PROSTATE CANCER

GENERAL INFORMATION

The prostate is part of the male reproductive system and is a small, walnut-sized gland that sits below the bladder and in front of the rectum. The prostate gland secretes fluid that makes up part of the semen.

1 in 7 Australian men will develop prostate cancer before the age of 75 years. In 2009, there were 2030 new cases of prostate cancer diagnosed in Western Australia. Prostate cancer is the second most common cause of cancer-related death.

SYMPTOMS

Most men with prostate cancer have no symptoms or urinary issues. The diagnosis is usually made when a routine PSA blood test comes back high, or the prostate feels abnormal on examination. However, some of the symptoms include:

Blood in the urine or semen
Dull pain in the lower pelvic area
Problems with urination such as pain, burning, weakened flow and going often
General pain in the lower back, hips or upper thighs
Loss of appetite and/or weight
Persistent bone pain, especially at night

CAUSES

Scientists still do not know what triggers the start of a cancer, and why some people get cancer whilst others don't. However research shows that patients who develop cancer may have certain common characteristics (risk factors) that may or may not directly cause, but increase the chance of getting the disease.

For prostate cancer, these risk factors include:

Age – risk increases as you get older
World Region Location – more common in Western countries
Ethnicity – being African American doubles your risk
Family History – 2-11 times higher
Lifestyle – linked to smoking, obesity, high fat diet, lack of exercise
Vasectomy – controversial, most studies show no increased risk

DIAGNOSIS

Digital rectal exam – your doctor will check your prostate for hard or lumpy areas by inserting a lubricated, gloved finger into the bottom end.
PSA - blood sample is sent to the lab to measure the level of PSA, a substance produced by the prostate. A high level may be caused by prostate enlargement, inflammation or cancer.
Prostate biopsy – using an ultrasound probe to examine the prostate, tissue is taken from different areas in the prostate with a fine needle and checked for cancer cells by a pathologist.

MRI and bone scan – if cancer is diagnosed, these scans are used to stage the cancer (to see if it has spread to outside the prostate capsule, to the lymph nodes or bony skeleton).

MANAGEMENT

There are many treatment options for prostate cancer. Your doctor will take the following things into account before discussing your options:

Your age
Your general health
Your symptoms
The grade of your tumour (Gleason score)
The stage of your cancer (localised, locally advanced or metastatic)

The treatment options include:

Active surveillance
Surgery
Radiation therapy
Watchful waiting
Hormone suppression therapy
Chemotherapy

Active surveillance is suitable for men who have insignificant cancer, as the risks and side effects of treatment may outweigh the benefits. The aim is to monitor the cancer closely with prostate exams and PSA tests every 3 to 6 months, and intervene when the cancer shows signs of progression. Prostate biopsies are usually done every 1-2 years, or if there are concerns If your prostate feels abnormal, your PSA rises, the Gleason score rises or you develop symptoms, then you can start the appropriate treatment.

Surgery is one of the two main options to cure men who have low to intermediate prostate cancer. The entire prostate gland is removed, together with the pelvic lymph nodes if there is a worry that the cancer has spread. There are several ways to remove the prostate: open surgery (through a large incision), laparoscopic surgery (through small cuts) or robotic surgery (through small cuts, the surgeon controls the camera and robotic tools from a console in the theatre).

Radiation therapy is the other main option to treat men with all stages of prostate cancer. The radiation can be delivered externally (using a large machine outside the body) or internally (using seed implants or rods).

Watchful waiting may be suitable if the risks of treatment outweigh the benefits. Men who choose this option will be monitored, and treated if the cancer causes symptoms or progresses.

Hormone suppression therapy is used in combination with radiotherapy, to prime cancer cells and improve the cure rates. It is also used to suppress the male hormone, testosterone, when the cancer has spread outside the prostate. These cancer cells rely on testosterone for growth, and removing the influence of testosterone can arrest the progression of the cancer for years. The benefits are offset by side-effects and increased risk of osteoporosis, heart disease and diabetes. It is important to focus on a healthy diet and lifestyle when on this treatment.

Chemotherapy is reserved for patients who have progression of cancer despite hormone suppression therapy (castrate resistant prostate cancer). There is a wealth of research into these drugs, and you will need to see a medical oncologist to discuss the best option and trials you may be eligible for.

RESOURCES

http://www.cancerwa.asn.au/resources/2012-04-12-wa-cancer-statistics-2009.pdf - Western Australian Cancer Statistics, 2009 from the Cancer Council, Western Australian

http://www.health.wa.gov.au/docreg/Reports/Diseases/Cancer/WACR_Cancer_incidence_mortality_main_2009.pdf - Cancer Incidence and Mortality in Western Australia, 2009, a report from the Western Australian Cancer Registry

What You Need To Know About Prostate Cancer booklet - cancer.gov is the official Web site for the National Cancer Institute, the U.S. Federal Government's principal agency for cancer research and training.

After a diagnosis of prostate cancer - cancer.org.au is the official Web site for Cancer Council Australia, a national non-government cancer control organisation.

Useful Information

NCI Booklet

Cancer Council Fact Sheet

EPIC-26 Questionnaire

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