Diagnosis and staging

The following tests may be performed to confirm a diagnosis:

• DRE (prior to biopsy)
• multiparametric MRI
• systematic and/or targeted prostate biopsy.

Implications of both a positive and negative biopsy result should be discussed with the patient before the biopsy. A prostate biopsy should not be offered on the basis of serum PSA level alone.

Staging investigations in patients with clinically localised disease should be based on their risk of metastatic spread (Gleason score, clinical stage, PSA) and provisional treatment intent. Tests may include:

• DRE assessment to evaluate T-stage
• CT abdomen-pelvis and bone scan (PSMA-PET/CT has been shown to have greater accuracy than conventional imaging for high-risk prostate cancers for assessing nodal or distant metastatic disease).

Genetic testing

For detailed information and referral guidelines for prostate cancer risk assessment and consideration of genetic testing, refer to the Royal Australian College of General Practitioners 2019 Genomics in general practice.

Treatment planning

The multidisciplinary team should discuss all newly diagnosed patients with prostate cancer before starting treatment and as soon as possible after the initial specialist consultation.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from multidisciplinary meetings (MDMs).

Checklist

Timeframe

Investigations should be completed within 4 weeks of the initial specialist appointment.