Skip to Content

A word from the Principal Medical Adviser

< Previous | Table of Contents | Next >

Dr Ian Gardner

Prof Ian R Gardner
Principal Medical Adviser
Department of Veterans' Affairs

Get good advice before having prostate cancer surgery

In recent months, I have been contacted by middle-aged veterans worried about the very common, lifelong implications of their planned surgery for prostate cancer.

These men were fit, well and sexually active and, while wanting to be treated for their prostate cancer, were very concerned about the risks of surgery, including the almost unavoidable side effects of permanent impotence and long-term urinary incontinence.

In every case, I asked the veteran whether they had fully discussed all the treatment options with their GP, and whether they had obtained an independent second opinion from an appropriate specialist, such as a radiation oncologist, who had no financial interest in them having surgery.

Alarmingly, very few had been told of any treatment options other than immediate surgery. And in the rare case where the veteran had asked the urological surgeon to whom they’d been referred about other options, such as localised radiation treatment, they reported that they’d been told in effect that ‘if you have radiation treatment then you won’t be able to subsequently have surgery’. This statement is 100 per cent wrong!

In most men, prostate cancer is a very slow-growing condition that is strongly associated with age. There are many causes of prostate cancer including: certain genetic factors such as the BRCA2 gene (the same gene associated with breast cancer); family history; alcohol consumption; smoking; obesity; high animal fat consumption; and exposure to some chemicals such as dioxins.

Many prostate cancers do not need active treatment. In fact, ‘watchful waiting’ has five-year clinical outcomes that are just as good as many active treatments for men with cancer that remains within the prostate gland.

However, there are more aggressive prostate cancers that definitely DO need active treatment. Treatments can include: hormonal treatment (such as androgen deprivation therapy); definitive external beam radiotherapy; brachytherapy (locally implanted ‘seed’ pellets of radiation); and, of course, surgery for the removal of the prostate.

But prior to embarking on any of these treatments, I would strongly recommend that men and the people who love them ensure they get advice from their GP regarding all the options and that they get at least two specialist opinions – including from a nonsurgical specialist. Only then will the veteran and his partner be able to make a fully informed decision as to what treatment (if any) is right for him at that time.

In addition to the issue of treatment is that of diagnosis. The PSA blood test is a commonly used method of detecting the possible presence of cancer in the prostate. However, it is not entirely reliable. I encourage you to discuss with your GP the various additional means of diagnosing the condition. A magnetic resonance imaging (MRI) scan, for instance, is an effective way of identifying whether and precisely where cancer is present. This information can also be of use for subsequent biopsies as well as treatments.

There are some excellent evidence-based internet resources that may help veterans research all their treatment options and ensure they ask the right questions of their treating doctors.

Australian websites include eviQ Cancer Treatments Online. Full access to this site requires free registration, and includes information for treatment providers, patients and carers. However, an excellent two-page pamphlet entitled ‘Prostate Cancer Treatment Options’ can be downloaded from this website without registration.

Another very good cancer information source is the NSW Cancer Institute website.

There’s also the Faculty of Radiation Oncology’s ‘Targeting Cancer’ website, which includes information about treatment of a variety of cancers (including prostate) with radiation. Most of the radiation oncology services in Australia are provided through the public health system, so there’s little direct financial benefit to these specialists.

See also the Prostate Cancer Foundation of Australia website, which focuses mainly on the surgical treatment of prostate cancer.

Finally, it may be difficult in some parts of Australia to find treating specialists who will accept a DVA Health Card as full payment for prostate cancer treatment, so it is important to ask around. The fees charged for prostate surgery in Australia vary from about $3,500 to nearly $25,000! There is no evidence that paying a higher fee will result in better surgery or outcomes for prostate surgery.

It is critically important to find out well in advance of any planned surgical treatment whether your treatment provider will accept your DVA Health Card as full payment for the proposed surgery, otherwise you may be significantly out of pocket. DVA does have limited scope to consider higher than usual fees through our Prior Approval process, but this is rarely necessary and dependent on there being additional clinical needs that justify the higher fees.

The relevant form is D1328, which your treatment provider should complete and submit to DVA. They can access it on the DVA website.

DVA can also arrange free transport to the nearest appropriate treatment provider if one isn’t available to you locally.

In summary, prior to undergoing any major surgery such as prostate cancer surgery, make sure that you discuss fully with your treating doctors all of the possible treatment options to identify the best treatment for your needs. It is your right to ask for a second specialist opinion – and make sure that the person providing this opinion is completely independent and has no direct financial interests in the proposed treatment.

< Previous | Table of Contents | Next >

Average: 3.7 (15 votes)