Prostate cancer is the second most common cancer diagnosed in men in Australia after skin cancer. More than 3200 deaths each year are claimed by prostate cancer. Prostate cancer is most common in men 60 and older, although for men with a strong family history of certain cancers the risk is also high. *

One in six men will be diagnosed with prostate cancer by the age of 85. It is more common in older men, with more than 63% of cases diagnosed in men over 65 years of age. There are no tests available with sufficient accuracy to screen the male population for early stages of prostate cancer. However, early detection and treatment can significantly improve prostate cancer outcomes. *

The five-year survival rate for prostate cancer is 95%. *

Men concerned about prostate cancer should talk to their doctor and make an informed choice about whether to have any tests designed to find early signs of prostate cancer, in view of the potential risks and benefits. 

Over the past decade, the number of prostate cancer diagnoses has increased to more than 19,000 each year in Australia. Though this increase in number may be due to the increase in testing and diagnoses, this can be beneficial as early detection with any cancer can save your life.  

Prostate cancer is not preventable. The causes of it are unknown, but factors that can increase the risk include older age (age 60 and over) and family history. But there are things you can do that may reduce the risk of getting prostate cancer. Studies show that a healthy diet and weight, plus regular physical activity can also be protective factors. *

Causes of Prostate Cancer

Some factors that can increase your risk of prostate cancer include:

age, increasing rapidly after 50 years of age

family history of prostate, breast or ovarian cancer, especially BRCA1 and BRCA2 gene mutations or a father or brother diagnosed with prostate cancer before the age of 60.

There is also an association of prostate cancer with men of high testosterone levels. 

What Are the Warning Signs of Prostate Cancer?

Prostate cancer develops when abnormal cells in the prostate gland grow in an uncontrolled way, forming a malignant tumour. Early (localised) prostate cancer refers to cancer cells that have grown but do not appear to have spread beyond the prostate.

There are two stages of advanced prostate cancer:

1. Locally advanced prostate cancer where the cancer has spread outside the prostate to nearby parts of the body or glands close to the prostate
2. Metastatic prostate cancer where the cancer has spread to distant parts of the body.

The Five Most Common Symptoms of Prostate Cancer

1. A painful or burning sensation during urination or ejaculation.
2. Frequent urination, particularly at night.
3. Difficulty stopping or starting urination.
4. Sudden erectile dysfunction.
5. Blood in urine or semen.

These are the most common early symptoms of prostate cancer, though more widespread disease often spreads to the bones and can cause pain or unexplained weight loss and fatigue.*

Testing for Prostate Cancer

There is no single, simple test to detect prostate cancer. It is important to make your own decision about whether to be tested or not. Ensure you get good quality information from your doctor to make an informed decision. Unfortunately, current tests for prostate cancer are not good at differentiating between cancers needing aggressive treatment and those that should be left alone.

More research is being done to develop a more accurate test for prostate cancer and better treatment outcomes.**  

If your doctor suspects you may have prostate cancer, you may have one or more of the following tests:

PSA blood test

A prostate specific antigen (PSA) blood test measures the PSA levels, the proteins made by both normal and cancerous prostate cells. Because PSA levels can be variable, it is common for your doctor to use results from more than one blood test, over time, to help determine your risk of prostate cancer.

Some men with prostate cancer have normal PSA levels, and only one in three men with an elevated PSA level has cancer. As it is not a definitive test, a PSA test is normally used with other tests to diagnose prostate cancer.

A digital rectal examination

Digital Rectal Examination (DRE) is no longer recommended as a routine test for men who do not have symptoms of prostate cancer. As not all prostate cancers produce high levels of PSA, it may still be used to check the prostate before doing a biopsy.

Biopsy

A biopsy removes small pieces of tissue from different parts of the prostate with the aid of a rectal ultrasound, for examination under microscope. It is used to detect the disease and determine its aggressiveness (the Gleason score of 1-5 is added from two samples to form a score out of 10; low scores of 6 or less, indicate slow growing disease).

Further tests

If cancer is detected in your prostate, you may have other tests such as MRI, CT or bone scans to see if the disease is contained to the prostate or to help with management and treatment options.

A Diagnosis of Prostate Cancer  

After finding out you have prostate cancer, you may feel shocked, upset, anxious or confused. These are normal responses. Talk about your treatment options with your doctor, family and friends. Ask questions and seek as much information as you need. It is up to you as to how involved you want to be in making decisions about your treatment. 

Treatment for Prostate Cancer

Treatment of prostate cancer depends on the extent of the cancer. These treatments can include the following procedures. **

Staging

The staging system used for prostate cancer is the TNM system, which describes the stage of the cancer from stage 1 to stage 4. Ninety per cent of patients present with local disease. Bone and CT scans are used to determine spread.

Active surveillance

Active surveillance monitors prostate cancer that is not causing symptoms and is considered low risk (that is, the cancer is small and slow growing and unlikely to spread). Generally active surveillance involves PSA tests every 3-6 months, rectal examination every 6 months and MRI scans and biopsies at 12 months and 3 years.

Watchful waiting

“Watchful Waiting” is another form of monitoring prostate cancer that involves regular PSA tests and check-ups. Watchful waiting can be suitable for older men where the cancer is slow-spreading and not likely to cause a problem in their lifetime.

Surgery

Surgery with curative intent removes the whole prostate (radical prostatectomy). The main side effects may include impotence and incontinence.

Radiation therapy (radiotherapy)

Radiation therapy is one treatment offered to men with early prostate cancer. It may also be offered if surgery is not an option. Radiation therapy can be given either with external beam radiation therapy (EBRT) or by implanting radioactive seeds (brachytherapy). Side effects are similar to surgery; however, bowel problems may also occur.

Androgen deprivation therapy (hormone therapy)

Prostate cancer needs testosterone to grow. Androgen Deprivation Therapy or ADT (once referred to as hormone therapy) is used to slow the production of testosterone. ADT is often used before, during and after radiation therapy and is often used with chemotherapy. Although no longer commonly used, surgery to remove part or all of the testicles may be preferable in some cases.

Sources:

*https://www.cancer.org/

** https://www.healthdirect.gov.au/prostate-cancer

Resources:

Prostate Cancer Foundation of Australia
https://www.pcfa.org.au/