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Prostate Cancer

Prostate cancer can be a tough topic to navigate. There’s loads of information on testing, treatment and how to manage your daily life. Here we’ve rounded up some prostate cancer basics to help simplify it all.

When cells in the prostate multiply too quickly and grow out of control, this creates a cancerous tumor. Often, this type of cancer grows slowly and doesn’t cause big problems right away.

However, sometimes 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. It is especially common over the age of 50 years.

A man sitting on a fallen tree on the sea shore and enjoying the view.

One in Nine

One in Nine

In the USA, 1 in 9 men will be diagnosed with prostate cancer at some point in their lives.

One in Six

One in Six

1 in 6 African American men will be diagnosed with prostate cancer in their lifetime.

192,000

192,000

Nearly 192,000 men are diagnosed with prostate cancer each year. That’s around 526 men every day.

3 million

3 million

Over 3 million men are currently living with prostate cancer or experiencing life after it.

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. It is particularly common over the age of 50 years.

Where is the prostate?
What does it do?

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 (pee) 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.

Diagram of Male Anatomy
1

Bladder
Organ in the lower stomach that stores urine (pee) after it's made by the kidneys.

2

Spermatic Cord
Tube carrying sperm from the testes to the prostate

3

Urethra

Tube carrying urine (pee) from the bladder, as well as semen and sperm to the tip of the penis

4

Penis
External male organ

5

Testicles

Egg-shaped structures in a pouch of skin called the scrotum, which make sperm and testosterone

6

Seminal glands

Located below the bladder and above the prostate, and produce some of the fluid that combines with sperm to make semen

7

Prostate

Sits below the bladder and sends fluid to the semen which nourishes and protects sperm

8

Anus

The outside opening of the rectum for bowel movements (poop)

Who’s at risk
for prostate cancer?

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.

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

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.

If you're Black or have a family history of prostate cancer, you need to start that conversation earlier at 40 to 45.

Guidelines can be different, depending on where you live - so check with your doctor.

Ancestry

African American men are more likely to develop prostate cancer compared to men without African ancestry, and twice as likely to die from the disease.

It also tends to develop at a younger age, and grow faster in Black men compared to any other racial 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 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.

PSA Test

A PSA test is really just a blood test. 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 pretty 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 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 a small device (called an ultrasound probe) 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 similar to 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 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 simpler (with just 5 grades, 1-5), 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?

Localized 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.

There are two different types of metastatic cancer:

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.

So, 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 lead you to make the right decisions for yourself.

Types of treatment

Surgery (radical prostatectomy)

Surgery to completely remove the prostate, and sometimes the surrounding nerves if the cancer has spread. In some cases, a surgeon will use a robot to assist with the surgery.

Radiation therapy

Use of high energy rays to destroy cancer cells. There are a few ways radiation therapy can be done. A machine outside the body directs radiation at the cancer cells (external beam radiation therapy). Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells (low dose rate (seed) brachytherapy). Thin tubes are inserted into the prostate gland, and pass radiation down the tubes and into the prostate (high dose rate brachytherapy).

Hormone Therapy

Also known as androgen deprivation therapy (ADT), this lowers the level of testosterone in the body. This can help slow down the prostate cancer but, used alone, cannot cure it. It’s commonly used alongside other treatments, to help fight cancer cells.

Chemotherapy

Special drugs are used to shrink or kill the cancer. These are sometimes taken by mouth, or can be given as an infusion.

Active Surveillance

Closely monitoring prostate cancer with blood tests, DRE, imaging tests and biopsies to determine when further treatment is needed. Your doctor will keep an eye on any quality of life issues.

Watchful waiting

Prostate cancer is monitored closely with testing, but it’s less intense than active surveillance. Usually an option for older men or those with other serious health issues which helps avoid unnecessary treatment side effects. The intention is not to treat for cure but to slow down cancer spreading outside the prostate.

Cryotherapy

Placing a special probe inside the prostate cancer to freeze and kill the cancer cells.

High-Intensity Focused Ultrasound (HIFU)

This therapy directs high-energy sound waves (ultrasound) at the cancer, to kill cancer cells.
Treatment can be focused on the
tumour
or the entire prostate.

Immunotherapy

Boosts your body’s natural defence system (immune system), to help target cancer cells.
Immunotherapy is a newer treatment for prostate cancer, so how well it works and its side effects are still being understood.

Treatments used in clinical trials

You might want to consider taking part in a clinical trial. Clinical trials often involve your doctors suggesting new therapies, drugs or treatments that have not been widely used yet, in hopes of effectively treating the prostate cancer. While in the trial, your doctors monitor your progress very closely to understand how and if the treatments are working. These trials vary from region to region, so it's best to talk to your oncologist or urologist to discover your options.

Additional
Resources

National Alliance on Mental Illness (NAMI)

Confidential and free crisis counseling

The American Counseling Association

Information on locating a therapist or counselor near you

American Cancer Society

Information on types of support services and choosing a cancer counselor

Prostate Cancer Foundation

Information about online support groups for people affected by prostate cancer, their caregivers, and families

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