Stage 2: Localised Prostate Cancer

Stage 2 prostate cancer means the cancer is still confined to the prostate but is larger than in Stage 1. At this stage:

• The cancer may be felt during a digital rectal exam
• The cancer may be visible on imaging tests
• PSA levels are usually between 10-20 ng/mL
• The Gleason score is typically 7

Stage 2 is further divided into 2A and 2B, based on how much of the prostate is affected and the Gleason score.

Stage 2 is typically categorised as "intermediate-risk" prostate cancer. In New Zealand, intermediate-risk prostate cancer is the most common risk category at diagnosis, representing about 44% of all diagnoses.

Cultural Context for Māori with Stage 2 Prostate Cancer

Stage 2 prostate cancer is particularly significant for Māori men, as research shows Māori are often diagnosed at more advanced stages. The Ministry of Health data indicates Māori men face up to 72% higher mortality rates from prostate cancer compared to non-Māori, despite having similar incidence rates.

Holistic Wellbeing Approach

The Te Whare Tapa Whā model provides a helpful framework for addressing Stage 2 prostate cancer as a Māori patient:

• Taha tinana (physical health) - Understanding treatment options (surgery, radiation therapy) and their physical impacts
• Taha wairua (spiritual health) - Incorporating karakia (prayer) and connection to ancestral strength during the treatment journey
• Taha whānau (family health) - Engaging extended whānau for practical and emotional support
• Taha hinengaro (mental health) - Managing the emotional impact of a Stage 2 diagnosis and treatment decisions

Treatment Decision Considerations

When considering treatment options for Stage 2 prostate cancer, Māori men may benefit from:

• Discussing treatment and follow-up schedules with healthcare teams in the context of whānau, work, and community obligations
• Requesting a support person or Māori health navigator (kaiāwhina) to attend appointments and help navigate the healthcare system
• Asking about complementary integration of rongoā Māori (traditional medicine) alongside Western treatments, where appropriate
• Understanding how treatments might impact cultural roles and responsibilities within whānau and hapū

Rongoā Māori and Complementary Approaches

While Western medical treatments are the primary approach for Stage 2 prostate cancer, some Māori men integrate traditional healing practices:

• Kawakawa preparations used for inflammation and general wellbeing (discuss with your healthcare team before using)
• Traditional mirimiri (massage) for relaxation and wellbeing
• Spiritual healing and karakia to support overall wellbeing
• Wai (water) therapy such as ocean bathing or natural springs

Always discuss integration of traditional practices with your healthcare team to ensure they complement your medical treatment.

Culturally Responsive Support Services

Several organizations provide culturally appropriate support for Māori men with prostate cancer:

• Hei Āhuru Mōwai - Māori Cancer Leadership: Provides advocacy and navigation support for Māori cancer patients
• Te Aho o Te Kahu: Offers cancer resources specifically for Māori
• Cancer Society's Māori Support Services: Provides culturally responsive support and resources
• Your local DHB may have dedicated Māori health navigators (kaiāwhina) to support your cancer journey

Communicating with Whānau

Sharing a Stage 2 diagnosis with whānau may follow cultural protocols:

• Consider hosting a whānau hui to share information and discuss support plans
• Acknowledge the impact on the collective wellbeing of the whānau
• Clarify how whānau can practically support treatment journeys (transport, appointments, home support)
• Discuss updated roles and responsibilities during treatment and recovery

"Ehara taku toa i te toa takitahi, engari he toa takitini."
My strength is not that of an individual, but that of the collective.

This whakatauki reminds us that healing is a collective journey. With intermediate-risk prostate cancer, the support of whānau, health professionals, and community is essential for successful treatment outcomes.

Several treatment options are available for Stage 2 prostate cancer in New Zealand, with the choice depending on factors such as your age, overall health, and personal preferences:

Radical Prostatectomy

Surgical removal of the prostate gland is the most common treatment for Stage 2 cancer in New Zealand, with approximately 59% of intermediate-risk patients choosing this option. This can be performed through:

• Open surgery
• Laparoscopic surgery
• Robotic-assisted surgery (available at some hospitals)

New Zealand data shows younger patients (under 60) are more likely to receive surgery (82% of intermediate-risk patients) compared to older patients over 75 (19%).

Radiation Therapy

Radiation therapy is used in about 16% of intermediate-risk cases in New Zealand. Options include:

• External beam radiation therapy (EBRT) - using high-energy x-rays aimed at the cancer
• Brachytherapy - inserting radioactive sources directly into the prostate

Older patients (over 75) are more likely to receive radiation therapy alone (25% of intermediate-risk patients) compared to younger patients under 60 (7%).

Radiation Therapy with Hormone Therapy

Some intermediate-risk patients (about 3-8%) receive a combination of radiation therapy and hormone therapy (also called androgen deprivation therapy or ADT). This approach is more common for higher-risk cases.

Active Surveillance

For some Stage 2 patients with lower Gleason scores, active surveillance may still be an option, particularly for older men or those with other health conditions. In 2021, about 15% of intermediate-risk patients in New Zealand were managed with active surveillance.

Watchful Waiting

A less intensive monitoring approach called watchful waiting is used in about 4% of intermediate-risk cases, primarily in older patients or those with significant health issues.

Based on data from New Zealand patients, here are common side effects reported one year after treatment:

Surgery Side Effects

• Urinary issues: 31% of patients needed more than one urinary pad per day, 20% experienced more than one urinary leak per day
• Sexual function: 45% reported sexual function as a problem, only 22% reported having fair to very good erections
• Other effects: 10% reported feeling depressed, 13% reported lack of energy

Radiation Therapy Side Effects

• Bowel function: 7% reported bowel habits as a problem
• Urinary function: 9% reported urinary function as a problem, 5% needed more than one pad per day
• Sexual function: 34% reported sexual function as a problem, 36% reported having fair to very good erections
• Other effects: 8% reported feeling depressed, 18% reported lack of energy

Radiation with Hormone Therapy Side Effects

• Sexual function: 37% reported sexual function as a problem, only 12% reported having fair to very good erections
• Other effects: 12% reported feeling depressed, 31% reported lack of energy

The Canterbury Regional Cancer and Haematology Service and other cancer centers in New Zealand provide comprehensive support for managing these side effects, including:

• Medications for managing urinary issues
• Pelvic floor exercises for urinary control
• Sexual health support and medications
• Psychological support for emotional side effects

New Zealand offers various support services for prostate cancer patients:

• Cancer Society New Zealand: Located on many hospital campuses with information resources and support services
• Prostate Cancer Foundation NZ: Provides support groups throughout New Zealand
• District Health Board Services: Including:
• Dietitians - to assist with nutrition
• Social Workers - for psychosocial support and financial assistance
• Occupational Therapists - to help maintain independence
• Physiotherapists - to assist with physical function
• Cancer Psychological and Social Support Service - specialist support for those with complex issues
• Local Support Groups: Available in most regions of New Zealand. You can find them here

Financial assistance may be available through Work and Income New Zealand (0800 559 009) and the National Travel Assistance programme for those who need to travel for treatment.

Day-to-Day Life

Most people can continue normal activities during and after treatment:

• As long as you feel capable, continue normal activities and diet
• You may become more tired than usual, so pace yourself
• Any amount of activity can help you regain strength
• Communication with family about your diagnosis is important

Sexual Health

Treatment side effects can affect your sexual health:

• Open communication with your partner about changes is important
• Sexual function may improve over time after treatment
• Medications and devices can help with erectile dysfunction (60% of surgery patients use these aids)
• Counseling services are available for relationship support

Follow-up Care

Regular monitoring is important:

• PSA testing to monitor for any cancer recurrence
• Regular check-ups with your healthcare team
• Continue general health maintenance with your GP

Reliable New Zealand-specific resources for Stage 2 prostate cancer:

• Ministry of Health
• Canterbury Regional Cancer and Haematology Service
• Cancer Society of New Zealand
• Prostate Cancer Foundation NZ
• Urology Associates - For specialist urology care
• Health Navigator NZ

For concerns about treatment side effects, contact your oncology team at any time by telephoning (03) 364 0020 (Canterbury) or your local cancer center.