Prostate cancer

About prostate cancer | Reduce your risk | Screening | Diagnosis | Treatment | Coping with cancer | Support services | More information and resources

About prostate cancer

The Prostate

The prostate is a small gland that sits below the bladder and is found only in men. A normal prostate is about the size of a walnut and feels rubbery and smooth. The prostate gland produces most of the fluid that makes up semen. It surrounds a tube called the urethra, which carries urine (from the bladder) and semen (from the prostate and other sex glands) through the penis and out of the body.

Male reproductive system

Image courtsey of Cancer Council Victoria

Prostate Cancer

Prostate cancer is the uncontrolled growth of cells in the prostate. 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 prostatic hyperplasia' (BPH).

Benign means non-cancerous and hyperplasia means to get bigger. BPH is far more common than cancer of the prostate. Sometimes however, the growth that constricts the urethra can be malignant (cancer).

How common is it?

Prostate cancer is the most common cancer affecting men in Western Australia. In 2014, 1945 men were diagnosed with prostate cancer.

The chances of getting prostate cancer by the time you are aged 75 (lifetime risk) is 1 in 8. This means for every 8 people one person will get prostate cancer. In 2014, 231 Western Australian men died from prostate cancer.1

Risk factors

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, including being a man, which can increase your risk of developing 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 was diagnosed with prostate cancer at a young age or you have a strong family history of breast cancer your chances of developing prostate cancer are 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.

Symptoms

Prostate cancer in the early stages rarely has symptoms. Symptoms usually develop later, in older men, but if you are experiencing the following you should contact your doctor promptly:

  • A weak or 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 (termed indolent), but in others it can grow very fast (termed aggressive).

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.

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Reduce your risk

Through our prevention and education programs the Cancer Council WA encourages Western Australians to lead a healthier lifestyle and reduce their cancer risk by:

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Screening

Presently, it is not clear from a number of international trials whether the benefits of screening for prostate cancer outweigh any harms. Based on the current evidence the Cancer Council WA does not support routine screening for prostate cancer. 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.

Cancer Council recommends that you discuss your options with your doctor, or contact Cancer Council 13 11 20 for more information.

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Diagnosis

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, but is normally contained within 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. A value around 4 ng/ml or less is less likely to be of concern.

    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 (BPH). It is also raised in prostate cancer. Some men with high PSA levels do not have prostate cancer and some men with prostate cancer do not have elevated 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 (TRUS) 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 to ask your doctor or specialist?

A cancer diagnosis can be very confusing time. There are many different cancers so it is important to find out information that is relevant to you.

There are several things you can do to help prepare for your appointment and to improve your understanding.

  • It can be helpful to write a list of questions to ask your doctor or specialist. You may need to ask for a longer appointment
  • Take some paper and a pen so that you can write down notes and instructions
  • Take a relative or friend with you for support - it can be helpful to have an extra person to hear what is being said and write down any notes
  • It may be helpful to record your visit - make sure you ask your doctor if it's okay. Remember, many smart phones and mp3 players can make audio recordings

This can be a worrying time. If you have any questions or concerns speak to your doctor or specialist, or call  Cancer Council on 13 11 20.

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Treatment

If you have been diagnosed with prostate cancer, you should expect to be cared for by a multidisciplinary team (MDT). This is a group of doctors and other health professionals who are experts in a specific cancer who work together to plan the best treatment for you. Everyone's treatment is different and depends on the type of cancer and how far the cancer has spread.

Prognosis

Prognosis means the expected outcome of a disease. In most cases, the earlier prostate cancer is diagnosed and treated, the better the outcome.

You may wish to discuss your prognosis and treatment options with your doctor, but it's not possible for any doctor to predict the exact course of your cancer. Test results, the type of cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and medical history are all important in assessing your prognosis.

Types of Treatment

The decision on how best to treat prostate cancer treatment will depend on your age, general health and the results of the tests on your cancer (for example, how advance it is). If you or someone you know has been diagnosed with cancer, you may have many questions and concerns and need more information to help you make decisions about your treatment.

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, also known as watchful waiting, is a treatment option available to many men. 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

  • Prostatectomy (also called radical prostatectomy or RP) is the surgical removal of the prostate. Sometimes the surrounding tissue will 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.
  • Nerve-sparing surgery involves the removal of the prostate and the preservation of the nerves controlling erections. These nerves can only be saved if the cancer has not spread along them and there were no problems with the nerves prior to surgery
  • Keyhole surgery (also called a laparoscopic prostatectomy or a robot-assisted laparoscopic prostatectomy) involves several small cuts being made in the skin and a small tube is passed into the abdomen. A small telescope with a camera attached (the laparoscope) is passed through the tube to allow the surgeon to see inside the abdomen. The prostate is cut away and removed through the tube.

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.

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.

Brachytherapy is a type of targeted internal radiotherapy where the radiation source is placed directly within a tumour. This allows higher doses of radiation to be given with minimal effect on nearby healthy tissues such as the rectum.

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.

Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life or reduce pain. There is no evidence that these therapies can cure or prevent cancer.
It is important to know that some complementary therapies have not been tested for side effects, may work against your medical cancer treatment and may be expensive. Let your doctor know about all complementary therapies you are thinking of using.
For more information about complementary therapies visit Memorial Sloan-Kettering Cancer Centre's About Herbs, Botanicals and Other Products.

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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.

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More information and resources

Cancer Council WA offers a range of support and information services to help cancer patients, their families and friends.

Cancer Council 13 11 20 is available to answer all of your questions about prostate cancer. You can call 8am-6pm Monday to Friday to speak to one of our experienced cancer nurses.

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References

  1. Cancer incidence and mortality in Western Australia, 2014. [Internet] Perth: Department of Health; 2015. http://www.health.wa.gov.au/docreg/Reports/Diseases/Cancer/WACR_Cancer_incidence_mortality_main_2014.pdf