Health insurance for prostate cancer
Expert tips on choosing health insurance
Our health insurance expert, Steven Spicer, offers some tips on choosing health insurance that will best cover your needs.
Steven Spicer
Executive General Manager – Health, Life & Energy
Consider the inclusions you’ll need
When it comes to complex conditions such as cancer, you may require several different health services as part of your care. Therefore, your insurance policy will need to include several clinical categories if you want benefits paid for each treatment. For example, if your treatment plan includes chemotherapy and surgery, these two procedures fall under different clinical categories. Doing your research now will provide you the peace of mind that you’ll have cover when you need it most.
Plan ahead with waiting periods
Whether purchasing health insurance for the first time or upgrading your existing policy, you’ll need to serve a waiting period before making a claim. The standard waiting period for most services is two months. However, for pre-existing conditions, most services have a waiting period of up to 12 months. This extended waiting period could make a big difference, especially if a diagnosis is unexpected and treatment is needed immediately. When possible, it’s worth considering what conditions you’re at risk of and planning ahead so that your waiting period is already served when you really need the cover.
Adapt your cover to meet your needs
As you age, your health needs and risks will change. Though prostate cancer can happen to younger men, it’s much more common for those over fifty. Regularly checking your policy lets you see if it’s still meeting your requirements or whether it’s time to tweak a few aspects. Taking your age, health conditions and family history into account will help you choose a policy that suits you.
What is prostate cancer?
Prostate cancer occurs when abnormal cells grow in the prostate gland and lead to a malignant tumour.1 Prostate cancer is the most common cancer diagnosis in Australia, with one in seven males likely to be diagnosed by the time they’re 85. While prostate cancers are usually slow-growing, there are cases where the cancer is aggressive. Compared to other cancers, prostate cancer has one of the highest five-year survival rates if caught early.
Advanced prostate cancer has two stages:1
- Locally advanced prostate cancer means the cancer has spread beyond the prostate to nearby parts of your body.
- Metastatic prostate cancer is when the cancer has spread to distant parts of your body.
Symptoms of prostate cancer
During the early stages of prostate cancer, there are often no symptoms. More advanced prostate cancer symptoms include:2
- Frequent urinating
- Pain during urination
- Blood in your urine or semen
- Pain in the back or pelvis
- Weakness in legs or feet.
If the disease has spread, other symptoms include pain throughout the body, weight loss and fatigue.1 While many of the above symptoms can be caused by other conditions, it’s important to be checked. The earlier prostate cancer is found, the better your treatment options and survival chances.
Your risk of prostate cancer can increase if:2
- You’re over 50 years old
- You have a family history of prostate, ovarian or breast cancer
- Your father or brother was diagnosed with prostate cancer before they turned 60.
Other factors, like having high testosterone levels, can increase your risk of prostate cancer.2
Prostate cancer diagnosis
Unfortunately, there isn’t a simple test to detect prostate cancer.2 There are several procedures your doctor can use to help diagnose changes in the prostate and this information can help make a prostate cancer diagnosis. Some of the procedures used include:
- Prostate-specific antigen (PSA) blood test: A blood test used to measure a specific protein created by your prostate.1 A high PSA may indicate you have prostate cancer but could also be a symptom of another condition.
- Digital rectal examination (DRE): A doctor will insert a gloved finger into your rectum to check the condition of your prostate.1
- MRI scan: A detailed medical screening of your prostate used to find any signs of cancer or abnormalities.1
- Bone scans and CT scans: These help determine whether the cancer has spread to other body parts.2
- Biopsy: A small amount of tissue will be taken from the prostate using a needle. A specialist or pathologist will then examine the tissue for cancer cells.2
Tests like PSAs and DREs are a good starting point to detect changes or abnormalities in the prostate, but further tests will be needed to determine whether you have prostate cancer.2
Treatment options
There are several potential treatment options for prostate cancer, including:
- Active surveillance. This involves monitoring prostate cancer that isn’t causing symptoms and has been classified as slow-growing and low-risk.2 This usually involves regular checks and examinations to see if the cancer has worsened.
- Radiation therapy (radiotherapy). Radiation therapy may be offered during the early stages of prostate cancer.2
- Androgen deprivation therapy (hormone therapy). Prostate cancer requires testosterone to grow, and hormone therapy aims to slow the production of testosterone.2
- Chemotherapy. Anti-cancer medicine that is more likely to be used if the cancer has spread to other parts of your body.1
- Prostatectomy. A procedure that removes the entire prostate.1 While this may treat the cancer, it can have potential side effects such as incontinence and urinary issues, lower sex drive and impotence.
The best treatment for you will depend on your cancer diagnosis and your health professionals’ recommendations. Your treatment plan may require multiple different procedures.
How much does prostate cancer treatment cost?
The cost of prostate cancer treatment can vary greatly depending on which procedures are part of your treatment plan. The severity of your cancer diagnosis will determine both the types of treatment you’ll have and the total costs.
Below is a table outlining the typical costs of some of the most common prostate cancer treatments. Prices are sourced from the Australian Government’s Medical Costs Finder.
| Treatment | Medicare Benefits Schedules item number(s) | Typical specialist fees | Specialist fees covered by Medicare | Median amount of specialist fees typically covered by insurer | Median out-of pocket costs (typically paid by patient) | Typical hospital fees |
|---|---|---|---|---|---|---|
| Chemotherapy or immunotherapy for cancer | 13950 | $230 | $150 | $80 | $0 | $600 |
| Transperineal prostate biopsy | 37219 | $1,700 | $680 | $570 | $490 | $800 |
| Transrectal prostate biopsy |
37216 55603 |
$1,300 | $470 | $350 | $360 | $660 |
| Total prostatectomy | 37210 | $9,000 | $2,500 | $1,300 | $5,300 | $11,000 |
| Total prostatectomy with lymphadenectomy | 37211 | $10,000 | $2,800 | $1,600 | $6,200 | $11,000 |
|
Source: Australian Government Department of Health and Aged Care: Medical Costs Finder. Accessed March 2025.3,4,5,6,7 |
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The medical cost of prostate cancer treatment varies depending on various factors, including:1
- Your cancer diagnosis/stage of cancer
- The medical treatment(s) you’re receiving
- Whether the cancer has spread
- Other medical conditions you have
- Choice of healthcare specialist.
Cases will vary between patients, so the only way to get an accurate quote for your treatment is to discuss it with your health team.
Private health insurance cover for prostate cancer
Private health insurance can cover various diagnostic procedures and treatments for prostate cancer when you are admitted to hospital as an inpatient. For prostate surgery, your policy will need to include the ‘Male reproductive system’ clinical category; this is a minimum requirement for Bronze, Silver and Gold hospital cover.
You may require chemotherapy or radiation therapy as part of your cancer treatment. If you have a Bronze tier policy or higher, the ‘Chemotherapy, radiotherapy and immunology’ clinical category must be included by your health fund.
If the cancer has spread to other parts of the body, then additional clinical categories may be required for treatment. It’s a good idea to speak to a health insurance expert if you are unsure what you may need to include on your policy.
There can be some key benefits to being treated as a private patient in a private hospital, including:
- Choice of available specialist/clinic
- Avoiding public hospital waitlists
- Private room (subject to availability)
- More flexibility with the booking procedure time.
Be aware that specialists can charge more than the MBS fee for a procedure. The difference between the specialist fee and the MBS fee is known as a medical gap or gap payment. Your health fund may pay some or all of this amount or you may pay the gap payment out-of-pocket, depending on your policy. Check your policy documentation for more details.
Does Medicare cover prostate cancer treatment?
Medicare can cover the costs of various prostate cancer treatments when you have them performed in public hospitals as a public patient.
Due to high demand, the Australian public health system often has long waiting lists for elective surgeries. In 2023-24 a prostate biopsy had a median wait time of 29 days, while a prostatectomy had a median wait time of 58 days.8 These waiting times can vary depending on where you live and other factors.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
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1 Health Direct – Prostate cancer. Accessed March 2025.
2 Cancer council – Prostate cancer. Accessed March 2025.
3 Medical Costs Finder – Chemotherapy or immunotherapy for cancer. Accessed March 2025.
4 Medical Costs Finder – Transperineal prostate biopsy. Accessed March 2025.
5 Medical Costs Finder – Transrectal prostate biopsy. Accessed March 2025.
6 Medical Costs Finder – Total prostatectomy. Accessed March 2025.
7 Medical Costs Finder – Total prostatectomy with lymphadenectomy. Accessed March 2025.
8 Australian Institute of Health and Welfare – Elective surgery waiting times 2023-24. Accessed March 2025.