Prostate cancer



Description

Prostate cancer is a relatively common type of cancer affecting the small walnut-shaped prostate gland located near base of the bladder found only in men. The gland surrounds the upper segment of the urethra, the tube that leads from the bladder to the penis. In more advanced stages of the disease the tumour may spread to other areas of the pelvis and may eventually metastasise to other areas of the body.

In Australia there are more than 17,400 cases of prostate cancer (nearly 30% of male cancers) are diagnosed each year. 85% of cases are diagnosed in men over 65 years. It is rare in men under 45 and quite common in men over 80. However, in older men the cancer is often small, restricted to the prostate and without symptoms.

Often, the first symptom of prostate cancer is difficulty in urination, as the growing tumour constricts the urethra. Frequent urination (especially at night); a weak or interrupted urine stream; pain or burning upon urination or ejaculation; pus or blood in urine or semen; and discomfort in the lower back, pelvis or upper thighs, are also symptoms of the disease. Other conditions, such as urinary-tract infections, benign enlargement of the prostate (benign prostatic hypertrophy or BPH), and sexually transmitted diseases can also cause some of these symptoms. A doctor is best able to evaluate your symptoms and request the tests necessary to make a diagnosis.


Tests to diagnose and monitor the condition

The tests most commonly used to investigate men with symptoms suggestive of prostate cancer are rectal examination and the prostate-specific antigen (PSA) blood test. To perform a rectal examination, the doctor inserts a gloved, lubricated finger into the rectum (back passage) and feels the prostate gland with his or her finger for localised hardness or nodules. For the PSA test, blood is taken and sent to a clinical laboratory. There the blood is examined for an increased level of the serum marker associated with prostate inflammation or cancer.

While the PSA level is raised in up to eighty percent of prostate cancers, an abnormal result is not a cancer diagnosis. In fact, two-thirds of men with a raised serum PSA level do not have prostate cancer, although other abnormalities requiring treatment may be the cause of a raised PSA results. Rectal examination and PSA measurement can also assist in the early detection of benign prostatic hypertrophy (BPH). The current Australian position about the use of PSA to screen men without symptoms for prostate cancer is explained under Screening/Adults 50+.

Should you have symptoms described previously, be sure to let your doctor know. If your PSA and/or rectal examination have normal results, your doctor can recommend when re-testing is appropriate. If your results are abnormal, the PSA result should be confirmed and may include a Free/Total PSA measurement. Your doctor may then recommend further tests, such as a transrectal ultrasound-guided biopsy. This procedure allows a doctor to take tissue from the prostate for further study. It may be necessary to stop taking certain medicines up to ten days beforehand.

Once a diagnosis of prostate cancer is made, doctors may use a variety of tests to monitor the cancer, determine treatment options, and evaluate the effectiveness of a chosen course of treatment. In addition to using rectal examination and PSA for this purpose, tests using X-ray, ultrasound, magnetic resonance imaging (MRI) and tissue sampling may be used.


Treatment

Treatments for prostate cancer differ and are influenced by how much the tumour has spread outside the prostate (the ‘stage’ of the cancer) and by how aggressive or fast growing the tumour is found to be in a tissue sample (the ‘grade’ of the tumour). A doctor may use one or more of the tests discussed earlier to determine the stage of the tumour.

The decision to pursue one or a combination of treatments depends not only on the stage and grade of the tumour, but also on other factors such as the age of the patient and the patient's individual preferences.

Prostate cancer is typically treated using one or more of the following methods: ‘watchful waiting’, surgery, radiation therapy and hormone treatment. Chemotherapy is rarely used for prostate cancer, but may be used in advanced cases that are unresponsive to hormone therapy.

Watchful waiting, surgery and radiation are most often used when the tumour is contained and has not spread to other areas. As many prostate tumours grow slowly, a programme of watchful waiting may result in an unaffected life span that is largely symptom-free and uncompromised by side effects. This programme will be likely to include regular PSA testing and rectal examination.

Surgery can remove the entire tumour in early cases, and may be used to ease urination in more advanced cases. Cryosurgery, a relatively new surgical option, freezes and kills the affected tissue with liquid nitrogen. Radiation may be delivered as targeted rays from outside the body, or by inserting tiny radioactive seeds in the prostate, or by injection. Radiation can also be coupled with hormone treatment to provide pain relief.

Hormone therapy is most commonly used to treat prostate cancer that has metastasised to other areas of the body. While it is not a cure at this stage, the treatment can shrink tumours, relieve symptoms and extend the life of the patient. Hormone therapy is also used to treat less advanced stages of prostate cancer - either in conjunction with radiation therapy or to shrink a tumour prior to surgery. Men with decreased testosterone levels due to hormone treatment for prostate cancer are at an increased risk for developing osteoporosis. Your doctor can tell you whether you should undergo testing for such a loss in bone density, or whether measures or treatments to prevent osteoporosis should be considered.

The side effects of different prostate cancer treatments can range from none to fatigue, hair loss, incontinence and the inability to have an erection. Your doctor can make treatment recommendations based upon your test results and particular circumstances.


Related pages

On this site
Tests: Prostate-specific antigen (PSA), tumour markers
Conditions: Benign prostatic hypertrophy (BPH)
Other: Screening tests for adults (Ages 30-49)/Prostate cancer
Screening tests for adults (50 and up)/Prostate cancer

Elsewhere on the web
HealthInsite: Prostate diseases
Andrology Australia