By John Stewart
Doctors and patients are concerned that people with prostate cancer are not being properly informed of their treatment options, leading many to elect to undergo costly surgeries.
There are major cost differences between the two main treatments, with surgery costing more than $20,000 in private hospitals, while radiation therapy is free in public hospitals.
Patients and radiologists are concerned urologists, who perform the surgery, are not giving patients the full information they need to choose their treatment.
Last year, 69-year-old David Tuddenham was diagnosed with an aggressive prostate cancer.
“It was found that the whole prostate was covered in cancer and the rating on the cancer was between eight and nine, with 10 being the top end of the scale,” he said.
His doctor referred him to a urologist who recommended immediate surgery, but the surgery’s $22,000 price tag came as a shock to the pensioner.
“Truthfully I nearly fell out of the chair,” he said.
“I just could not believe $22,000 for an operation and being a pensioner I don’t have a lot of money and if I was to take that from my superannuation it would leave me with virtually nothing.”
Mr Tuddenham does not own a home and retired last week.
He and his wife live on the age pension and have $70,000 in superannuation savings.
Mr Tuddenham said it was not until after he told the surgeon he could not afford the operation that he was informed he could receive free radiotherapy in a public hospital.
“I wasn’t given the choice to start with. It was only after I couldn’t afford the operation that … it was ‘go to West Mead’,” he said.
Radiation oncologist Sandra Turner from West Mead Hospital said many of her patients were not told about the option of free radiotherapy.
“As somebody who has been treating prostate cancer for 20 years, that’s what we see every day,” Associate Professor Turner said.
“A lot of men are not fully informed about their options for treatment.
“I would say men are not in a position to choose their treatment until they have actually heard their treatment options from the experts involved and that is not happening across the board in Australia.”
A recent study of over 2,000 Australian prostate cancer patients, published in the Journal of Medical Imaging and Radiation Oncology, found no major difference in cure rates between each treatment.
Despite this, most patients still choose surgery.
Associate Professor Turner told Lateline there was a systematic problem.
She said surgeons were acting as gatekeepers in the prostate cancer treatment process and it had been too long since someone had spoken out.
“Men can be very influenced by the way that surgeons present information,” she said.
National data on prostate cancer treatment is limited because of Australia’s different state and territory health systems.
However, Victoria has a Prostate Cancer Registry and the most accurate data available about which treatment patients are choosing.
Victorian data from 2014 showed that 48 per cent of men in the state with prostate cancer chose surgery compared with just 18 per cent who chose radiation therapy.
“Something’s going wrong,” Associate Professor Turner said.
“We’ve got two very good treatments. We’ve got at least three to four-fold more patients opting for surgery and there’s absolutely no reason for that.”
Urological Society of Australia and New Zealand president Mark Frydenberg told Lateline surgeons regularly had meetings with radiation oncologists.
“Virtually all referrals that radiation oncologists get for treating prostate cancer actually come from urologists,” Associate Professor Frydenberg said.
“We can’t force patients to go visit other specialists, just like there are some people that are quite adamant they want radiation therapy and have no interest in having surgery.”
There are various potential downsides to both forms of treatment.
Surgery can cause incontinence and impotence, while radiotherapy can lead to problems with the bowel.
Mr Tuddenham will start radiation therapy treatment at West Mead Hospital next week.
“The choice is the most important thing. If you’ve got a choice, you can sit down and actually look at it and run through and think ‘Which way do I go? What’s the best for me and my family?'” he said.
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