Prostate cancer: are men making informed choices about their treatment?

Older Australians with prostate cancer are twice as likely to receive surgery over radiotherapy, despite similar survival rates, according to new research from our 45 and Up Study.

Research snapshot:

  • Men with prostate cancer are twice as likely to receive surgery over radiotherapy, despite similar survival rates for the two interventions
  • Those with private health insurance were more likely to receive invasive surgery, compared with those without insurance
  • Fewer than one in seven men were referred to a radiation oncologist prior to prostatectomy
  • Education programs about treatment options are needed to better inform patients, caregivers and their physicians

Prostate cancer is the most frequently diagnosed cancer in Australian men, with over 19,000 cases diagnosed in 2019 alone. Treatment options are usually radical prostatectomy where the prostate gland and surrounding tissue is removed, or external beam radiotherapy (EBRT).

Australian researchers are calling for a review to prostate cancer treatment.

Both treatments have similar survival rates, but distinctly different side effects and costs, with surgery linked to higher rates of urinary incontinence and sexual dysfunction, and generally higher out-of-pocket costs. Radiotherapy is a much less invasive intervention but still has potential side effects, such as rectal bleeding.

Until now, it’s been unclear who is receiving which types of treatment and why. Dr Mei Ling Yap, a radiation oncologist, was keen to take up the unique opportunity to use 45 and Up Study data to investigate why prostate cancer patients were receiving different treatments.

“I felt it was important to shed light on this issue,” she explains. “Prostate cancer is the most common cancer in NSW and its management options, while similar in cure rates, are very different with regards to side effects and financial costs. For these reasons, men should have equitable access to all management options, including radiotherapy and I hoped that our study could help highlight issues that need to be addressed in order to achieve this.”

Dr Yap and her co-researchers analysed 4,000 NSW men participating in the 45 and Up Study who were diagnosed with prostate cancer between 2006 and 2013. They found that men were twice as likely to receive surgery to remove their prostate, over radiotherapy to treat their cancer. A key reason for this may be that only one in seven patients were referred to a radiation oncologist and therefore they may not have received all the information they needed for an informed choice.

Critically, those with private health insurance were more likely to undergo surgery, while patients without insurance more often received EBRT. A few other influencing factors were at play: patients with partners tended to have surgery, suggesting that spouses or caregivers may be weighing in on preferred treatment choice. Also, patients who lived further than 100 kilometres from a radiotherapy centre were less likely to have EBRT, suggesting access problems.

Dr Yap says she hopes the findings will lead to education initiatives, advocacy and policy review around equitable access to all management options, including radiotherapy, for prostate cancer patients.

“If men with prostate cancer are able to access all management options and are referred to all relevant specialists to discuss the options, this will lead to patients having the ability to choose the treatment that is most likely to result in the best quality of life for them.”

Read the full study here.

The 45 and Up Study is the largest ongoing study of healthy ageing in the Southern Hemisphere. It’s made possible thanks to over 250,000 dedicated participants across NSW, who are kindly sharing their health information with us to help create a healthier Australia.

Find out how the Study is powering other research into mental health and cancer.

If you’d like to stay up-to-date on the study, sign up for our newsletter or explore more of the research here.

Editor’s note: In an article published on January 18, 2022, this research was ranked by the Medical Journal of Australia as among the 10 best research papers of 2021.