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Prostate cancer is a tumour, or growth, that begins in cells within the prostate gland. Only men have a prostate and this walnut-sized and shaped gland lies at the base of the bladder and produces most of the fluid that makes up semen. A cancer is a malignant tumour that grows uncontrollably, invades locally and has the chance to spread to other sites in the body. There are many different types of cancer, defined both by where it starts from and how it behaves. Some other cancers usually grow quickly and are dangerous, but most forms of prostate cancer grow slowly and never cause harm. However, some prostate cancers do behave aggressively, can spread to other parts of the body and sadly can kill.
Prostate cancer is more common as men age and if you have one or more close relatives with prostate cancer – a father or brother diagnosed before 65 years of age. Also, like many cancers, smoking increases the risk of dangerous prostate cancer.
Interestingly, one observational study has demonstrated an association between frequency of ejaculation and a lower risk of prostate cancer. Although not conclusive, it is suggestive that regular ejaculation (in whatever manner is chosen…) may be protective and certainly not harmful (assuming that safe sex practices are followed, of course).
Rarely (in about 5% of cases) genetic factors also play a role in the developments of prostate cancer. In these cases, a family history of ovarian or breast cancers in close female relatives may also influence your risk. If you’d like more information on familial prostate cancer, please look at the NSW Health Department’s website at http://www.genetics.edu.au/Genetic-conditions-support-groups/prostate-cancer-screening
There may be none, and cancer may be detected incidentally (during investigations of different problems) or through opportunistic screening (see below).
Otherwise symptoms may include;
If you develop any of these symptoms, then you should see your GP urgently. Most people with the above symptoms won’t have prostate cancer, as they can also be seen in other less worrying conditions for example a simple urine infection, but it is important to get it checked out.
Depending on the circumstances your GP will take a full history and perform an examination. This will usually involve feeling your abdomen, performing a quick test on a urine sample and may involve a digital rectal examination of the prostate, but not always.
Screening means testing a group of people without symptoms with the aim of detecting disease in an early or latent phase before it can do harm. For a screening program to be successful, the testing itself must be acceptable to people and earlier detection ought to lead to a benefit that outweighs any potential harm. It is for this reason that decisions about active screening for prostate cancer has produced significant debate – because many prostate cancers that are detected are low risk and would never have caused any harm. Whereas the test itself, and possible subsequent treatment, can cause undue worry as well physical harm. Widespread population-based screening is therefore not currently recommended and there is no government or national prostate screening program like there is for other cancers like breast or bowel cancer.
Screening nowadays is generally with the PSA blood test.
The good news is that for asymptomatic screening, digital rectal examination, where a doctor inserts a finger into the rectum to palpate the prostate gland, is no longer recommended in addition to PSA testing. This is different to the situation where a man has symptoms suggestive of possible prostate cancer (see above).
Any man can choose to have prostate cancer screening or chose not to, but currently there is no evidence to suggest that young men need to consider PSA screening. For men aged 50-69 without a family history, the current benefit versus harm evidence is also unclear, but we do encourage all men to have a conversation with their GP about this and an individual decision can then be made.
The PSA test measures a protein present in all men called Prostate Specific Antigen. The PSA value rises slowly with age in all men, but if it is higher than expected it may mean that something is wrong with the prostate, but not necessarily cancer. It can also be raised in prostate infection (prostatitis) or even mild trauma to the prostate (it is slightly high in men that ride bicycles regularly for instance). Other drawbacks with PSA include the fact that it does not distinguish between aggressive cancers that can cause harm and the slow growing ones that won’t.
If the PSA is very high it will certainly need further testing, but often the level is only slightly raised and so the PSA is usually repeated after an interval to see if this is stable or only slowly rising (reassuring) or going up more quickly which may be a concern. Where the PSA level, or rate of rise, is a concern then next step is remove a sample of tissue from the prostate (biopsy) – this is performed by a specialist surgeon (urologist). Nowadays, other tests may be advised before the biopsy and may include an ultrasound or MRI of the prostate to locate precisely where any abnormal areas may be. The biopsy itself is performed under ultrasound guidance at the time.
If a prostate biopsy has confirmed prostate cancer, your surgeon will give you information about whether it is a low or high-risk cancer.
For low risk cancers, active surveillance or regular monitoring of the PSA is often all that is required since invasive treatment has the potential to cause more damage than the cancer itself would.
High-risk cancer may require treatment and in these cases the standard of care is for your surgeon to discuss treatment options in a multi-disciplinary team meeting before discussing treatment options with you. This meeting usually includes a urologist, a pathologist, a radiologist and oncologist as well as nurses and physiotherapists.
If active treatment is proposed this can be include one of, or a combination of;
Surgery and radiotherapy aim to remove and / or destroy prostate cancer cells to treat the cancer and put it into remission. Running alongside the prostate are nerves that are important for erections and continence. Although surgeons and radiation oncologists are very careful to avoid damaging these nerves, sometimes damage still occurs. Risks of urinary incontinence and erectile dysfunction after prostate removal is one of the reasons why it is not usually justified to remove low risk prostate cancers.
Exciting new technology like the DaVinci robot allow for greater preservation of these nerves in some case.
Since many prostate cancers are influenced by androgens (male hormones) drugs to block or inhabit these can be useful to control some prostate cancers or inhibit their growth in patients where surgery is not the best option
Should I have prostate cancer screening? Royal Australian College of General Practitioners patient information.
https://www.racgp.org.au/download/Documents/Guidelines/prostate-cancer-screening-infosheetpdf.pdf
NSW Health Centre for Genetics Education. Prostate Cancer Screening.
https://www.genetics.edu.au/individuals-and-families/prostate-cancer-screening
Frequent ejaculation may decrease prostate cancer risk
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