Prostate Cancer

"Prostate cancer affects so many Australian men and their families. We encourage everyone to have an annual general health check which may include a prostate check for men over 45. Ladies, please encourage the men in your life to have this simple health check." Dr Christine Bennett, MBF's Chief Medical Officer.

What is prostate cancer?

After skin cancer, prostate cancer is the most common form of cancer affecting Australian men, with around one in 11 men likely to be diagnosed with the condition by age 75.

The prostate is a small gland, normally about the size of a walnut that is found just behind the scrotum and below the bladder. Its function is to produce seminal fluid and control urinary flow.

Prostate cancer is a malignant growth within the prostate gland when cells have begun to reproduce abnormally to form a cancerous lump or tumour. The cause is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels.

Generally prostate cancers are slower growing than many other cancers but they can still spread to other parts of the body, especially the bones and the liver. Even so, not all prostate cancers are the same and some can grow very quickly and aggressively.

What are the symptoms?

If the prostate cancer grows to involve the urethra (urine tube) or the bladder outlet, it may cause the following symptoms, depending on where it spreads:

difficulty urinating
decreased force of the urine stream
urinating more often than usual
urgency - an intense need to urinate
urinary retention - a usually sudden inability to pass urine
repeated urinary tract infections
blood in the urine or semen
fatigue

If prostate cancer spreads it can cause lymphadenopathy (swollen glands), bone pain, weight loss, anaemia, shortness of breath and other symptoms.

How do I know if I'm at risk?

Family History - if you have an immediate relative (father or brother), the risk increases by 5 to 10 times;
Age - prostate cancer is seldom diagnosed before the age of 40, and more than 75% of all prostate cancers are diagnosed in men over age 65;
Race - some racial groups (eg. African Americans) are at much higher risk than Asians and Caucasians;
Ethnicity - the disease is common in North America and North-Western Europe and is less common in Asia, Africa and South America
Fat intake and meat - a diet rich in fat especially smoked and burned meat, and low in fresh fruit and vegetables has been associated with an increased risk of prostate cancer.

How is it diagnosed?

Three tests are commonly used to detect prostate cancer:

Rectal examination - by ultrasound examination and/or the doctor places a gloved finger in the rectum and feels the prostate directly. This may reveal an enlarged, hard-feeling prostate gland. This should be done as part of an annual general health check for men over the age of 45.
PSA (prostate specific antigen) levels - measured by a blood test. This is often used to monitor the progress of the disease or of the treatment, or to confirm suspicions raised during rectal examination. Its value as a stand-alone test remains controversial.
Biopsy - some tissue from the prostate is removed for testing.

Doctors often use the three factors - stage, grade and PSA levels - to describe the extent of prostate cancer. The combination of these three factors assists with estimates about the type of cancer and the likelihood of it spreading.

Stage - refers to whether the cancer has already spread and if so, to where;
Grade - refers to the aggressiveness of the tumour - how quickly it is likely to grow or spread based on the microscopic appearance of the cells from the biopsy;
PSA Levels - 'prostate specific antigen' is a protein that is created with assistance from the prostate gland and a high PSA level may sometimes be a sign of cancer.

How is it treated?

The choice of treatment tends to be strongly influenced by both a patient and their clinician's personal preferences or experience. However a number of factors are considered when planning treatment options. These may include:

The stage, extent, size and grade of the cancer
The expected speed of growth and spread of the cancer
Whether the cancer has spread to other parts of the body
PSA levels
Age and life expectancy
General health and underlying health conditions
Willingness to risk side effects
Most recent evidence comparing the outcomes and the risk of complications of the various options

Treatment for prostate cancer commonly includes a combination of some or all of the following:

Surgery - through the urethra, direct, or by keyhole approach
Radiotherapy (radiation therapy) - external or internal, including brachytherapy (implanted radiation beads), proton or photon beam radiation
Chemotherapy
Hormone therapy
Watchful waiting - doing nothing immediately but monitoring the cancer closely (because it can be such a slow growing tumour many men will be advised that it may be sensible to monitor the tumour, subject to it growing more quickly than anticipated but avoid any potential side effects by delaying surgery.)

What are the treatment outcomes?

Nearly all patients who present with localised prostate cancer will live beyond 5 years, with the 10 and 15 year survival rates being 93% and 77% respectively. ¹

A recent international study has shown that compared with other standard treatments, such as watchful waiting and hormonal therapy, surgery may offer a better chance for long-term survival among patients with localised prostate cancer especially younger men. However, "the effect of treatment on prostate cancer mortality at short- and long-term is only one of the aspects to take into consideration when deciding the best treatment approach for a patient with localised prostate cancer." ²

Where do I go for more information?

For more information talk to your GP

Cancer Council at www.cancer.org.au

Prostate Cancer Foundation of Australia www.prostate.org.au

Sources

1. The Cancer Council of Australia (www.cancer.org.au)

2. Medscape (http://www.medscape.com/viewarticle/564292)

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