Prostate cancer

What is prostate cancer? 

After skin cancer, prostate cancer is the most common form of cancer affecting Australian men - one in nine men will develop the condition in their lifetime. Each year in Australia, close to 3,300 men die of prostate cancer - equal to the number of women who die from breast cancer annually. However, with greater awareness and regular checks this number could be reduced.

The prostate is a small gland, normally about the size of a walnut, which is found just behind the scrotum and below the bladder. Its function is to produce seminal fluid and control urinary flow. A number of conditions can affect the prostate, with the most common being benign prostate enlargement, infection, pain and cancer.

Prostate cancer is a malignant growth inside the prostate gland. It occurs when the cells of the prostate multiply abnormally, forming a cancerous lump or tumour. The causes of prostate cancer are unclear, but some studies have shown a relationship between high amounts of fat in the diet and increased testosterone levels with the cancer.

Generally prostate cancers are slower growing than many other cancers. But not all prostate cancers are the same and some can grow aggressively (very quickly), spreading to other parts of the body, especially the bones and the liver.

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
• An urgent and intense need to urinate
• An inability to pass urine (urinary retention)
• Recurring 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.

What can increase my risk of developing prostate cancer? 

• Family history. If an immediate relative (father or brother) has had prostate cancer, your risk increases by five to 10 times.
• Age. Prostate cancer is seldom diagnosed before the age of 40, and more than 85% of all prostate cancers are diagnosed in men over age 65.
• Race and ethnicity. The risk varies by race and ethnicity, with African Americans at much higher risk than Asians and Caucasians. And the disease is more common in North America and North-Western Europe than in Asia and South America.
• Fat meat intake in diet. A diet rich in fat especially from smoked and burned meat, and low in fresh fruit and vegetables has been associated with an increased risk of prostate cancer.

How can my doctor test for prostate cancer? 

Your GP can carry out two simple tests to determine if you need any further investigation for prostate cancer.

• Digital rectal examination (DRE). 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.
• Prostate specific antigen (PSA) blood test. This blood test measures the level of PSA, a protein that is created with assistance from the prostate gland. However, the prostate usually grows larger as a man ages, increasing the amount of PSA produced. An unusual age-specific increase in PSA indicates there may be something affecting the prostate, but it doesn't necessarily point to cancer. That's why this test is usually done in combination with the DRE to make it more sensitive for prostate cancer detection.

More about PSA testing

The value of PSA-based testing as a standalone test or screening for prostate cancer is still being debated. It's currently not recommended as a routine screening for the general population, unlike screening for breast and bowel cancers.

However, there is growing evidence that PSA based testing can reduce prostate cancer mortality and should be offered to appropriately selected patients. Recent research suggests that a one-off prostate screening before the age of 50 can help predict a man's long-term risk of developing the cancer, giving patients and doctors the chance to more closely monitor those who are at ‘high risk' to detect any disease early.

The Urological Society of Australia and New Zealand (USANZ) recommends that men have a single PSA test and DRE at or beyond age 40 to give them an estimate of their prostate cancer risk over the next 10 to 20 years. This can help their doctor determine how frequently and closely they need to be monitored. It should also help reduce over-diagnosis in men at low risk of prostate cancer and improve compliance with screening in men who will benefit the most.

How is prostate cancer treated? 

First, a diagnosis of prostate cancer should be confirmed, usually with ultrasound examination and a biopsy that takes a sample of tissue from the prostate for testing. Doctors will then often use three factors - stage, grade and PSA levels - to describe the extent of prostate cancer.

• 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 - as mentioned before, a high PSA level indicates an abnormality of the prostate and may sometimes be a sign of the extent of the cancer.

The combination of these three factors assists with estimates about the type of cancer and the likelihood of it spreading, which in turn helps you and your doctor make decisions about appropriate treatment. A number of other factors are usually considered when planning treatment options and may include:

• your age and life expectancy
• your general health and underlying health conditions
• whether you're willing to risk side effects
• the most recent evidence available comparing the outcomes and the risk of complications of the various options.

The choice of treatment tends to be strongly influenced by both you and your doctor's personal preferences or experience.

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 - because it can be such a slow growing tumour, many men may be advised to do nothing immediately but monitor the tumour closely. While the cancer may grow more quickly than anticipated, by waiting you may avoid any potential side effects by delaying surgery.

What are the treatment outcomes?

According to the Cancer Council, nearly all patients who have prostate cancer that hasn't spread aggressively will live beyond five years, with the 10 and 15 year survival rates being 93 percent and 77 percent respectively.

Some international research has shown that compared with other standard treatments, such as watchful waiting and hormone therapy surgery may offer a better chance for long-term survival among patients with localised prostate cancer, especially for younger men. However, your mortality risk in the short and long-term should be taken into account, along with other considerations, when you and your doctor discuss what treatment options are right for you.

Further information 

Cancer Council
www.cancer.org.au

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

Sources 

Cancer Council Australia. Prostate cancer. [online] Surry Hills, NSW: Cancer Council [last updated 20 Jun 2011, accessed 24 Jun 2011] Available from: www.cancer.org.au/aboutcancer/cancertypes/prostatecancer.htm

Merglen A Schmidlin F Fioretta G et al. Short- and long-term mortality with localised prostate cancer. Arch Intern Med. 2007; 167(18): 1944-1950.

The Urological Society of Australia and New Zealand (USANZ). USANZ revised policy on PSA screening. [online] Edgecliff, NSW: USANZ. 2009 [accessed 24 Jun 2011] Available from: http://www.usanz.org.au/USANZ-2009-psa-testing-policy

Prostate Cancer Foundation of Australia (PCFA). Prostate Cancer Statistics. [online] St Leonards, NSW: PCFA. c2011 [accessed 24 Jun 2011] Available from: http://www.prostate.org.au/article Live/pages/Prostate-Cancer-Statistics.html

Disclaimer
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