What is the prostate?
The prostate is a small but important gland (organ) in the male reproductive system. The main role of the prostate is to make fluid that protects and feeds sperm.
What is prostate cancer?
Prostate cancer is a problem where cells within the prostate grow and divide abnormally so that a tumour forms. Prostate cancer is diagnosed mainly in men over the age of 50 years.
Prostate cancer cells often grow very slowly and may not cause any problems or symptoms, or become life-threatening. However, less commonly, the cancer cells grow more quickly and may spread to other parts of the body. It is not known why cancers grow at different rates and why some tumours spread to other parts of the body.
How common is prostate cancer?
Excluding some forms of skin cancer, prostate cancer is the most common type of cancer diagnosed in men in Australia, with more than 19,000 Australian men diagnosed each year. It is more common in older men, particularly over the age of 50 years.
What causes prostate cancer?
The causes of prostate cancer are not known. However there are certain risk factors that have been linked with developing prostate cancer, including:
- family history: a father or brother with prostate cancer now or in the past or, in some instances, a relative with breast cancer
- older age
- history of subfertility
- a diet high in animal fat and protein
- Race: men of Caucasian background are more likely to get prostate cancer than Asian men.
What are the symptoms of prostate cancer?
Early prostate cancer rarely causes any symptoms. Problems with urination are sometimes present with prostate cancer; however, urinary symptoms are most likely to be caused by benign (non-cancerous) prostate conditions such as BPH (prostate enlargement) or prostatitis.
How is prostate cancer diagnosed?
There are several tests that can lead to a diagnosis of prostate cancer.
A digital rectal examination and a PSA test are done to see if a man is likely to have prostate cancer. If these tests indicate that prostate cancer may be present, a biopsy is done to confirm the diagnosis.
A digital rectal examination (DRE) is where a doctor places a gloved finger into the rectum (back passage) to feel for size, shape and outline of the prostate (‘palpating’ the prostate). Although the prostate sits below the bladder, it can be felt through the rectum.
A PSA test measures the level of prostate specific antigen (PSA) in the blood.
If the level of PSA or the DRE is abnormal, there is a higher chance of prostate cancer being found when a biopsy is done. However, most men who have a normal feeling prostate and a slightly raised PSA level do not have cancer found at biopsy.
How is the type of prostate cancer treatment decided?
Once a diagnosis of prostate cancer has been made a man and his doctor must decide what steps to take next for management and treatment. The decision will depend on a number of factors including:
- Gleason score – high (more aggressive), intermediate (Gleason 7), or low grade
- stage of the cancer – localised in the prostate gland or spread to other parts of the body
- level of PSA in the blood and the rate of change of PSA over time (velocity)
- age and general health
- side-effects of treatment
- personal preference.
To help with making decisions about treatment, patients can be placed into high, intermediate or low risk groups with respect to likely cancer outcome. This is done using a combination of factors.
How is localised prostate cancer treated?
If the cancer is localised, that is, only in the prostate gland, the options available include observation monitoring (watchful waiting), active surveillance, radical prostatectomy (surgery) and radiation therapy (external beam radiotherapy or brachytherapy).
Surgery and radiation therapy both work well in treating localised prostate cancer but they have different side-effects.
How is advanced prostate cancer treated?
If the prostate cancer is aggressive and has spread to other parts of the body, the standard treatment is removal of the male hormones which help the tumour grow. This treatment is called androgen deprivation therapy (ADT).
What is castrate-resistant (formerly called hormone-resistant) disease?
Most prostate cancers will shrink or stop growing with ADT. However, after some time, which is different for each man, the prostate cancer will start to grow again. These tumours become very sensitive to any remaining androgens produced by the adrenal glands and the cancer cells themselves.
Measurement of PSA levels is used to monitor the response to ADT. For most patients an increase in PSA levels means the prostate cancer has progressed.
How is castrate-resistant prostate cancer treated?
Chemotherapy (docetaxel) has been shown to give a modest improvement in survival and quality of life. Also, changing to different forms of ADT can help for a period of time
For further information see also Andrology Australia
As ever, if you have any queries or concerns contact your local doctor!
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