Everything You Need To Know About Prostate Cancer
The prostate is a small walnut sized gland found only in men. It sits just below the bladder and surrounds the urethra, the tube which carries urine and ejaculate along the length of the penis and to the outside of the body Its function is to produce part of the fluid that makes up semen. The male hormone testosterone, which is produced mainly by the testicles, has a key role in controlling prostate growth and development. As men age the prostate tends to increase in size, which can cause urinary problems and symptoms associated with prostatitis or benign prostatic hyperplasia (BPH) which is non-cancerous.
What is Prostate Cancer?
Prostate Cancer results from the growth of abnormal cells within the glands of the prostate. These glands are lined with cells that secrete the protein prostate specific antigen (PSA). The cancerous overgrowth can occur in these secretory cells.
The staging of prostate cancer is determined by the extent to which the cancer has been contained within the prostate or has spread to other parts of the body:
Localised prostate cancer – the cancer has not grown beyond the prostate.
Locally advanced prostate cancer – the cancer has spread outside the prostate to nearby organs and tissues, but still remains within the prostate region.
Metastatic prostate cancer – the cancer has spread to other parts of the body like the lymph nodes or bones.
The TNM System is the most widely used method for staging and grading prostate cancer:
T (Tumour) Stage: shows if a tumour has spread outside the prostate or the region. Physical Digital Rectal Examination (DRE), imaging, biopsy, or endoscopy assist with T staging.
N (Node) Stage: shows if a tumour has spread to lymph nodes in the pelvic regions. This is typically assessed by imaging and a transrectal ultrasound during prostate biopsy.
M (Metastatic) Stage: shows if a tumour had spread to other sites such as the bones. This is typically assessed by imaging such as a whole body bone scan.
What are the Risk Factors for Prostate Cancer?
The main established risk factors are age, family history and race/ethnicity:
- The older you are the more likely you are to develop prostate cancer. Males under 50 are rarely diagnosed, but the risk of diagnosis by the age of 75 years is 1 in 8 in 2013.
- If you have had a first-degree relative (father, brother or son) with prostate cancer, then you have a higher risk of developing it, particularly if they were diagnosed at an earlier age. For example, if your father was diagnosed at age 50, then your risk of developing prostate cancer is doubled. If you have had two relatives diagnosed at 50 years, then your risk is up to seven times higher.
- Prostate cancer diagnoses vary between ethnic groups. For instance, males with an African background have a higher risk, compared with males with an Asian/Pacific Islander background.
Other possible risk factors that could have an effect on prostate cancer:
- Mutations in the BRCA1 and BRCA2 genes may raise the likelihood of prostate cancer risk. Men who know they have these mutations may consider screening at an earlier age.
- Whilst there is no direct proof, some studies suggest that eating a lot of saturated fat in your diet may increase your chances of prostate cancer. WebMD provides a list of recommended items to help with a prostate cancer diet.
- Some studies have suggested that drinking may increase the risk of prostate cancer. A recent meta-analysis suggested that 6 drinks or more per day can increase your risk of developing prostate cancer by 18% compared with men who do not drink.
How is Prostate Cancer Detected and Diagnosed?
The most common tests are:
Digital Rectal Examination (DRE) – If your doctor is testing for prostate cancer, they may want to do a physical examination to determine if the prostate feels hard or bumpy.
PSA Test – The Prostate-Specific Antigen (PSA) blood test is a screening tool for early detection of prostate cancer. It measures the level of prostate specific antigen in the blood, which is produced by the prostate gland. PSA levels in the blood naturally increase with increasing age. Higher levels than normal are a possible indicator for prostate cancer. PSA levels can also rise due to benign prostatic enlargement, inflammation or infection. As a cancer screening tool, the test is not perfect, with high numbers of false positive and some false negatives.
Prostate Biopsy – Under ultrasound guidance a biopsy needle is inserted into the prostate by a Urologist and a core or sample is removed to determine if any cancer cells are present. This is the only way to provide a definitive diagnosis of prostate cancer. When examined under the microscope a pathologist will report the number of positive and/or negative cores, as well as the Gleason Grade if positive for cancer.
Magnetic Resonance Imaging (MRI) – An MRI may indicate evidence of cancer in the prostate gland, particularly if you have a high or rising prostate-specific antigen (PSA) level.
How Common is Prostate Cancer in Australia?
- Estimated 18,138 new cases diagnosed in 2016
- Most common diagnosed cancer in males
- 1 in every 8 males aged to 75 years has prostate cancer
- Median age at diagnosis is 67.6 years
- 26% of males (one quarter of all men who had a radiotherapy course in 2014-15) were for prostate cancer
- 95 % of men with prostate cancer survive for at least 5 years following diagnosis compared to other males with commonly diagnosed cancers
- At the end of 2012, 94,114 males diagnosed with prostate cancer in the previous five years were still alive
- 7% of men had survived 15 years after diagnosis (2009-2013)
- 1 in every 130 males aged to 75 years dies from prostate cancer
- It is predicted that prostate cancer will be the second most common cause of death in males in 2017
- 8% of all male deaths are from prostate cancer in 2016
- 3,398 males died from prostate cancer in 2016
Burden of Disease
- Prostate cancer is the third most common cancer in males (10%) that contributes to Australia’s cancer burden in 2011
Aboriginal and Torres Strait Islander People
- Indigenous Australians are 20% less likely to die from prostate cancer than non-indigenous Australians
- Men living in inner regional areas were 1.5 times more likely to be diagnosed with prostate cancer than those living in very remote areas (2008-2012)
- Men living in very remote areas are 1.2 times more likely to die from prostate cancer than those from major cities (2010-2014)
- Men in the lowest socioeconomic group were 1.2 times more likely to die from prostate cancer than compared with the highest group
What are the Signs and Symptoms of Prostate Cancer?
In the early stages, prostate cancer may cause no signs or symptoms at all. As a slow-growing cancer it may not show any obvious symptoms for years.
But with many men over 50 years the symptoms of prostate cancer can include:
- The need to frequently urinate, mostly at night
- A sudden need to urinate.
- Difficulty and pain when starting to urinate.
- Burning sensation or pain during urination.
- Leakage after urination.
- Incomplete emptying of the bladder.
- A weak, dribbling flow of urine.
- Difficulty in getting an erection (erectile dysfunction).
- Painful ejaculation or a decrease in the amount of fluid that is ejaculated.
- Blood in the urine (haematuria) or semen.
More generally, symptoms can range from:
- Pain and stiffness in the bones, lower back, pelvis, sciatica, and thighs.
- Swelling in the legs or pelvic region.
- Numbness or pain in the feet, legs or hips.
- Unexplained weight loss and fatigue.
What is the Treatment for Prostate Cancer?
Prostate cancer is a slow growing disease, and in most cases men will have time to make a decision about the best type of treatment that is suited to them. Talking about treatment options with your doctor based on your personal diagnosis will help you make an informed decision, particularly weighing up the advantages and disadvantages, possible side effects like incontinence and infertility, availability and cost. In general the treatment options are:
1. No Treatment
- Active Surveillance
Active Surveillance is for close monitoring of low risk biopsy-diagnosed prostate cancer. This can involve regular PSA testing, biopsies (every 1- 3 years), MRI scans and check-ups for maintenance of quality of life, or until intervention is necessary.
- Watchful Waiting
This option is for observing prostate cancer, a less intensive form of active surveillance that requires fewer tests and no biopsies.
Radiotherapy is offered to men with localised prostate cancer with the intent to cure. The main two types are:
Low dose rate (LDR) using permanent radioactive seeds or high dose rate (HDR) using temporary seeds targeted directly to the prostate.
- External Beam Radiation Therapy (EBRT)
EBRT involves radiotherapy applied outside the body. It uses high energy x-ray beams directed towards the prostate daily over a period of seven weeks.
- Radical Prostatectomy
This option is the surgical removal of the prostate gland, part of the urethra and seminal vesicles. Radical prostatectomy can be performed laparoscopically, Robot Assisted or as an Open (small cut through the lower abdomen). It usually requires a few days in hospital and your usual activities can be resumed after several weeks. There are some possible side effects to surgery to discuss with your doctor: nerve damage, loss of bladder control, erectile dysfunction and infertility.
- Androgen Deprivation Therapy (ADT)
Reducing hormones to slow the growth of prostate cancer is a common treatment for men with advanced prostate cancer. Hormone therapy reduces testosterone levels in the hope of slowing cancer growth or keeping it under control.
May be offered if other forms of treatment have not been effective.
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