Prostate cancer survival at ‘all-time high’ – but is it a happy life?

Matt Woodley

14/11/2019 2:04:47 PM

Life goes on but its quality is often diminished, according to a new study.

Quality of life post prostate cancer.
A recent study has found many men's quality of life is diminished after experiencing prostate cancer.

According to a new 10-year study, a significant number of Australian men affected by prostate cancer have lower life satisfaction and experience long-term impairments to quality of life as a result of the disease.
The study, the first of its kind to track men for a decade following a prostate cancer diagnosis, has prompted researchers to call for urgent action by health providers and policy makers.
Associate Professor Nicholas Ralph, Cancer Council Queensland and University of Southern Queensland researcher, has led these calls. He said more needs to be done to support the more than 200,000 Australian prostate cancer survivors.
‘Although men with prostate cancer are living longer, they are not necessarily living well, with symptom burden increasing and quality of life declining over time,’ he said.
‘We found that 35–40% of men experience poorer physical and mental quality of life outcomes and life satisfaction 10 years after the diagnosis and treatment of prostate cancer.
‘These symptoms were more pronounced for men with multiple conditions, those treated with androgen deprivation therapy, and those from socioeconomic disadvantage.’
Around one in six Australian men will be diagnosed with prostate cancer in their lifetime. Melbourne University Herman Professor of Primary Care Cancer Research Jon Emery told newsGP this cancer should be considered a chronic condition that can be managed, at least in part, in primary care.
‘We know that men with prostate cancer experience a range of effects from their disease and its treatment, including depression, anxiety, urinary incontinence, and impairments in sexual and bowel function,’ he said.
‘GPs have an important role in identifying these problems and offering treatment or referral to specific services to help manage these issues, including, for example, to psychologists, exercise physiologists, and incontinence services.’
The Prostate Cancer Foundation of Australia (PCFA) recently released the Australian-first Position statement on screening for distress and psychosocial care for men with prostate cancer, which aims to address and raise awareness of the daily struggles – physical and psychological – that accompany a diagnosis.
While 95% of men are likely to survive at least five years after diagnosis, one in four will subsequently experience anxiety and up to one in five report depression.
PCFA Chief Executive Professor Jeff Dunn believes health service providers and policy makers need to prioritise and fund new models of care to help transform the way Australia manages prostate cancer.
‘For most men, a diagnosis of prostate cancer generates strong feelings and a life permanently changed. Few men have access to specialised psychosocial care to help manage the symptoms and side effects,’ he said.
‘With survival rates at an all-time high, we must ensure that those who are living with the disease are living well, by restoring hope in a future free from both physical and psychological pain.
‘Ultimately, this means we need to improve community awareness of the daily struggles that accompany prostate cancer survivorship and ensure life-changing support services are routinely available.’
The PCFA position statement recommends clinicians and health professionals apply a new comprehensive model of care that screens for distress, so psychological and quality-of-life concerns can be identified and managed – an initiative Professor Emery supports.
‘The PCFA prostate cancer distress screening tool is a relatively quick tool that could be administered within the context of a chronic disease management plan in general practice, either by a GP or practice nurse,’ he said.
‘It would help identify a range of supportive care needs which may otherwise go unnoticed.’
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Dr Peter Robert Bradley   15/11/2019 9:23:58 AM

Even before dealing with the aftermath of treatment, we need to reassess the actual mode of treatment. It has been recognised for some time that those treated without surgical removal, (ie EBR in some form, and now newer alternatives like trans-rectal U/S are coming on stream), are generally happier with their outcome and post treatment life. So, being a little more circumspect re the radical prostatectomy option, robotic or not, needs to be considered. Then there is the specific mention of androgen deprivation therapy as a negative. Definitely something that needs a re-think. I can speak from personal experience re the above points, having elected in my own case to have stereotactic enhanced EBR, and I also declined the ADT, and I literally flew through the treatments, didn't miss a single surgery session, and there really has been little or no aftermath of concern. So, yes, there definitely needs to be a re-think on the accepted approach to management.