Prostate cancer in men

Prostate cancer develops when abnormal cells in the prostate gland start to grow more rapidly than normal cells, and in an uncontrolled way. Most prostate cancers grow more slowly than other types of cancer, although this is not always the case.

Early (or localised) prostate cancer means cancer cells have grown but, as far as it is possible to tell, have not spread beyond the prostate.

If the cancer grows and spreads outside the prostate gland into the seminal vesicles (glands that lie close to the prostate) or nearby parts of the body, such as the bladder or rectum, it is locally called advanced prostate cancer. Metastatic prostate cancer is when the cancer has spread to distant parts of the body such as the lymph glands or bones.

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How common is prostate cancer?

Prostate cancer is the most common cancer in Queensland men. There are about 3900 new cases in Queensland every year. One in five men in Australia are at risk of developing prostate cancer before the age of 85. It is uncommon in men younger than 50, although the risk increases in younger men who have a strong family history of prostate cancer, breast cancer or ovarian cancer.

Risks factors of prostate cancer

While the causes of prostate cancer are unknown, your risk of developing prostate cancer increases:

  • As you get older – prostate cancer is mainly diagnosed in men aged 60-79.
  • If your father or brother has had prostate cancer – your risk is twice that of other men.
  • If you have a strong family history of breast or ovarian cancer, particularly BRCA1 and BRCA2 gene mutations.
  • If you have an inherited gene that increases your risk – multiple relatives on the same side of the family with prostate, breast and/or ovarian cancers; a male relative under 50 with prostate cancer.

If you are concerned about your family history, your GP can advise you on the suitability of PSA testing for you and your family. For more information call Cancer Council 13 11 20.

Symptoms of prostate cancer

Early prostate cancer rarely causes symptoms. Even with advanced prostate cancer there may be no symptoms. Where symptoms do occur, they are often due to non-cancerous conditions, such as benign prostate hyperplasia (BPH).

Symptoms may include:

  • Feeling the frequent or sudden need to urinate
  • Pain in the lower back/pelvic area or sciatica
  • Unexplained weight loss
  • Weak urine flow
  • Leakage after urination
  • Difficulty starting to urinate
  • Incomplete emptying of the bladder

These symptoms are not always a sign of prostate cancer, but you should speak with your doctor if you are concerned and or are experiencing any of these symptoms.

Diagnosis

There is no single, simple test to detect prostate cancer.

Two commonly used tests are:

  • PSA Blood test – to measure prostate specific antigen (PSA), a protein made by both normal prostate cells and cancerous prostate cells. PSA levels are measured by a blood test.
  • Digital rectal examination – involves a doctor inserting a gloved finger into your rectum to feel the back of the prostate gland.

These tests, used separately or in combination, can only indicate changes in the prostate gland. They are not diagnostic tests. If either show an abnormality your doctor will refer you to a urologist for further evaluation.

Further tests include :

  • Biopsy – small amounts of tissue are taken from different parts of your prostate using a special needle, and are then sent to a lab where a pathologist examines the tissue.
  • Blood tests – may be taken regularly to monitor your PSA level.
  • Bone scan – this scan can show whether the cancer has spread to your bones.
  • MRI scan
  • CT scan
  • PET scan

Some tests may be repeated during or after treatment to check how well the treatment is working. Waiting for the test results can be a stressful time. It may help to talk to a friend or family member, a healthcare professional, or call Cancer Council on 13 11 20.

Treatment of prostate cancer

There are different options for managing and treating prostate cancer. For some men immediate treatment is not required or may not be appropriate. Your treating specialist will advise you of your options based on your age, general health, the stage and grade of the prostate cancer, the severity of the symptoms and the likely side effects.

  • Active surveillance – is a way of monitoring prostate cancer that isn’t causing any symptoms or problems and is considered to be low risk. Typically it involves PSA tests every 3-6 months, rectal examination every 6 months, multi-parametric MRI scans, and biopsies at 12 months and three years. Active surveillance may be a preferred option if the possible side effects of treatment would have more impact on your quality of life than the cancer itself.
  • Watchful waiting – is a way of monitoring prostate cancer that involves regular PSA tests and clinic check-ups. It may be suitable for older men where the cancer is unlikely to cause a problem in their lifetime, or where other treatments such as surgery or radiotherapy may not be appropriate.
  • Radical prostatectomy – removal of the prostate gland, part of the urethra and the seminal vesicles, and for more aggressive cancer, the adjacent lymph glands may also be removed. Your doctor may suggest surgery if you have early prostate cancer, are fit enough for surgery and expect to live longer than 7-10 years.
  • Radiotherapy
  • Brachytherapy
  • Androgen deprivation therapy – slowing the production of testosterone may slow the growth of the cancer or shrink it temporarily

For more information on the management or treatment of prostate cancer please refer to the Understanding Prostate Cancer booklet.

Prognosis

Prognosis means the expected outcome of a disease. Generally, prognosis is better when the prostate cancer is diagnosed while it is early stage, and at a lower grade. You will need to discuss your prognosis with your doctor, however it is not possible for any doctor to predict the exact course of your disease.

To assess your prognosis, your doctor will consider your test results, the extent of the spread of the cancer, and factors such as your age, level of fitness, medical history and family history. These factors will also help your doctor advise on the best management or treatment options and tell you what to expect.

Prostate cancer often grows slowly and even more aggressive prostate cancer grows more slowly than other types of cancer. Compared with other cancers, prostate cancer has one of the highest five-year survival rates. For many men, the prostate cancer grows so slowly that it never needs treatment. Many men live with prostate cancer for many years without any symptoms and without it spreading.

Support

Whether you have been diagnosed with a 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.

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

For more information on prostate cancer please refer to the Understanding Prostate Cancer booklet. You can download the PDF or order a hard copy.