Prostate Cancer
Prostate cancer can be a tough topic to navigate. There’s loads of information on prostate cancer testing, treatment and how to manage your daily life. Here we’ve rounded up some prostate cancer basics to help simplify it all.
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Prostate cancer statistics
One in Five
In Australia, about 1 in 5 men will get prostate cancer at some point in their lives.
21,800
Over 21,800 men are diagnosed with prostate cancer each year—that's almost 60 men every day.
240,000
Over 240,000 men are currently living with and beyond prostate cancer.
3,620
About 3,620 men die from prostate cancer each year.
What exactly is prostate cancer?
When cells in the prostate multiply too quickly and grow out of control, this creates a cancerous tumour.
Often, this type of cancer grows slowly and doesn’t cause big problems right away. Sometimes, however, prostate cancer can be fast-growing and spread to other parts of the body, causing major damage.
Catching cancer early, so that your doctor can keep an eye on it and recommend next steps, is ideal. If the cancer is caught later, you may still have options to work through with your healthcare team that put your quality of life first.
Prostate cancer is the most commonly diagnosed cancer in men and is particularly common over the age of 50 years.
Where is the prostate? What does it do?
Where is the prostate located? The prostate gland sits just underneath the bladder and is usually about the size and shape of a walnut. The prostate also surrounds the urethra, which is the tube you urinate and ejaculate through. It’s normal for the prostate to grow with age, and sometimes a larger prostate can cause problems with passing urine (pee). This is not always a sign of cancer but should be checked with your doctor.
The main job of the prostate is to help make semen—the fluid that carries sperm. Take a closer at the prostate and how it’s connected to the surrounding areas below.
Bladder
Muscular sac that stores urine (pee) after it’s made by the kidneys
Spermatic cord
Tube carrying sperm from the testes to the prostate
Urethra
Tube carrying urine from the bladder, as well as semen and sperm to the tip of the penis
Penis
External male organ
Testicles
Egg-shaped structures in a pouch of skin called the scrotum, which make sperm and testosterone
Seminal glands
Located below the bladder and above the prostate, and produce some of the fluid that combines with sperm to make semen
Prostate
Sits below the bladder and sends fluid to the semen which nourishes and protects sperm
Anus
The outside opening of the rectum for bowel movements (poo)
Prostate cancer risk factors
Anyone with a prostate can get prostate cancer. And it’s important to have regular check-ups with your doctor to monitor your prostate health and prostate cancer risk factors related to your personal circumstances.
Not everyone has good access to a regular doctor but if possible, check to see if you can find support using the resources at the end of this page.
What exactly causes prostate cancer is unknown—but some factors can increase your risk, including age, ancestry, and family history. Carrying too much weight or having an unhealthy lifestyle can also increase your risk.
Age
Age is amongst the prostate cancer risk factors. Your risk of developing prostate cancer increases with age, but that doesn’t mean it’s a disease that only affects older people.
If you’re 50 or over, it’s important to talk to your GP about keeping yourself healthy and any ongoing tests you may need as part of your health check-ups.
You have a family history of prostate cancer.
You're Black.
You need to start that conversation earlier, at 40 to 45, if:
Guidelines can be different, depending on where you live—so check with your doctor.
Ancestry
Black men are more likely to develop prostate cancer and more likely to die from it, compared to men of different ancestry. Prostate cancer also tends to develop at a younger age and grow faster in Black men than in any other group.
Family history
Certain genes, passed on from your parents (or other relatives), can affect your prostate cancer risk. If your father or brother had prostate cancer before the age of 60, you may be twice as likely to develop the disease yourself. If you have more than one male relative with prostate cancer, your risk could be 5 times more. If there is a strong family history of breast or ovarian cancer, especially on the same side of the family (mother’s or father’s side), your risk is increased.
If you’re worried about prostate cancer and considering having prostate cancer tests done, ask your doctor to discuss it with you. Just having the conversation can help you decide what’s right for you.
How do you test for prostate cancer?
The first tests to check for prostate cancer are usually a blood test (PSA test) and a physical exam (digital rectal exam or DRE). Which tests you have will depend on your doctor’s guidance.
Prostate cancer test: the PSA test
A PSA test is just a blood test for prostate cancer. You’ll have a small blood sample taken from your arm and sent off for lab testing. It is a simple test which does not require fasting or any other type of preparation.
PSA, or prostate specific antigen, is a protein made by your prostate and found in the blood. PSA is found in both healthy cells and cancerous cells, so it’s quite normal to have some PSA in your blood. When problems with the prostate happen, the levels of PSA in the blood rise. Understanding how much PSA you have in your blood is important, especially if the levels go up. This is where PSA testing comes in.
PSA testing is one of the first checks to find prostate problems and a high PSA level does not always mean you have cancer. PSA levels can also increase if there is growth, inflammation (prostatitis) or infection of the prostate. Sometimes even ejaculation can raise the PSA, so your doctor may tell you to not to ejaculate for a few days prior to the test. It’s important to keep track of your PSA levels even after cancer treatment, as this can help indicate if the cancer has returned.
Digital Rectal Exam (DRE)
You might be tempted to groan at the thought of a DRE—but it does help some doctors get a better idea of anything unusual going on with your prostate.
The back of the prostate sits close to the rectum, and prostate cancer is often found here. To get right to it, the doctor inserts just one gloved, lubricated finger into the rectum. This helps them estimate the size of the prostate and feel for lumps or anything unusual.
Although this exam may sound painful, it’s usually just a bit uncomfortable or awkward. A normal DRE does not mean you don’t have prostate cancer, but it is important to do, together with the PSA test. Also, just because the prostate feels a bit abnormal does not always mean you have prostate cancer—it just may be something your doctor needs to investigate further.
Depending on the results of either test, your doctor may refer you to a urologist, a specialist doctor who is an expert in this area.
How is prostate cancer diagnosed or confirmed?
Biopsy
Depending on the results of your PSA test or DRE, the urologist may do a biopsy. A biopsy takes some tissue from your prostate, using a thin needle guided by ultrasound, to get a better look at what’s happening. A biopsy is the only way to diagnose prostate cancer.
There are a couple of different ways to reach the prostate for the biopsy, depending on your current health, how many tissue samples are necessary, and what your team believes will work best. Speak with your doctor or healthcare team to understand more.
Transrectal ultrasound (TRUS) guided biopsy
A needle is inserted into the prostate through the back passage (rectum) guided by an ultrasound probe (a small device that is also passed into your back passage so your doctor can see an image of the prostate). TRUS first measures the size of your prostate, using sound waves to build up a picture of the prostate gland. It might be a little uncomfortable (it is like the DRE) but should only take a few minutes. Then, the needle is used to take samples of tissue from the prostate.
Local anesthesia is used for a TRUS. This type of anesthesia numbs the area tissue samples will be taken from.
Transperineal biopsy
A needle is inserted into the prostate, through the skin between the back passage (rectum) and testicles. An ultrasound probe is then placed in the back passage to allow the doctor to see where to pass the needle to take small samples of tissue from your prostate.
So you don’t feel anything, general or local anesthesia can be used for a transperineal biopsy, depending on your health and how many tissue samples are going to be taken. General anesthesia puts you to sleep. Local anesthesia may be used at some centres for a perineal biopsy. This type of anesthesia numbs the area that tissue samples will be taken from.
Magnetic resonance imaging (MRI) scan
An MRI creates a detailed picture of your prostate (and the surrounding tissues) to help diagnose prostate cancer. It’s also used to detect problems in your prostate if you have a raised PSA level.
Not everyone requires an MRI, but your doctor may order one for you. An MRI can be used before or after a biopsy. If it’s used before, it’s to help target cancer found in a biopsy, or to see if cancer is present at all. If it’s used after a biopsy, it’s to help to determine if the biopsy may have missed a cancer in the prostate.
Gleason score
Almost all prostate cancers are called adenocarcinomas.These types of cancers are given a “grade”—to help understand how aggressive the cancer is. The most commonly used grading system is known as the Gleason score, ranging from 6 to 10, and it’s named after Dr Gleason, a pathologist (a doctor who examines body tissues).
Here’s how the Gleason score is put together
After a biopsy, a pathologist uses a microscope to check how the samples look compared to normal prostate tissue and identify any obvious patterns. There are 5 different patterns usually recognised. They record the most common pattern, the second most common pattern, and the most aggressive pattern found.
Prostate tissue that looks close to normal but contains some abnormal cells is typically referred to as Gleason pattern 3 and indicates a slow growing tumour. If there are more abnormal cells, looking irregular and different from the normal prostate cells, then a Gleason pattern of 4 or 5 is assigned, with 5 indicating very aggressive cancer.
From here, a Gleason Score is determined. This can be done by adding together the numbers of the two most common patterns found. This can also be done by adding together the number of the most common Gleason pattern found, plus the highest pattern number found.
For example, if the pathologist has assigned the most common pattern as 3 and another (worse) pattern as 4, the Gleason score is 7.
Gleason scores tend to range from 6 to 10, with 6 being the lowest grade of cancer.
Although the Gleason score is the most commonly used grading system, a new way to grade prostate cancer (based on the Gleason system), called the ‘ISUP Grade Group’, is emerging. The ISUP Grade Group is easier to understand and more accurate for predicting how quickly the cancer will spread, and helps doctors decide on the best way to treat the cancer. However, it is not widely available just yet and most doctors use the Gleason Score.
What are the types of prostate cancer?
There are different types of prostate cancer, the main difference being the type of the cell where the cancer starts growing.
Localised prostate cancer
When the cancer is only within prostate and has not spread to the tissue surrounding the prostate.
Locally advanced prostate cancer
When the cancer has spread to tissue immediately surrounding the prostate.
Advanced (metastatic) prostate cancer
If the cancer spreads outside the prostate, this is known as advanced (metastatic) cancer. Common places for the cancer to spread include the lymph nodes in your pelvis, tissue in and around your pelvis and abdomen, and bones in the hips and back.
Advanced prostate cancer can present as:
Hormone sensitive or castration sensitive prostate cancer
This is prostate cancer that has spread to other parts of the body but still responds well to hormone therapy (otherwise known as androgen deprivation therapy or ADT).
Castration resistant prostate cancer
This is prostate cancer that has spread to other parts of the body and can no longer be slowed down by low testosterone levels (from using hormone therapy). It’s usually defined by a rising PSA level, worsening symptoms or a CT or bone scan showing growing cancer.
How is prostate cancer treated?
Treating prostate cancer may be heavy on your mind, but what will work for each person is different. Fortunately, there's usually time to talk to your doctor and discuss your options before jumping into any decisions.
Before choosing a treatment option, take time to carefully think about the things that are most important to you. Each treatment comes with some sort of side effect, so understanding each treatment and any risks are critical. Asking some necessary questions and reviewing the options below with your doctor will help you to make the right decisions for yourself.
