Prostate Cancer
Prostate cancer is the most common cancer in men in WA with more than 1,600 men diagnosed with the disease every year.
The good news is that the five-year survival rate for WA men diagnosed with prostate cancer is now more than 90%.
- What is prostate cancer?
- What are the risk factors for prostate cancer?
- Is screening available for prostate cancer?
- How is prostate cancer diagnosed?
- What treatments are used for prostate cancer?
- How can I decide what treatment is best for me?
- Are there any workshops for men with cancer that I can go to?
- What other support services are available?
What is prostate cancer?
Prostate cancer is the uncontrolled growth of cells in the prostate, which is a gland found only in men. The prostate is about the size of a walnut. It lies below the bladder and surrounds the urethra, the tube that allows urine to pass out of the body. It is a reproductive gland that produces some of the nutrients that sperm need once they leave the body. Secretions from the prostate make up a large part of semen.
The most common problem associated with the prostate is enlargement of the gland. This commonly occurs when men get older. If the prostate becomes so large that it presses on the urethra, problems passing urine can occur. This is most commonly caused by a condition called ‘benign prostate hyperplasia' (BPH).
Benign means non-cancerous and hyperplasia means to get bigger. Benign prostate hyperplasia is far more common than cancer of the prostate. However, sometimes the growth that obstructs the urethra can be malignant (cancer).
Prostate cancer in the early stages rarely has symptoms. Symptoms usually develop in older men, but if you are experiencing the following you should contact your doctor promptly:
- A weak of hesitant stream when urinating
- A delay in starting when wanting to urinate
- A need to urinate more frequently
- A need to urinate frequently during the night (nocturia)
- Dribbling at the end of voiding
- Being unable to control the bladder (incontinence)
These symptoms are also very common in BPH as it is far more common than cancer of the prostate. Symptoms associated with advanced prostate cancer include:
- Painful ejaculation
- Blood in the urine
- Bone pain, particularly in the lower back
In some men prostate cancer can be slow growing, but in others it can be aggressive or grow very fast.
Localised prostate cancer is cancer that grows within the prostate. These early cancers often don’t produce symptoms and may never spread outside the prostate.
Locally advanced prostate cancer is cancer that has spread outside the prostate to the surrounding tissues and lymph nodes.
Metastatic prostate cancer is cancer that has spread from the prostate to other parts of the body, for example to the bones.
What are the risk factors for prostate cancer?
The cause of prostate cancer is still unknown and there is no clear prevention strategy to reduce the chances of developing this cancer.
There are a number of factors that, if you are a man, mean you may be more likely to develop prostate cancer. These include:
- Age. The main risk factor for developing prostate cancer is getting older. Prostate cancer is rare in men under 50 years of age.
- Family history. If your father or brother were diagnosed with prostate cancer at a young age, your chances of developing prostate cancer is increased. Having an elderly relative with prostate cancer is quite common and doesn’t increase your chances of developing the disease.
- Race. Prostate cancer is more common in people of African descent.
- Diet, physical activity and alcohol. Despite considerable research examining the link between these risk factors and prostate cancer, we are not able to say with any certainty if there is anything a man can do to reduce his risk of prostate cancer. There are however plenty of other reasons to eat a diet rich in fruit and vegetables, be physically active and avoid alcohol.
Is screening available for prostate cancer?
Presently, there is no reliable medical proof that screening for prostate cancer saves lives.
Based on current evidence the Cancer Council WA does not support routine screening for prostate cancer. However, we – along with other organisations such as the Urological Society of Australia and the Australian Prostate Cancer Collaboration – believe that men need to make their own decision about whether to be tested or not, after weighing up the pros and cons.
The Cancer Council recommends that you discuss your options with your doctor, or contact the Cancer Council Helpline on 13 11 20 for more information.
How is prostate cancer diagnosed?
There is no single, simple test to detect prostate cancer. There is also no way to test whether your prostate cancer will grow slowly or fast.
Tests used to diagnose prostate cancer include:
- Digital rectal examination (DRE). This involves your doctor inserting a gloved finger into your rectum to feel your prostate. It is possible to tell if the prostate is enlarged, but it is not possible to feel the entire prostate. A small cancer, or one that is out of reach, may be missed.
- Prostate specific antigen (PSA) test. This involves a blood test to measure the amount of prostate specific antigen (PSA) in your blood. Most of the PSA in your body is made by the prostate. There is no PSA level that is considered to be normal. This is because PSA levels increases with age and what is considered normal for one man will be different for another. However, a value around 4ng/ml or less is considered to be in the normal range.
The most likely cause of high PSA levels is some form of prostate disease. PSA can be raised in a range of benign (non-cancer) conditions, such as benign prostatic hyperplasia. It is also raised in prostate cancer. However, some men with high PSA levels do not have prostate cancer and some men with prostate cancer do not have high PSA levels.
- Prostate biopsy. If the digital rectal exam or prostate specific antigen test indicate that prostate cancer may be present, a prostate biopsy will be carried out. In this procedure, a trans-rectal ultrasound probe is placed in the rectum to give a picture of the prostate. Then, using the ultrasound picture as a guide, a needle is inserted through the wall of the rectum into the prostate and six or more tissue samples are taken. The tissue samples are examined in a laboratory for signs of prostate cancer. There is a risk of infection and bleeding associated with having a prostate biopsy and it is normal for a course of antibiotics to be prescribed.
What treatments are used for prostate cancer?
The decision on how best to treat prostate cancer will depend on your age, general health and how advanced your cancer is. Although nearly all treatments have side effects, most can be effectively managed. Ask your doctor to explain what side effects to expect and how best to manage these.
Treatments include:
- Active surveillance (watchful waiting) is sometimes a valid treatment option. This is where your doctor will just ‘watch and wait’ to see if the cancer grows. Some prostate cancers are slow growing and occur in older men. In this case, the cancer is not always a threat to life. As the possible side effects of prostate cancer treatment (impotence and/or incontinence) may have more of an impact on your life than the effect of the cancer you may decide that you don’t want to have treatment unless it is necessary. If you choose active surveillance, you will still need regular prostate tests, which may include repeated biopsies, to make sure things haven’t changed.
- Surgery is the removal of the prostate (prostatectomy). Sometimes the surrounding tissue may also be removed. Surgery requires on average three to six days in hospital, followed by about a six week recovery period. Surgery is an option if you have localised prostate cancer (cancer that has not spread outside the prostate gland) and you are well enough for surgery. If the cancer has spread outside the prostate gland, surgery is not normally an option, however other treatments are available.
- Radiation therapy uses x-rays to destroy cancer cells. Radiation therapy may be recommended to treat localised prostate cancer. It may be used instead of surgery or in combination with surgery. Radiation therapy can also be used to reduce the size of the cancer and relieve pain, discomfort or other symptoms.
- Hormone treatment involves reducing levels of the male hormone, testosterone, in your body to help slow the growth of the cancer. Testosterone levels can be reduced by taking drugs that stop the release of the hormones that cause your body to produce testosterone. Hormone treatment is often an option if the cancer has spread or if you are unsuitable for other treatment. Hormone treatment is not a cure for localised prostate cancer, but it will usually stop the prostate cancer from growing (remission). This remission can last several years.
- Chemotherapy is not routinely used in prostate cancer when it is first diagnosed, but may be offered if the cancer spreads and other treatments have not been effective.
- Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life and to reduce pain. However, there is no evidence that these therapies can cure or prevent cancer. It is important to remember that some of these therapies have not been tested for side effects, may work against other medical treatments and may be expensive. Let your doctor know about all complementary therapies you are thinking of using.
How can I decide what treatment is best for me?
There is no test available to tell the difference between prostate cancers that grow quickly and are life-threatening and those that grow slowly and don’t require treatment. This means you may end up having treatment you don’t need.
Diagnosis and treatment for prostate cancer is not without risk and can occasionally lead to complications, such as incontinence and loss of sexual function. Therefore it is important to understand the risks and benefits involved.
If you have the symptoms of prostate cancer, there is no doubt you need to see your doctor straight away to be tested. However, it is not easy to decide to be tested if you are healthy.
The decision should only be made when you are fully informed of all the facts. For more information speak to your doctor or call the Cancer Council Helpline on 13 11 20.
If you or one or more close relatives have had prostate cancer at a young age then you should consider being tested from the age of 45.
Are there any workshops for men with cancer that I can go to?
Look Good…Feel Better is a practical workshop for men with cancer designed to help men face cancer with confidence. It teaches you so much more than grooming techniques. It boosts self esteem and helps you to be confident and positive during cancer treatment.
In a relaxed and friendly workshop environment you will learn how to manage the changes that may occur to your skin, hair and general appearance as a result of your treatment.
Workshops are completely free of charge and available to men with a recent diagnosis of cancer, undergoing or about to undergo chemotherapy and/or radiotherapy treatment for cancer.
Experienced volunteers will help you learn how to care for your skin and minimise the appearance-related side effects of treatment. You will be shown creative and practical ways of dealing with possible hair loss.
Workshops last for approximately two hours and you are welcome to bring a friend.
To register for this fun and informative workshop please call 1800 650 960. Or call the Cancer Council Helpline 13 11 20 for details.
What other support services are available?
The Cancer Council WA offers a range of support and information services to help cancer patients, their families and friends.
Our Cancer Council Helpline 13 11 20 is available to answer all of your questions about prostate cancer. You can call 8am-8pm Monday to Friday to speak to one of our experienced nurses.
