What is prostate cancer?

Prostate cancer begins when abnormal cells in the prostate start growing in an uncontrolled way.

How common is prostate cancer?

Prostate cancer is the most common cancer in Australian men (apart from common skin cancers). About 4754 Queenslanders are diagnosed with prostate cancer every year. About 1 in 10 men will get prostate cancer before the age of 75. Anyone with a prostate can get prostate cancer – men, transgender women and intersex people. For information specific to your situation, speak to your doctor.

Risks factors

The exact cause of prostate cancer is not known. Things that can increase the risk of developing prostate cancer include:

• older age – over 90% of people diagnosed with prostate cancer are aged 55 and over
• family history of prostate cancer- if your father or brother has had prostate cancer before the age of 60, your risk will be twice that of others
• strong family history of breast or ovarian cancer, particularly cancer caused by a fault in the BRCA1 and BRCA2 gene
• race – people of African American descent have a higher risk.

While prostate cancer is less common if you are under 55, people aged 40-55 may have a higher than average risk of developing prostate cancer later in life if their prostate specific antigen (PSA) test results are higher than the typical range for their age.

Symptoms

Early prostate cancer rarely causes symptoms. Even people diagnosed with advanced prostate cancer may have no symptoms.

Symptoms such as difficulty passing urine are most often due to non-cancerous changes, such as benign prostate hyperplasia. If symptoms occur, they may include:

• frequent or sudden need to urinate
• blood in the urine or semen
• a slow flow of urine
• needing to get up at night to pass urine
• feeling like your bladder is not empty after passing urine
• unexplained weight loss
• pain in bones, e.g. the neck, back, hips or pelvis.

These are not always symptoms of prostate cancer, but you should see your doctor if you are worried or the symptoms are ongoing.

Diagnosis

There is no simple test to find prostate cancer. Two commonly used tests are the PSA blood test and the digital rectal examination. These tests, used separately or together, only show changes in the prostate. They do not diagnose prostate cancer. If either test shows an abnormality, you will usually have more tests.

Health professionals use Australian clinical guidelines to help decide when to use PSA testing and other early tests for prostate cancer.

• Prostate specific antigen (PSA) blood test – is a protein made by both normal prostate cells and cancerous prostate cells. PSA is found in the blood and can be measured with a blood test. The test result will show the level of PSA in your blood as nanograms of PSA per millilitre (ng/mL) of blood.
• Digital rectal examination (DRE) – to do a digital rectal examination (DRE), the urologist places a finger into your rectum to feel the back of the prostate. They will wear gloves and put gel on their finger to make the examination more comfortable.
• MRI scan
• Biopsy – small amounts of tissue are taken from the prostate using a special needle. The samples are sent to a laboratory, where a specialist doctor called a pathologist looks for cancer cells in the tissue.
• Bone scan – this scan can show if prostate cancer has spread to your bones.
• CT scan
• PET-CT scan

Waiting for the results can be a stressful time. It may help to call Cancer Council on 13 11 20.

Management and Treatment of prostate cancer

There are different options for managing and treating prostate cancer, and more than one treatment may be suitable for you. Your specialist will let you know your options. The treatment recommended by your doctor will depend on the stage and grade of the prostate as well as your general health, age and preferences.

• Active surveillance is a way of closely monitoring low-risk prostate cancer that isn’t causing any symptoms or problems. The aim is to avoid unnecessary treatment, while looking for changes that mean treatment should start. About 70% of Australians with low-risk prostate cancer choose active surveillance. Active surveillance usually involves PSA tests every 3-6 months; a digital rectal examination every six months; and repeat mpMRI scans and biopsies as advised by your urologist. Ask your doctor how often you need check-ups. If results show the cancer is growing faster or aggressively, your specialist may suggest starting active treatment.

• Watchful waiting is another way of monitoring prostate cancer. This approach may be suggested if you are older and the cancer is unlikely to cause a problem in your lifetime. It may be alternative to active treatment if the cancer is advanced at diagnosis. It can also be an option if you have other health problems that would make it hard to handle treatments such as surgery or radiation therapy. The aim of watchful waiting is to maintain quality of life rather than to treat the cancer. If the cancer spreads or causes symptoms, you will have treatment to relieve symptoms or slow the growth of the cancer, rather than to cure it.

• Surgery the main type of surgery for localised and locally advanced prostate cancer is a radical prostatectomy. This involves removing the prostate, part of the urethra and the seminal vesicles. After the prostate is removed, the urethra will be rejoined to the bladder and the vas deferens (tubes that carry sperm from the testicles to the penis) will be sealed.
• Radiation therapy also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill or damage cancer cells so they cannot grow, multiply or spread.
• Brachytherapy is a type of targeted internal radiation therapy where the radiation source is placed inside the body. Giving doses of radiation directly into the prostate may help to limit the radiation dose to nearby tissues such as the rectum and bladder.
• Androgen deprivation therapy (ADT) slowing the production of testosterone may slow the growth of the cancer or shrink the cancer temporarily. It is also known as hormone therapy.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.

To work out your prognosis, your doctor will consider test results, the type of prostate cancer, the stage, grade and risk category, how well you respond to treatment, and factors such as your age, fitness and your medical history.

Prostate cancer often grows slowly, and even the more aggressive cases of prostate cancer tend to grow more slowly than other types of cancer. Compared with other cancers, prostate cancer has one of the highest five-year survival rates if diagnosed early. Some low-risk prostate cancer grow so slowly that they never cause any symptoms or spread, others do not grow at all.

Support for Queenslanders

Whether you have been diagnosed with prostate cancer or have a family member or friend who is affected by cancer, there are times when you may need support. Our professional services and support programs are here to help you.

Find out more about:

• Phone support
• Email support
• Cancer counselling
• Practical and financial support
• Support groups
• Information sessions

You don’t have to face cancer alone – we’re here to help.

Resources

For more information on prostate cancer please see these resources

If you are a patient, family or friend and would like to order a copy of the Understanding Prostate Cancer booklet, please call Cancer Council 13 11 20