Prostate cancer

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Unit 613

July 2024

Prostate cancer

The purpose of this activity is to provide you with an understanding of the diagnosis, assessment, investigation and management of prostate cancer, including the palliative care approach to people with advanced prostate cancer.

In Australia, prostate cancer is the most commonly diagnosed cancer in men (excluding non-melanoma skin cancers) and overall, with an estimated 25,500 cases in 2023. While prostate cancer has a very high survival rate, it is still responsible for a significant number of deaths – an estimated 3743 in 2023. The use of prostate specific antigen blood tests as a screening tool for prostate cancer in asymptomatic men remains widespread in Australian general practice despite uncertainties around its benefits.

The evolving landscape of prostate cancer management underscores the pivotal role of general practitioners in the diagnosis and management of patients with prostate cancer. The introduction of innovative imaging techniques has changed the approach to the management of abnormal prostate specific antigen levels, offering more precise diagnostics and individualised treatment plans. Advances in surgical, radiation and medical oncological treatments have also contributed to improved outcomes for patients.

General practitioners play a critical role in prostate cancer management as they remain at the heart of shared decision making with patients, balancing the benefits and risks of prostate cancer testing and choosing between different treatment options. Care coordination and navigation are important functions of general practitioners to ensure that patients benefit from multidisciplinary care expertise and are protected from financial toxicity. As more people live with or after treatment for prostate cancer, the role of the general practitioner extends beyond the initial testing phase to encompass a holistic management approach throughout the patient’s journey, including shared care arrangements with cancer specialist services.

Learning outcomes

At the end of this activity, participants will be able to:

  • describe the key considerations in shared decision making with asymptomatic, low-risk patients regarding prostate cancer screening
  • outline the initial assessment and management of men presenting with lower urinary tract symptoms and men with elevated prostate specific antigen test results
  • compare and contrast the different management options available to men with low-grade and high-grade prostate cancer
  • identify members of the multi-disciplinary care team involved in prostate cancer care and describe their roles
  • describe the assessment and management of patients presenting with complications or side effects of prostate cancer treatment
  • outline the principles in palliative care for patients with advanced prostate cancer.

Case studies

Below is a list of the case studies found in this month's edition of check. To see how these case studies unfold and gain valuable insights into this months topic, log into gplearning to complete the course.

Dan, aged 48 years, has come to see you about problems with pains in his knees. You have known him for a few years and have seen him regularly for various minor ailments and sporting injuries. You could not find anything abnormal on examining him, but decided to order some blood tests for reassurance and suggested checking his lipid levels too, as they have not been checked before.

Pio, aged 62 years, has a follow-up visit with you after it was noted that he had an elevated prostate specific antigen level of 6.3 ng/mL on a recent routine annual health check organised by another practitioner in the clinic. He has no significant lower urinary tract symptoms and no symptoms suggestive of a urinary tract infection. His father had some ‘prostate issues’ aged in his late 70s and required a transurethral resection of the prostate, but it is not clear if there was ever any diagnosis of prostate cancer. There is no family history of ovarian or breast cancer in his female relatives and no history of colorectal cancer. 

Bruce, aged 75 years, presents to you complaining of poor sleep. He reports progressively worsening sleep quality and daytime fatigue. He notes he has been regularly getting up 4–5 times a night to pass urine despite cutting down on alcohol and caffeine. He has no prior issues with bladder function and past screening has shown no elevated prostate specific antigen levels. His medical history includes hypertension and mild hypercholesterolaemia, both controlled with medication.

Bob comes to your clinic asking for a renewal of his antihypertensive prescription. While you are reviewing his past medical history and previous prescriptions, he complains of the expense of medications today, notes how expensive incontinence pads are and how many he seems to be going through.

Lars, aged 83 years, is approaching the end of his life due to advanced metastatic castration-resistant prostate cancer. You receive a telephone call from his son Jan telling you that Lars would like to have end-of-life care at home. 

CPD

This unit of check is approved for 10 hours of CPD activity (two hours per case). The 10 hours, when completed, including the online questions, comprise five hours’ Educational Activities and five hours’ Reviewing Performance.
 
Educational
Activities
5
hours
Measuring
Outcomes
0
hours
Reviewing
Performance
5
hours

Complete check online

To enroll in this check unit online: 

  1. Log into myCPD home page
  2. Select 'Browse' and search for 836400
  3. Select the course and register

Please note: If you're not a member of the RACGP or don't have a check subscription, click here.

TOPICS

Men's healthPalliative care

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