Care pathway for a prostate cancer patient

A suspicion of prostate cancer usually arises on the basis of an elevated level of plasma PSA (prostate-specific antigen). In prostate cancer, the level of PSA in plasma rises (PSA ‘leaks’ from cancer cells into blood circulation), but PSA levels can also be raised by benign prostatic hyperplasia and infections, for example. Hence, a PSA level above reference values does not automatically indicate prostate cancer. In this case, a new measurement is usually needed. 

A prostate cancer diagnosis is based on needle aspirate samples of the prostate, taken under ultrasound guidance through the rectum. 

For more information on diagnosing prostate cancer, visit the Health Village (Terveyskylä).

If a low-risk cancer is found but you have no symptoms, no routine metastasis examinations are required. In the case of medium or high-risk cancers, or if you have symptoms, further examinations may be made to determine the spread of the disease (radioisotope bone scan, CT scan of the body, MRI scan of the prostate, or, in certain cases, a PET scan). 

For more information on metastasis examinations for prostate cancer, visit the Health Village (Terveyskylä).

When the results of the examinations are available, you will be invited to an appointment with a urologist for a consultation meeting at the Helsinki University Hospital Urology Outpatient Clinic at Meilahti Hospital or Peijas Hospital. Your family members are welcome to attend the meeting too.  

You will be supported and assisted during treatment by a prostate cancer nurse, with whom you can also book an appointment. Guidance and support are also available via a phone helpline. 

For more information on treatment selection and consultation meetings, visit the Health Village (Terveyskylä)

Local prostate cancer refers to cancer that is confined to the prostate. The treatment options here are active monitoring, surgery, or radiation therapy, with hormone therapy if needed. 

For more information on the treatment of local prostate cancer, visit the Health Village (Terveyskylä)

We monitor the progress and efficacy of your treatment. Monitoring may be partly undertaken by basic health care services. PSA level monitoring can also be partly automated (mobile monitoring). 

For more information on treatment monitoring, visit the Health Village (Terveyskylä)

More information on the Noona mobile app we use for treatment monitoring.

A urologist and oncologist are jointly in charge of the treatment of metastatic prostate cancer in the HUS area. A urologist is usually in charge of your treatment in the early stage of the disease. 

Responsibility for care is generally transferred to an oncologist at the Helsinki University Hospital Comprehensive Cancer Center when: 

• traditional hormonal therapy is no longer effective 
• cytotoxic therapy is needed at the early stages of a metastatic cancer because of the extent of the growth, or 
• radiation therapy is required to alleviate the symptoms 

The treatment of metastatic prostate cancer aims to effectively slow down the disease and, hence, maintain as good a quality of life as possible and prolong life expectancy. 

Appointment with a physician

When you are being treated by a urologist, you will have appointments at the Urology Outpatient Clinic at Meilahti Hospital or Peijas Hospital. The uro-oncological appointments at the Oncology Outpatient Clinic are on the 1st floor of the Comprehensive Cancer Center. 

At your appointment, we will review the current state of your disease and survey its symptoms, your general health, any illnesses relevant for the treatment, and your preferences. We decide on the treatment together. You may bring family members to the appointment if you wish. 

After the physician’s appointment and during the same visit, you will often also meet a clinic nurse: a prostate cancer nurse at the Urology Outpatient Clinic, or a uro-oncological nurse at the Oncology Outpatient Clinic. In connection with these meetings, hormone therapy (such as LHRH analog injections) that slow down cancer, or medication to strengthen the bones, may be administered to you. The clinic nurse is also your contact person for any issues that arise between appointments.

For more information on the treatment of metastatic prostate cancer, visit the Health Village (Terveyskylä)

In urotherapy, we will advise you concerning functional urinary problems following prostate cancer. For instance, we will teach you how to perform intermittent self catheterization. We also provide guidance on the care of a permanent catheter, coordinate the acquisition of the appliances in outpatient care, and plan the catheter replacements either in outpatient care or in specialist medical care. 

We teach you how to use a urinal condom in case of incontinence and advise you on nutrition and fluids in case of urinary problems. We will also provide advice on skin issues and on diapers. We will advise you where to seek help for any sexual problems. Unfortunately, we do not currently have sexual counselors or therapists available. Patients that require medication are referred to a urologist. 

Radiotherapy 

Average treatment wait time of prostate cancer patients from the time when their referral is received at the Comprehensive Cancer Center, when radiotherapy is the only form of treatment. Generally, patients undergo diagnostic examinations at a urology outpatient clinic before they are referred to the Comprehensive Cancer Center. If the initial treatment is hormone therapy, radiotherapy will begin 2 to 3 months later according to the plan. 

Table 1: Average wait time of prostate cancer patients, from the time when their referral is received to when they have their initial outpatient clinic appointment, and from the time when their referral is received to starting radiotherapy.

Surgery

Average treatment wait time of prostate cancer patients from the time when their referral is received at a urology outpatient clinic, when surgery has been chosen as the form of treatment. The table below shows wait times for surgery per quarter. 

Table 2: Average wait time of prostate cancer patients, from the time when their referral is received to their initial outpatient clinic appointment, and from the time when their referral is received to the day of surgery.