacing as a treatment option for their radiation therapy, and this is something that your radiation oncologist will discuss with you. As the rectum sits close to the prostate, the use of a gel creates a space between the prostate and the rectum, ensuring the radiation is targeted at the prostate, to minimise the amount and to lower the chances of damage to the rectum. This may be done at the same time as the placement of fiducial markers, to provide additional guidance for your treatment.

Are there risks of radiation therapy that I should be aware of?

Side effects may arise because of the proximity of the rectum and bladder. During treatment, these symptoms are usually mild, and only occasionally moderate in intensity. There may be slowing of the urinary stream, increased frequency of needing to pass urine and a degree of stinging when passing urine. Similarly, you may pass more wind from the rectum and have some irregularity of bowel functioning and loose stools.

Side effects usually decrease within a few weeks of the treatment being completed. You will be given clear instructions on things you can do to minimise these symptoms during treatment.

Occasionally symptoms can persist more long term, and your radiation oncologist will discuss the potential long-term changes that can affect your bladder, bowel, and erectile functioning.

Chapter 05

Hormonal therapy

The majority of men undertaking prostate radiation therapy will also undertake hormonal therapy leading up to, during, and sometimes for a time after radiation therapy. This improves the outcome of prostate radiation therapy by enhancing local control, and by potentially reducing relapse.5 Your treatment team will discuss and prescribe hormone therapy where required. They will also monitor you whilst on the treatment, supporting you to manage potential side effects.

Chapter 06

Chemotherapy

Chemotherapy is medication that treats your cancer. It kills cancer cells, preventing them from dividing and spreading further.

Traditional or standard chemotherapy works by disrupting the cell cycle. Each time a new cell forms it goes through a series of phases to become mature. Traditional chemotherapy drugs target the different phases of the cell cycle. By disrupting or stopping a particular phase, a cancerous cell can no longer mature and divide and ultimately dies.

Chemotherapy is generally used to kill cancer cells in advanced prostate cancer cases when the cancer has spread outside the prostate gland. In this instance, the aim of chemotherapy is to shrink the tumour and slow its growth; it is not used to cure the cancer. By doing this, it may help to prolong the survival of advanced prostate cancer patients.6

Chemotherapy is generally given intravenously at a GenesisCare clinic as a day procedure. The number of sessions will be based on the latest scientific research and personalised to your specific cancer.

The side effects of chemotherapy may include fatigue, hair loss, weight loss, nausea, vomiting, loss of appetite, changes in nails, low energy and changes in blood counts increasing the risk of infection or bleeding and numbness or tingling in the hands or feet.6

Chapter 07

Theranostics

Theranostics is a treatment that combines diagnostic imaging with radiation treatment; identifying if target receptors are present on cancer cells, and then delivering precision radiation treatment to target these receptors.

Theranostics can be used to treat cancers that have spread (metastasised), or where cancer is advanced and/or has not responded to other treatments.

While in the future theranostics may be used for different cancers, to date most experience and success has been in metastatic prostate cancer and neuroendocrine tumours.

How theranostics works

Theranostics uses PET scan imaging to see if specific targets, known as tumour receptors, are present on tumour cells.

If these targets are present and visible on the scan, a radioactive drug is used to treat the tumours. The drug is given as an injection and selectively targets the tumour cells while avoiding healthy areas. Most of the radioactive drug that doesn’t reach the target is quickly passed out of the body.

It’s important to note that at this time, limited clinical trial evidence is available for the use of theranostics in prostate cancer and the treatment has not yet been reviewed by the Australian Medicines Regulator – The Therapeutic Goods Administration (TGA).

Access to treatment is authorised via the TGA Special Access Scheme, a scheme for compassionate access to medicines before registration. It is an out-of-pocket expense for patients as theranostics is not currently covered by Medicare or private health insurance.

Treatment for advanced prostate cancer

Lutetium-177 PSMA therapy (Lu-PSMA) is a new treatment for advanced prostate cancer. It delivers high doses of targeted radiation to the cancer sites. It is used to specifically target the abnormal cells while limiting damage to surrounding healthy tissue.

GenesisCare offer theranostics treatment in five centres in Australia, as listed below:

  • Waratah Private Hospital, Sydney, NSW
  • North Shore Private Hospital, Sydney, NSW
  • John Flynn Private Hospital, Gold Coast, QLD
  • Chermside Medical Complex, Brisbane, QLD
  • Hollywood Private Hospital, Perth, WA
Chapter 08

Emotional support

A cancer diagnosis is life changing. Even before you come to GenesisCare you may experience a wave of emotions. Our care team know your name and get to know who you are as a person. We don’t want you to feel alone when you’re at GenesisCare. We believe it is the details that make a difference.

Your nursing team and radiation oncology team are here to support you before, during, and after your prostate cancer treatment. We are here to provide you with the support you need which may include a psychologist, exercise physiologist, physiotherapist, and dietician.

Please contact your local GenesisCare centre for more details on services available. View a list of our centres here.

Helpful services

We understand that you may still have some unanswered questions, and we are here to help you in any way we can.

Feel free to contact a staff member at one of our centres, or additional resources with further information to help you include:

Targeting Cancer

Prostate Cancer Foundation of Australia

Cancer Council Australia

References

  1. Prostate Cancer Foundation Australia. What you need to know about prostate Available at: https://www.prostate.org.au/media/195388/brochure_1_what_you_need_to_know_about_prostate_cancer.pdf. Accessed on: 11/05/21.
  2. Prostate Cancer Foundation of Australia. Advanced and metastatic prostate cancer – what is it? Available at: https://www.prostate.org.au/news-media/news/advanced-and-metastatic-prostate-cancer-what-is-it/. Accessed on: 11/05/21.
  3. Australian Urology Associates. Prostate cancer. Available at: https://aua.com.au/urological-conditions-and-our-expertiseurological-cancersprostate-cancer/.Accessed on: 11/05/21.
  4. Cancer Council Australia. Prostate Cancer. Available at: https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer/.Accessed on: 12/05/21.
  5. Prostate Cancer Foundation of Australia. Understanding hormone therapy for prostate cancer. Available at: https://www.prostate.org.au/media/468683/understanding-hormone-therapy.pdfAccessed on: 12/05/21.
  6. Cancer Council Victoria. Prostate Cancer. Available at: https://www.cancervic.org.au/cancer-information/types-of-cancer/prostate_cancer/treatment_for_prostate_cancer.html Accessed on: 12/05/21.