Prostate cancer is one of the most commonly diagnosed malignancies in men and is increasingly being seen in younger patients.

In the lead up to Prostate Cancer Awareness Month in September, Melbourne-based urologist and academic Professor Shomik Sengupta says innovation, education and communication are key to tackling the disease.

Prostate cancer awareness and engagement

While most men diagnosed with prostate cancer are aged over 50, Professor Sengupta and his colleagues have seen an uptick in the number of cases in men aged in their 40s.

“To see serious cancer starting to appear more frequently in young men without a strong family history of the disease is a concern to us,” Professor Sengupta says.

“While we can’t be certain why this is happening, I think we're all conscious modern lifestyle factors like diet, stress and lack of exercise are all probably harmful for a range of illnesses, including cancers of any kind—not just prostate cancer.”

As prostate cancer can appear without symptoms, Professor Sengupta says highlighting the value of testing, while also ensuring General Practitioners (GPs) are informed of the benefits and risks, is crucial to ensuring cancers are identified at an early stage.

“We can do better in terms of the awareness of prostate cancer and making sure that men consider getting the test done, and that’s by engaging with GPs and the wider community.”

Professor Sengupta has developed a website   to provide guidance to GPs and the wider community on testing and treatments.

The Prostate Cancer Foundation of Australia is also currently updating its guidelines for testing with input from a wide range of specialties and medical practitioners, including GPs, oncologists, urologists and patient representatives.

Advances in surgical practice

Treatment options for prostate cancer have improved rapidly in recent years and patients have more choice than ever.

Major advances have been made in the use of robotic technology during surgery.

“I’m not sure we can any longer call it a recent advance, but the most significant change has been assisted laparoscopic operations. These have  really revolutionised the surgical approach to many of the cancers, but particularly prostate cancer,” Professor Sengupta says.

“Traditional open surgery for prostate cancer can still be a good operation when done well by an experienced surgeon. However, the location of the prostate and shape of the male   pelvis means that it is quite a difficult, technical procedure.”

Minimally invasive robotic and laparoscopic approaches offer benefits for the surgeon, the healthcare system (in that it is easier and cheaper once the equipment has been purchased), and the patient.

“Most importantly, it enhances the recovery period as there is less pain, less blood loss so the patient can bounce back quicker and suffer fewer complications.”

Another important consideration in prostate cancer treatment is the availability and accessibility of non-surgical options like radiation therapy, and the recent development of focal treatment and new treatment modalities, which aim to reduce the risk of side effects.

These often require a more holistic approach, with surgeons and radiation oncologists working alongside other specialists and health care professionals.

“There’s been a real explosion of additional treatment options available for patients with prostate cancer whose cancer has spread beyond their prostate.

“Now, in addition to traditionally used hormonal therapies, we have what’s called novel hormonal agents as well as other treatments that are specifically targeted to attack prostate cancer.

“Some of these treatments—representing so-called personalised or precision medicine—are being given to patients based on particular characteristics of their cancer, and that’s very exciting and interesting.”

Clinical decision-making and patient communications

The availability of a range of treatments for prostate cancer means patients need to be closely involved in decision-making around their care. 

The fact that the urgency to treat prostate cancer is rarely immediate means that there is usually time to facilitate this decision-making with adequate information.

Patients also have access to abundant information online, which can be a mixed blessing due to the prevalence of misinformation or commercial influences.

Professor Sengupta says these factors make communication critical in helping patients make informed decisions about their treatment.

He says prostate cancer support nurses can play a vital role in providing accurate and reliable information and support to patients as they navigate the healthcare system. 

“Sometimes patients are left not fully understanding—What do I have? What does this mean? What treatments do I need? What are the benefits of the treatment? What are the potential negatives?

“Knowledge empowers patients to take more responsibility for their treatment and helps them to cope and manage the problems on the occasions when the treatment doesn’t go well.”
Professor Sengupta says rather than having to convince patients to adopt innovative treatments like robotic surgery, it can sometimes be difficult to explain these approaches are not suitable for everyone.

“Sometimes when there is something new that’s around, a patient will hear about it or have it recommended by someone, and then they’re really keen on it.

“In some instances, that might be the right thing, but not always; it’s all about giving the patient the information and explain it thoroughly.”

Career journey and professional insights

One of the highlights of Professor Sengupta’s professional journey has been the opportunity to work at the Mayo Clinic in the United States.

He valued the huge volume of cases, inspiring colleagues, and plentiful resources available at the clinic.

“In one year, the number of prostate cancer surgeries, for example, was more than what I’d done in the preceding three years of training, and you get to learn from the world’s leading experts.

“It’s just an amazing experience, and you bring back some of the things you learnt specifically—such as surgical techniques. But more importantly, you bring back general approaches to providing care that you implement here.” 

Education and research

Professor Sengupta believes strongly in continuing education for surgeons at all stages to embrace new technologies and treatments.

“I think whatever specialty we work in, we owe it to patients, but also to ourselves, to keep up with the latest advances.

“In days gone by, you’d have to read about them in a journal or travel to attend a conference. Now, information is at our fingertips through a variety of electronic resources and it’s easier to keep in touch with what’s happening.”

Professor Sengupta undertakes collaborative research in his role as Professor of Surgery at Monash University’s Eastern Health Clinical School and he is also passionate about the benefits of surgeons actively participating in research.

“We're very proud that in Australia we do world-leading medical research and lots of developments in prostate cancer have really come about from here and been exported internationally.”

He would like the Royal Australasian College of Surgeons to take an active role in encouraging young surgeons to combine clinical practice with research, fostering innovation.

“Sometimes surgical training and surgical practise are so demanding they can leave relatively little room for research, so from a College perspective, I’d like to see more done to support that process and enable these to be melded together.

“It might mean designing a pathway where young surgeons do their training and perhaps a year or two of research or a higher degree.

“The more we can do to formally facilitate that and develop the next generation of surgeon scientists, the better.” 

Personal reflections

Juggling medical practice, academic research and other professional priorities with the opportunity to relax can be challenging, but Professor Sengupta finds that music provides him an important creative outlet.

He plays the Indian drums and enjoys both watching and playing sport—cricket in particular—and travel.

“I try to quarantine free time and not to do too much work on the weekend and in the evenings,” he says.

“You’ve only got one life so you have to take some time to do the things you enjoy, and if you do, then you come back refreshed and with energy for the hard work.”