Prostate Cancer Awareness
The Australian Institute of Health and Welfare estimates that the risk of a male being diagnosed with prostate cancer by his 85th birthday will be 1 in 6. It is the second most common cancer in Australian men and is accountable for a third of cancer-related deaths in Australia.
Health Deal takes a look at the signs, symptoms and treatment options of prostate cancer through private health insurance and Medicare.
What is Prostate Cancer?
The prostate is a walnut-sized gland in men that lies between the bladder and the penis, just in front of the rectum. The gland surrounds the urethra, which is the tube used to urinate and ejaculate.
Prostate cancer occurs when abnormal cells in the gland grow at a rapid pace, resulting in the formation of a malignant tumour.
Note that sometimes prostate cancer can grow at a languid rate and not cause major problems. But, everybody differs greatly and cancer can develop rapidly in some men more than others, and when this is left untreated, the cancer has a higher chance of invading distant parts of the body, in particular, the lymph nodes and bones.
Advanced prostate cancer has two stages:
- Locally advanced– this is where cancer has spread outside of the prostate to nearby parts of the body
- Metastatic-this occurs when cancer has spread to distant parts of the body.
Who is at risk of Prostate Cancer?
Prostate cancer is usually associated with age, but this does not mean that it only occurs in older men.
Some studies have shown that men of African or Caribbean descent are 2.5 times more likely to develop prostate cancer. So where men who are 50 or older should start discussing PSA testing with their GP’s, men of African or Caribbean descent should begin having those discussions with their doctors at around 45.
Detecting Prostate Cancer
Some men will experience differences in urinary or sexual function that may indicate the existence of prostate cancer.
However, not everyone experiences these symptoms and oftentimes the first signs of PC are detected by a doctor during a general check-up.
Common Signs and Symptoms of Prostate Cancer
- Needing to urinate frequently, particularly at night
- Finding difficulty to begin urinating
- Having a weak or interrupted urine flow
- Painful or burning sensation during urination
- Experiencing pain when ejaculating
- Bloody urine or semen
- Experiencing recurring stiffness and pain in the hips, lower back, and upper thighs.
Causes of Prostate Cancer
While the causes of prostate cancer remain unclear, these following factors could increase your risk:
- Age, especially for over 50’s
- Family history of prostate, breast, or ovarian cancer
- High-fat diet
- Low fruit and vegetable diet
- High testosterone levels may also be a factor
Prostate Cancer Screening
Like many cancers, there are no specific tests available with adequate accuracy to screen populations of men for early signs of prostate cancer. Having said that, early detection is the key to receiving prompt treatment and attaining higher survival rates.
A PSA test is the primary means to aid early detection. This test is used to determine the measurement of Prostate Specific Antigen concentration in the blood.
Speak to your family physician about a PSA test if you’re concerned about the presence of prostate cancer as well as the potential risks and benefits of tests and treatments.
Diagnosis for Prostate Cancer
If your doctor suspects the presence of PC, he may prescribe one or more of the following tests:
- PSA blood test – men with prostate cancer can have normal PSA levels, so it is not a definitive test. One in 3 men with higher-than-normal PSA levels have cancer, so you may find that the PSA test will be prescribed concurrently with other tests to confirm the diagnosis. Because it isn’t a conclusive test, there is a lot of confusion around PSA’s. Read here for more information.
- Biopsy – this test uses a rectal ultrasound to remove small pieces of tissue from parts of the prostate. These tissues will then be examined under a microscope to detect the disease and determine its aggressiveness.
- Digital Rectal examination – this type of examination is no longer recommended as a routine test for men without PC symptoms although those who request a DRE can have one done.
- Other tests – If cancerous cells are detected in your prostate, expect to have other tests such as a CT scan, MRI, or a bone scan to see how far the cancer has progressed and if it has metastasised.
Prostate Cancer Treatment
Be sure to discuss side effects, risks, and benefits with your doctor when considering treatment options.
Always get in touch with your health fund to see whether your prostate cancer treatment is covered by your private health insurance hospital policy.
Prostate cancer treatment depends on the extent of the cancer:
The TNM System is the staging system used to describe the stage and extent of cancer. The stages range from I to IV. CT and bone scans are used to determine the spread.
This is the process of monitoring prostate cancer through regular PSA tests and assessments. This may be suitable for older men where the cancer is slow-growing and not likely to cause any major issues
This type of evaluation is suitable for instances where the cancer is slow growing and not causing symptoms. This involves quarterly or bi-annual PSA and rectal examinations and MRI and biopsies every 1-3 years.
This curative treatment removes the entire prostate (radical prostatectomy) and primary side effects may include incontinence and impotence.
Radiotherapy can also be administered with curative intent in the form of external radiation or with the implanting of radioactive seeds (brachytherapy). The side effects of this treatment are similar to those of surgery, however, an additional side-effect may be bowel problems.
Hormone or Androgen deprivation therapy
Prostate cancer needs testosterone to grow. This type of therapy slows down testosterone production and is often used before, during, and after radiotherapy and is sometimes prescribed along with chemotherapy.
In some instances of acute prostate cancer, your health team may speak to you about palliative care. Palliative care focuses on improving quality of life by allaying the symptoms of cancer. In addition to reducing the spread of cancer, this treatment can relieve pain and other symptoms and may include radiotherapy, chemotherapy and other drug therapies
Health care team
Your health care team will depend on the scope of treatment needed. It is advisable to discuss with your doctor how many medical staff will be present for your treatments as they may incur separate costs. Once you have a fair idea of your potential out-of-pocket, be sure to call your private health insurance provider to ensure that your policy covers prostate cancer treatment and that you have served the relevant waiting periods.
Your GP will be the first person you see regarding your prostate cancer treatment options and will work in conjunction with your specialists in providing ongoing care.
This medical professional is responsible for the treatment of urinary systems and the male reproductive system. An urologist performs biopsies and prostate surgeries.
Endocrinologists diagnose and treat hormone imbalances
A radiologist examines and analyses X-rays and scans. Interventional radiologists may also perform some services like a biopsy via ultrasound or CT scan
A pathologist is responsible for analysing tissue samples and cells to determine the type and scope of cancer
Nurses assist doctors, administer drugs and provide information, care, and support throughout the course of treatment.
Also known as a clinical nurse consultant or clinical nurse specialist, care coordinators provide support for you and your family and liaise with other members of the MDT for the course of your treatment.
These physiotherapists help to improve and regain muscle strength in the pelvic floor region through exercise to improve bowel and bladder control.
These oncologists map out and prescribe the course of your radiotherapy for cancer treatment
These oncologists treat cancer with drug therapies like chemo and hormone therapy.
A physiotherapist helps people to improve their general wellbeing, fitness, energy levels and strength.
Sex therapists can help with sexual issues prior to and following treatment as well as help with erectile dysfunction and related issues.
An occupational therapist can help you resume your everyday activities by helping you to adapt to your working and living environment.
A psychologist can help walk you through your emotional health following diagnosis and treatment as well as help with emotional issues that may arise regarding your sex life.
Social workers create a network of support services to help you deal with emotional or financial issues
If you are unsure about what medical services you’re covered for and would like to weigh up your options, Health Deal is a free health insurance comparison service. Our experienced representatives can walk you through step-by-step to assist in finding the perfect policy to cover you for prostate cancer treatment.
Prostate Cancer Treatment Costs
Whether you choose to go public or private, expect to be paying some out-of-pockets.
If you have private health insurance, Medicare will still cover a sizeable portion of your prostate cancer treatment costs. If you aren’t, Medicare will pay for all your in-hospital treatments in the public system; however you may have to sit tight on the public waiting list for an indefinite period depending on the severity of the cancer. You also do not get to choose your own doctor.
After considering all your treatment options and consultations and how you would like to proceed, you will be better equipped to map out a treatment plan and the potential out-of-pocket costs to begin making financial preparations.
Out-of-pocket costs vary greatly from patient to patient as prostate cancer treatment is not as routine as say, mending a broken arm. Here are some things that will be taken into consideration:
- Varied treatment- Because cancer cases vary widely, costs will depend on whether you might need surgery for tumour removal, chemotherapy, radiotherapy, hormone therapy, and rehab or a combination of the above.
- Every cancer case is different- Depending on the stage and extremity of the cancer, you may need more specialists’ visits or blood tests.
- Time it takes to make a diagnosis- Keep in mind that depending on what type and stage of cancer is suspected, you may have to be going between your GP, clinics, and specialists and then back to your GP several times.
- Treatment locations- Depending on your treatment, there may be times when you will have no choice but to be seen at a private clinic for radiation therapy or an MRI. Alternatively, you could find a public clinic that will run these tests at a lower cost.
- Inpatient and outpatient treatment- Depending on what stage of treatment you’re at, you may not always be seen as an inpatient.
Medicare and Private Health Insurance out-of-pocket costs for cancer treatment
Knowing what out-of-pocket costs to expect when using Medicare or your private health insurance is essential when charting a financial plan for your prostate cancer treatment.
Visits to the GP
Private health insurance- health insurance does not cover GP visits
Medicare- If the GP bulk bills Medicare, your visit will be free. If they don’t bulk bill, it’s likely their fees are higher than the Medicare rebate. The difference between the rebate and the doctor’s charge is called the gap, which you will have to pay.
When you consider that prostate cancer treatment means multiple GP visits, it would be in your best interests to find one of the many GPs in Australia that bulk bill Medicare.
Scans and test
Private health insurance- biopsies, CT scans, MRI’s and blood work for prostate cancer will be covered by your private health insurance provider if it is part of your in-hospital treatment. Outpatient scans and tests aren’t covered by your health fund and you will have to rely on the Medicare rebate.
Medicare- Medicare will cover the full cost of outpatient scans and tests, however, there has been an increase in clinics and facilities turning private, therefore you may have to depend on the Medicare rebate as well as pay some out-of-pocket costs.
Even when you are treated for prostate cancer as a private patient in a hospital, you can still claim the Medicare rebate as long as that treatment is covered on the Medicare Benefits Schedule (MBS). You will have to shoulder the full cost of any scan or test that is not on the MBS list of services covered, as well as any gap payments.
Because cancer treatment varies greatly, it will be difficult to forecast costs without speaking to your doctor. You will need to have regular conversations with your GP about ways to minimise your out-of-pocket costs. It would be prudent to do some research on clinics and testing facilities and their costs and ask your GP if he can refer you to your preferred facility. Also, ask for the MBS item number of your recommended treatment services and ensure that your bank information is up to date to avoid any rebate delays.
Consultations with Specialists and review appointments
Private health insurance- Health funds do not cover specialist visits on their policies.
Medicare- As long as your specialist visit for prostate cancer was referred by a GP, is listed on the MBS, and the specialist participates in bulk billing, it is covered by Medicare. Provided the consultation is listed on the MBS, you will receive a rebate, however you’re more than likely to incur some out-of-pocket costs.
If your GP cannot refer you to a specialist who bulk bills, propose some names after doing some research into specialists who practise within a close proximity. Ensure that you ask any potential specialists to email you their fee catalogue so you able to compare the costs.
Private health insurance- Your health fund and Medicare will cover the cost of your prostate cancer treatment as a private patient as long as your hospital policy covers cancer. The out-of-pocket you can expect to pay here is your insurance excess, your co-payment, and any gap payments. If your surgeon agrees to participate in your fund’s gap scheme, you will pay a reduced gap or none at all.
Medicare- Medicare covers the cost of prostate cancer surgery and accommodation however you may have to wait for treatment unless the cancer is severe. You also will not be able to choose your own doctor.
Although it costs more to be seen as a private patient for your prostate cancer treatment, you will enjoy the numerous advantages of being treated privately. You will most likely be placed in a private room, which would afford you the privacy of recovering in your own space. You can choose your own surgeon and you won’t have to endure the long-drawn-out public waiting list. Ask your health fund about their agreement hospitals, which are specific private hospitals that have agreements with your health fund to lower your out-of-pocket costs. Alternatively, you could arrange to have your surgery in a public hospital by your private doctor if you would like to lessen your accommodation costs.
Chemotherapy, Hormone Treatments, and Radiotherapy
Private health insurance- Your health fund will cover your chemo and radiotherapy as long as it is received in-hospital, and you will only have to pay for any gap fees. If your treatment is administered to you as an out-patient, you can always claim a Medicare rebate. Private health does not include oral chemo treatment or hormone therapy taken out-of-hospital. However, some health funds such as Australian Unity will pay a benefit towards non-PBS-pharmaceuticals.
Medicare- chemo and radiotherapy are free in a public hospital; however, due to the growing number of private radiotherapy clinics, you may have to end up using one depending on where you live. Medicare will also pay for any chemo and hormone medication needed outside of hospital as long as it’s part of the Pharmaceutical Benefits Scheme (PBS). If the medication you require is not on the PBS for say, a rare form of cancer, you will most probably be shelling out the entire cost of the drug from your own pocket.
Many of the therapies you’ll require will be administered to you as an out-patient, so expect some out-of-pocket costs. In the absence of public clinics in your area, ask nearby private clinics to email you a copy of their fee catalogues and compare costs. To avoid shouldering potential hefty non-PBS-pharmaceutical bills, get in touch with Health Deal to assist in finding you an Extras policy that covers this.
Other pharmaceutical needs
Private health insurance- To relieve the side-effects of chemotherapy you will likely require some prescriptions such as anti-nausea medication. Whether you are an in or out-patient, your health fund will cover these costs as long as the prescription is on the PBS. If it isn’t, some health funds like HIF will pay a benefit towards your prescription.
Medicare- In-hospital medication that’s covered on the PBS is fully provided for. As an out-patient, you will be covered for most of the cost. If the prescription is not covered under the PBS, you’ll have to bear the entire cost yourself.
Ask your doctor if it is possible to prescribe your medication from the PBS or call Health Deal on 1300 369 399 to help you find an extras policy to reduce these pharmaceutical costs.
Associated therapies and allied health
Private health insurance- Private health hospital policies will cover you for in-hospital rehabilitation. If you require in-hospital psychology, make sure that you’re covered on your plan. Some surgeons in the private sector offer certain nutrition, yoga, or counselling classes for free.
Physiotherapy, speech therapy and counselling can be found on most extras policies. Ask a Health Deal consultant to help you find an extras policy with a high yearly limit and rebate such as this one from Australian Unity. To make the most out of your insurance policy you will require several follow up sessions.
Medicare- In-hospital psychology, physiotherapy, and rehab will be covered under the public system. You can claim a Medicare rebate for out-of-hospital rehab, psychology and psychiatry but expect some out-of-pockets as well.
You can ask your GP to sign you up for the Chronic Disease Management Plan to qualify for additional rebates like physiotherapy and speech therapy, however; patients seeking Medicare rebates for allied health services can only claim 5 services per year. Therefore, if you need to see a speech pathologist, a physiotherapist and an exercise physiologist, you will have used up 3 of your yearly maximum services.
With the right extras policy, you can claim a rebate on individual allied health services several times a year with the added advantage of being covered for other ancillary services such as dental and optical.
Prostate cancer: public or private health treatment?
Whether you approach your prostate cancer treatment through private health insurance or Medicare, you will end up with out-of-pocket costs. So should you be treated on the public system or through a private health insurer? The public system promises fewer out-of-pockets and the private system ensures prompt treatment and scope of choice.
If you feel that after weighing up all your options you would like to be privately insured, that’s where we come in
Here at Health Deal, we believe that there is no such thing as one perfect cover. However, there is a perfect policy out there for each Australian, and we can help you find one. Wondering if your policy covers you for treatment? Feel like you’re over or under-covered on your current health plan? Give us a call on 1300 369 399. It’s free, it only takes a few minutes, and we genuinely want to see a healthier Australia.
Compare your cover today.