Establish intent of treatment

• Curative
• Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation

If curative treatment is considered, men should be strongly encouraged to have an opinion from both a radiation oncologist and urologist to make a fully informed decision about their preferred treatment option.

Care and treatment of localised or locally advanced prostate cancer

• Watchful waiting: some patients (e.g. those with other health issues who are not expected to live more than 7 years) should be regularly monitored and symptoms treated if they arise.
• Active surveillance: most men with low-risk prostate cancer should be regularly monitored for signs of disease progression so curative treatment can be initiated if necessary.
• Surgery (radical prostatectomy): may benefit some patients with localised or locally advanced prostate cancer and at least a 10-year life expectancy.
• Radiation therapy (by external beam radiation therapy and/or brachytherapy) may benefit patients with:
  • localised/locally advanced prostate cancer who have at least a 10-year life expectancy or have symptomatic disease
  • locally advanced disease who may benefit from multimodal therapy
  • a rising/persistent PSA or established local recurrence without evidence of metastatic disease following radical prostatectomy
  • those who have limited bone metastases.

Treatment of advanced or metastatic prostate cancer

• Androgen deprivation therapy (ADT) is the standard treatment. The timing of starting ADT is often related to balancing the risk of side effects against the unwanted effects of the disease.
• Other systemic therapy may benefit patients with metastatic disease, cytotoxic chemotherapy, novel androgen receptor signalling inhibitors, bisphosphonates and RANK ligand inhibitors.

Palliative care

Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Surgery should be conducted /radiation therapy begin within 3 months of diagnosis or within 4 weeks if significant local symptoms are present.

ADT or other systemic therapy: Treatment should begin within 3 months of the diagnosis if asymptomatic, or within 4 weeks if symptomatic or extensive metastatic disease is present on imaging.