What is prostate cancer?
Prostate cancer is a condition that causes abnormal cells to develop within the prostate gland. These cells grow, divide and multiply, creating a tumour, and sometimes spread to other parts of the body.
Often, prostate cancer cells grow very slowly. They might not cause any problems or symptoms, or become life threatening; the majority of men with low grade prostate cancer live for many years without it spreading or becoming serious. Less commonly, the cancer cells grow quickly and can spread to other parts of the body. This type of high grade prostate cancer can be fatal. We don’t yet know why cancers grow at different rates, or why some tumours spread and others don’t.
Being diagnosed with prostate cancer can be a confronting and upsetting experience, but there are treatment options. It can help to speak with health professionals and counsellors, as well as family, partners and friends.
How common is it?
With the exception of some forms of skin cancer, prostate cancer is the most common type of cancer in men in Australia, with more than 19,000 Australians diagnosed each year. It’s more common in older men, particularly in those over the age of 50.
What causes prostate cancer?
We still don’t know what causes prostate cancer. However, there are some risk factors that have been linked with prostate cancer, including:
A history of low fertility levels
Many of these risk factors are unavoidable. But maintaining a healthy lifestyle with a balanced diet can help to avoid some of the risks.
What can I do if I’m worried?
If you’re concerned you might have prostate cancer, or just want a routine check-up, don’t put off a visit to the doctor.
Your doctor will conduct several tests to see if prostate cancer is likely. These might include a PSA test, a digital rectal examination, and an MRI scan. If these tests show worrying signs, your doctor might want to do a prostate biopsy (a small surgery that takes some body tissue samples for further examination) to confirm the diagnosis.
A PSA test measures the level of prostate specific antigen (PSA) in the blood. Prostate specific antigen is a protein made in the prostate gland. Low levels of PSA are normally found in the blood, but as you get older, the prostate often grows and the level of PSA gets higher.
A digital rectal examination (DRE) is where a doctor places a gloved finger into the rectum to feel for size, shape and outline of the prostate. Although the prostate sits below the bladder, it can be felt through the rectum.
A prostate MRI can see if a likely prostate cancer is visible and show its location in the prostate.
How is it diagnosed?
If your level of PSA or the DRE or the MRI aren’t normal, you’ll have a higher chance of finding prostate cancer when a biopsy is done. But if you have a regular feeling prostate and a slightly raised PSA level, it’s unlikely that a biopsy will discover cancer.
How do I decide whether to test for prostate cancer?
There are several things to think about before having a PSA test for prostate cancer such as, your age, level of concern, risk of having prostate cancer (e.g. family history), and the risk and benefits of finding it early. If the results from a PSA test are raised, you’ll need to make some decisions about what to do next.
The benefit of a PSA test is that it might discover prostate cancer when it’s small and can be cured. But there are risks, including the possible side effects of unnecessary surgery or radiotherapy for low risk cancers. Another option is active surveillance, where low risk cancer is closely monitored instead of being treated, which helps to lower the risks associated with surgery and radiotherapy. This means your doctors will only decide it needs to be treated if it starts to become a serious risk.
Why is a biopsy necessary to diagnose prostate cancer?
The PSA test is not a test specifically for cancer. The only way to make sure prostate cancer is present is by a biopsy. The biopsy will remove small tissue samples from the prostate, and is usually done by a urologist. The samples are then sent away to be studied at a lab.
How is the biopsy assessed?
If cancer cells are found in the biopsy, the tumour is given a grade by examining the sample through a microscope to see whether it looks like an aggressive or a slow-growing cancer.
The traditional grading scale used is called a Gleason score with scores from 6 to 10.
Aggressive or faster-growing cancers are more likely to affect your health and lifespan. These are called ‘high-risk cancers’, and usually have a Gleason score of 8 to 10.
A newer grading system is called the Grade Group system. It uses a scale of 1 to 5, with Grade Group 5 being the same as Gleason score 8-10.
What are the stages of prostate cancer?
Prostate cancer can be either ‘localised’ or ‘advanced’.
Localised prostate cancer is when the cancer is located only within the prostate.
Advanced (or metastatic) prostate cancer is when the cancer has spread to other areas in the body such as lymph nodes or bones. Sometimes the cancer can spread from the prostate to nearby tissues and organs, such as the bladder or rectum, which is described as ‘locally advanced’ prostate cancer.
What treatments are there?
Once a diagnosis of prostate cancer has been made, you and your doctor need to decide on what steps to take for management and treatment. There are different types of treatments you can have, depending on a number of factors, including:
Your Gleason score or Grade Group
Whether the cancer is localised or advanced
Your PSA level and the rate of change over time
Your age and general health
The treatments available for prostate cancer depend on the state of the disease. They include surgery, radiation therapy, chemotherapy and androgen deprivation therapy (ADT). ADT stops the production of male hormones called androgens, such as testosterone, or blocks these hormones from acting on the cells and tissues.
Being diagnosed and going through treatment for prostate cancer can be a confronting and upsetting experience. It’s important to reach out to family, friends and health professionals for support.
Your doctor’s appointment
Questions to ask your doctor
Should I be tested for prostate cancer?
If my PSA level is normal, what next?
If my PSA level is not normal, do I need to see a specialist? What tests might the specialist do?
Things to think about before your appointment
Do you have a family history of prostate cancer? i.e. father or brother.
What makes you concerned about prostate cancer?
Prostate cancer diagnosis
Prostate cancer treatment
How is prostate cancer diagnosed?
What is a prostate biopsy?
Understanding your prostate biopsy results
What are the different surgeries for treatment of prostate cancer?
What are the treatment options for prostate cancer?
What is active surveillance of prostate cancer?
What is radiation therapy for prostate cancer?
What is a PSA test?