Are Australian men receiving the best care for prostate cancer from their health professionals?

The short answer is no, but they soon can be because now we have the means.

Tens of millions of dollars are invested towards saving lives and helping more men survive prostate cancer — delivering research breakthroughs and new medicines. Treatments for prostate cancer have dramatically altered. Robot-assisted surgeries, refined methods of radiation therapy, a range of different hormone-blocking treatments, new chemotherapy regimens, and personalised medicine based on genomic profiling are now available. Survival rates for prostate cancer have soared. Over 95% of men are likely to survive at least five years post-diagnosis.

Yet, with all this medical intervention, being a prostate cancer survivor brings many men and their partners and their families a level of psychological distress that compromises both their mental and physical health. Many men will walk out of their urologist’s rooms after a diagnosis of prostate cancer into a world of private hurt and hopelessness. Lost, confused, with a head full of statistics, they will strive to cope with a major life stress that cuts to the very core of their beliefs about themselves and their place in the world. They will likely do that without obviously seeking help or even admitting they are under that much stress. “She’ll be right mate”. They will try to ‘man up’; to make sense of how to proceed using strategies and ideas from their life experience. Some will find it harder than others — too many in fact. Compared with men in the general population, men with prostate cancer are twice as likely to experience depression and three times more likely to experience anxiety. The risk of suicide for these men is greatest within the first year after diagnosis.

That’s a tragedy. But it’s also not good medicine. Such significant levels of psychological distress harm a man’s ability to navigate the complex treatment journey required for prostate cancer survivorship. It can compromise their physical health, their decision-making, and their ability to effectively use patient support networks, including those most commonly referred by their medical team.

What then is the value of a ‘successful’ surgical, drug, or radiation treatment outcome if the patient is unable to properly process what this success means to their day-to-day survivorship and how they will live with their disease?

In 2019, after extensive collaboration between Australian medical, nursing and research leaders, the Prostate Cancer Foundation of Australia (PCFA) and the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Prostate Cancer Survivorship released a monograph and position statement to address psychosocial care for men with prostate cancer.

The statement recommended that: “After the diagnosis of prostate cancer and regularly through treatment and surveillance, men who have been diagnosed should be screened for distress, and their psychological and quality of life concerns should be explored. Men who have high distress or need for support should be referred to evidence‐based intervention matched to their individual needs and preferences for support.”

This statement was endorsed by:

  • The Urological Society of Australia and New Zealand,
  • Australia and New Zealand Urological Nursing Society,
  • Royal Australian and New Zealand College of Radiologists,
  • Medical Oncology Group of Australia,
  • Australia and New Zealand Urogenital and Prostate Cancer Trials Group,
  • European Association of Urology Nurses,
  • and universities across Australia.

It was announced as the game-changer it is: “This is the next frontier in innovative care … to restore hope in a future free from both physical and psychological pain.” The initiative was expected to result in “much greater regard for each man’s right to enjoy a satisfactory quality of life.” Yet, in Australia in 2022, despite routine medical follow-up, many men with prostate cancer do not receive regular distress screening and psychological intervention in a timely manner, if at all.

This month, another edition of the monograph and statement will reiterate that psychological care is an essential part of best practice prostate cancer survivorship care. This time around though, health professionals finally have access to a psychological intervention designed precisely to address the need for regular distress screening and easy access to a tailored stepped care model approach for better prostate cancer survivorship.

In a world-first, Australia’s leading psycho-oncology and health psychology researchers have developed a guide for a wide range of health professionals on how to incorporate effective psychological support in the care they deliver to men with prostate cancer. It represents best practice in prostate cancer survivorship, and indeed, for cancer survivorship in general. Patient-centred, it makes use of a comprehensive knowledge base of psychological care and cancer control.

Its unique approach empowers the patient as a survivor, placing the man and his family at the centre of care throughout their treatment journey. The guide encourages oncology care coordination so that the man receives the best care possible in the right place at the right time. It allows for cost-effective support and a clear referral pathway for more specialist care through distress screening.

The guide makes use of the Facing the Tiger psychological care approach, developed by Professor Suzanne Chambers, who has worked with men with prostate cancer for many years and is a recognised world leader in the psychology of prostate cancer. This approach allows health professionals to support men with mild (or hidden) distress levels about their cancer diagnosis and treatment by simply providing them with a copy of a slim self-support book. Follow-up with a low-intensity care intervention for moderate levels of stress by nursing or allied healthcare workers can be provided through guided intervention sessions tailored to the needs of the patient. Referral to specialised care can then be made from information and assessments gathered with help from these sessions.

Embedding awareness, use, and understanding of this resource within prostate cancer treatment teams from diagnosis through to treatment or watchful waiting means Australian men will receive the best of care for prostate cancer. So just do it. Do it now.

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