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Prostate cancer

Prostate cancer affects so many Australian men and their families – one in nine men will develop the condition in their lifetime.

What is prostate cancer? 

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.

The position of the prostate gland and surrounding structures

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

Prostate cancer is the second most common form of cancer affecting Australian men after skin cancer. Each year in Australia, around 3,000 men die of prostate cancer - equivalent to the number of women who die from breast cancer annually.

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What are the symptoms? 

If the prostate cancer grows to involve or place pressure on the bladder outlet or the urethra , it may cause the following symptoms:

  • 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

If prostate cancer spreads, it can cause swollen glands, bone pain, weight loss, anaemia, fatigue, shortness of breath and other symptoms, depending on where it spreads. If you experience any of these symptoms, speak to your doctor.

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What can increase my risk of developing prostate cancer? 

Age and family history are the strongest risk factors for prostate cancer in Australia.

  • Family history. If an immediate relative (father or brother) has had prostate cancer, you have a two-and-a-half time greater risk.
  • Age. Prostate cancer is rarely diagnosed before the age of 40, and the majority (>85 percent) are diagnosed in men over age 65.

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Screening for prostate cancer 

There are two types of tests commonly used to screen 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.
  • 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.

It is important to know that there are no uniformly agreed upon recommendations on the use of these tests because it is not known if their benefits outweigh potential harms. There are a number of pros and cons to these tests and it is important to discuss these with your doctor so you can make a decision that is right for you and takes into account your age, preferences and personal health risks.

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More information about PSA testing 

 

The prostate specific antigen (PSA) blood test is one test that may alert you and your doctor of an increased risk for having developed prostate cancer, earlier than you would otherwise have been able to detect the disease. It is not, however, specific for cancer. To assess the difference, a biopsy is needed to tell if cancer is present after a positive PSA test.

What are the benefits and risks of PSA testing?

The main benefit claimed for PSA testing is that it can help identify an increased risk of prostate cancer at an earlier stage when it may be symptomless and before it has spread outside the prostate gland.

The main risk of PSA testing is that PSA levels are raised in many people who don’t have cancer. Around three in four positive tests will occur in men who do NOT have prostate cancer. Also, the PSA test can miss some cancers. That means even with a normal PSA test, some men will still have cancer that may go undetected at the time.

This is why PSA testing has not been recommended as a routine screening test for the general population of men, unlike mammography in women of certain ages for breast cancer, or screening for bowel cancer.

Most importantly, the evidence that PSA testing reduces the number of men who die from prostate cancer is not established. While many doctors believe that it does, large reviews by well-respected bodies, including Australia’s National Health and Medical Research Council (NHMRC), suggest it remains unproven. On balance, the unwanted side effects of investigations and treatments for prostate cancer may be creating more problems than would have been the case if the PSA testing had not been done.

Talk to your doctor about PSA testing

It is important you understand the risks and benefits of have a PSA test before you have one. It is recommended you talk to your GP before having the PSA test to clarify any concerns or questions you may have.

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How is prostate cancer treated? 

A diagnosis of prostate cancer is usually confirmed 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.

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

  • 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 of surgery.
  • Surgery - through the urethra (the tube that carries urine from your bladder and out through the penis), with the surgeon holding the tools directly or by keyhole approach.
  • Radiotherapy (radiation therapy) - including implanted radiation beads, proton or photon beam radiation.
  • Chemotherapy
  • Hormone therapy

Some treatments for prostate cancer can have potential adverse effects such as impotence or urinary incontinence (reduced control of urination). Talk to your doctor about your preferences and values when discussing treatment options.

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 93 percent living beyond 10 years and 77 percent beyond 15.

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.

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Further information 

Cancer Council
www.cancer.org.au

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

Sources 

Australian Institute of Health and Welfare (AIHW). Australia’s Health 2012. Australia's health no. 13. Cat. no. AUS 156. Canberra: AIHW.

Cancer Australia and Cancer Council Australia. Review of national cancer control activity in Australia. Canberra: Cancer Australia. 2010.

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/

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.

National Cancer Institute. Prostate-Specific Antigen (PSA) Test. [online] Bethseda, MD: National Institutes of Health [last reviewed 24 Jul 2012, accessed 14 Aug 2012] Available from: http://www.cancer.gov/

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

Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice (The Red Book). 7th ed. [Online] South Melbourne, VIC: RACGP. 2009 [accessed 23 Aug 2012] Available from: http://www.racgp.org.au/redbook/.

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Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

Bupa Australia Pty Ltd makes no warranties or representations regarding the completeness or accuracy of the information. Bupa Australia is not liable for any loss or damage you suffer arising out of the use of or reliance on the information. Except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health. For more details on how we produce our health content, visit the About our health information page.

Last published: 31 August 2012