Prostate cancer is a disease in which abnormal cells develop in the prostate, part of the male reproductive system. In Australia, it is the most commonly diagnosed cancer in men, affecting up to 1 in 7 men by the age of 75.

While high-grade prostate cancer spreads quickly and can be fatal, for most men it’s a slow-growing disease. With appropriate care, most men can live with prostate cancer for many years without serious consequences.

What is prostate cancer?

Prostate cancer occurs when cells in a man’s prostate gland grow in an unusual way to form an abnormal growth called a tumour. The prostate, normally a golf ball-sized gland that sits below the bladder, helps produce the fluid in semen. There are different kinds of prostate cancer. While most grow slowly and cause no symptoms for many years, some spread aggressively and can cause serious illness and death.

As you age, your prostate can also grow for other reasons, such as prostatitis (inflammation of the gland) or benign prostatic hypertrophy.  These conditions are common in older men.

What are the symptoms of prostate cancer?

Even if you have prostate cancer, you may not notice any symptoms unless the cancer grows large enough to cause problems.

Some symptoms of advanced prostate cancer include:

• needing to urinate frequently or suddenly
• finding it difficult to urinate (e.g. trouble starting, or being unable to urinate when the feeling is there or poor urine flow)
• discomfort when urinating
• finding blood in urine or semen
• pain in the lower back, upper thighs or hips

While these symptoms might not mean prostate cancer, if you notice any of them, check with your doctor.

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What causes prostate cancer?

While experts don’t fully know all the causes, a factor that increases your risk is obesity, which also increases the risk of aggressive prostate cancer.

Prostate cancer becomes more common with age. It is also more common if a close relative (e.g. a father, brother or son) was diagnosed with prostate cancer before 65 years of age.

Your ethnicity also affects your risk of getting prostate cancer. Men of Caucasian heritage are more likely to develop prostate cancer than Asian men, while men of African background experience the highest rates of death from prostate cancer.

In 1% to 2% of cases, men inherit genes (BRCA1 or BRCA2) that increase the risk of developing prostate cancer. These are the genes that can also cause women to have an increased risk of breast or ovarian cancer.

When should I see my doctor?

See your doctor if you notice any unusual or ongoing changes in your toilet habits (e.g. when you urinate). Most often, these won’t mean you have cancer, but finding cancer early improves the odds of treating it successfully.

If you don’t have any symptoms but are concerned about your risk, your doctor can also explain the risks and benefits of prostate cancer screening, such as having a PSA test.

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How is prostate cancer diagnosed?

There are several tests your doctor may perform to check your prostate:

• Digital rectal examination (DRE): Your doctor inserts a gloved, lubricated finger into your rectum to feel the prostate’s size and check for anything unusual.
• Prostate Specific Antigen (PSA) test: A simple blood test to measure a protein produced by your prostate. A high PSA might be a sign of prostate cancer, or another condition.
• MRI scan: A detailed scan of your prostate to help identify signs of cancer.

While these tests are helpful, a prostate biopsy is the only way to confirm a diagnosis of prostate cancer. A urologist, who your doctor will refer you to, removes some cells from your prostate using a thin, hollow needle. The cells are then examined under a microscope to check for cancer.

Confirmed prostate cancer is graded on a scale of 1 to 5 (known as a grade group system), based on how likely the cancer is to grow and spread to the rest of the body. Grade groups 4 to 5 are considered high risk.

An older system of grading, known as the Gleason score, grades the cancer from 1 to 10. A Gleason score of 8 to 10 is considered high risk.

Should I get prostate cancer screening?

You may have wondered why there is no nationwide prostate cancer screening program in Australia (like the programs for breast and bowel cancers). That’s because experts do not recommend routine prostate cancer screening if you’re aged between 50 and 69, healthy, and don’t have a family history of prostate cancer.

There are several reasons for this:

• A high PSA level can be a result of something other than cancer.
• Experts don’t fully agree on what is a normal or abnormal PSA level.
• Most men with a slightly raised PSA level have a biopsy that confirms no cancer.
• Many prostate cancers are low risk, slow growing, and are unlikely to cause harm if left untreated.
• Testing and treating low risk, slow growing cancers may cause more harm than good.

You should speak to your doctor if you have a family history or ongoing symptoms of prostate cancer, such as difficulty passing urine. Your doctor can help you make an informed decision about whether prostate cancer screening is suitable for you.

How is prostate cancer treated?

Treatment options for prostate cancer depend on several factors:

• whether the cancer is high risk (based on the grade group, or Gleason score)
• the stage of the cancer — whether it is only found in the prostate or has it spread (metastasised) to elsewhere in the body?
• the PSA level and how fast it might be changing
• age and general health
• side effects of treatment
• personal preference

Your doctor will recommend one or more of the following options if you have prostate cancer:

Watchful waiting

Instead of treatment, a localised cancer is monitored with regular PSA testing to ‘watch’ for any changes over time. This approach is typically used for men over 75 years of age or those who have other health problems to avoid the unwanted side effects of more invasive treatments such as surgery and radiotherapy.

Active surveillance

This involves a combination of regular PSA testing and repeat MRIs and/or biopsies to check the progress of a cancer. This approach may be suitable where there is a low risk, slow-growing prostate cancer. Only a small number of men with low-risk cancer will develop a more aggressive disease.

Radical prostatectomy

This is a surgical operation to remove the prostate gland and some of its surrounding tissue. It can be an open procedure or performed with a laparoscope (keyhole surgery).

Radiation therapy (radiotherapy)

Radiation therapy (radiotherapy) involves doses of radiation being delivered to the prostate, either from the outside (external beam radiation therapy) or by using an internal implant (brachytherapy).

Medication

Androgen deprivation therapy (ADT) is sometimes used together with radiotherapy if the cancer has spread to the rest of the body. ADT works by blocking the production of testosterone,  a male hormone, or its effects. This will cause most prostate cancers to shrink or stop growing. However, after some time — the period is different for every man — the prostate cancer may become sensitive to remaining testosterone and re-grow (castrate-resistant disease).

Each treatment has its advantages and drawbacks, so it’s important to speak with your doctor or specialist if you have any questions or concerns.

Are there complications of prostate cancer and treatment?

Treatments can cause side effects, including:

• Erectile dysfunction: More than 3 in every 4 men have problems with getting and keeping an erection after surgery. However, this can be minimised using nerve-sparing surgery techniques. Erectile dysfunction is also common after radiation therapy and ADT. There are effective treatments for erection problems.
• Poor bladder control (urinary incontinence): 5% to 10% of men have problems with urine leakage within one year after prostate removal.
• Urinary urgency: Radiation therapy can cause damage around the prostate, making you feel like going to the toilet more often.

Men who take ADT may also experience a reduced sex drive and hormone-related effects such as hot flushes, tiredness and sweating, loss of body hair and osteoporosis. ADT can also result in reduced muscle strength, an increased risk of getting heart disease and memory loss.

Living with prostate cancer

Receiving a diagnosis of prostate cancer can be alarming — studies show that the risk of suicide and cardiovascular disease goes up in the week after someone is told they have prostate cancer.

If you feel anxious, frustrated or upset about how prostate cancer may be affecting your life, talk with your doctor, partner or friend and get support.

Resources and support

For more information and support, visit:

• The Prostate Cancer Foundation of Australia website has information about prostate cancer and advice on living with prostate cancer in general
• Healthy Male (Andrology Australia) has a range of videos and other resources
• RACGP has a factsheet explaining the pros and cons of PSA testing
• The Cancer Council website describes each step of the prostate cancer pathway

 

Other languages

Do you prefer other languages than English? These websites offer translated information about prostate cancer:

• Multicultural Health Communication Service
• Health Translations Victoria