What is prostate cancer?

Prostate cancer is when abnormal cells grow in the prostate. The prostate is a part of the male reproductive system. Prostate cancer is the most common cancer in males in Australia. It affects up to 1 in 7 males.

Most types of prostate cancer are slow-growing and can be managed with treatment. Most males can live with prostate cancer for many years without serious issues. Less common types of prostate cancer spread quickly and may be fatal.

Prostate cancer forms when cells in the prostate gland grow abnormally, creating a tumour.

As you become older, your prostate can also grow for other reasons (not related to cancer). For example, prostatitis (an inflammation of the prostate gland) or benign prostatic hypertrophy (BHP). Both of these conditions are common in older males.

What are the symptoms of prostate cancer?

If you have prostate cancer, you may not notice any symptoms until the tumour grows to a certain size.

Some symptoms of prostate cancer include:

• needing to urinate often or suddenly
• difficulty with your urine stream — having trouble starting to urinate or a poor urine flow
• discomfort or pain when urinating
• blood in your urine or semen
• pain in your lower back, upper thighs or hips

Many people have these symptoms without having prostate cancer, but if you notice any symptoms, it’s important to check with your doctor.

What causes prostate cancer?

It isn’t always clear what causes prostate cancer.

Prostate cancer is more common as you get older. It is also more common if a close relative, such as your parent, sibling or child, was diagnosed with prostate cancer before 65 years of age.

Your ethnicity plays a role too. Caucasian males are more likely to develop prostate cancer than Asian males. African males have the highest risk of death from prostate cancer.

A very small number of prostate cancers are caused by a mutation in a gene, called BRCA1 or BRCA2. These genes can increase the risk of prostate, breast and ovarian cancer. If you have close relatives who have been diagnosed with these cancers, talk to your doctor about whether you should be tested.

Living with obesity increases your risk of having a type of prostate cancer that spreads quickly.

When should I see my doctor?

See your doctor if you notice any changes when you urinate. Changes do not necessarily mean you have cancer, but finding prostate cancer early improves your chance of treating it successfully.

If you don’t have any symptoms, but are worried about your risk, see your doctor. They can give you information about whether prostate cancer screening is right for you.

How is prostate cancer diagnosed?

There are several tests your doctor may perform to check your prostate:

• Digital rectal examination (DRE): Your doctor gently inserts a gloved finger into your rectum to check the size and condition of your prostate.
• Prostate specific antigen (PSA) test: A simple blood test to measure a protein produced by your prostate. A high PSA might be a sign of prostate cancer or another condition.
• MRI scan: A detailed imaging scan of your prostate helps recognise signs of cancer.

If these tests suggest that you may have prostate cancer, a prostate biopsy can confirm the diagnosis. Your doctor will refer you to a urologist, who will take some cells from your prostate using a thin needle. These cells are checked under a microscope to look for signs of cancer.

Prostate cancer is graded on a scale of 1 to 5. This scale shows how likely the cancer is to grow and spread to the rest of the body. Grades 4 to 5 are considered high risk.

Should I have prostate cancer screening?

There is no nationwide prostate cancer screening program in Australia. Routine PSA tests to screen for prostate cancer are not recommended for most males.

There are several reasons for this:

• High PSA levels are not always caused by cancer.
• Experts don’t fully agree on what is a considered a normal or abnormal PSA level.
• Many prostate cancers are low risk, slow growing and unlikely to cause harm if left untreated.
• Testing and treating low risk, slow growing cancers may cause more harm than good.

You should speak to your doctor if you have symptoms or a family history of prostate cancer. Your doctor can help you decide if prostate cancer screening is right for you.

How is prostate cancer treated?

Treatment options for prostate cancer depend on:

• how likely the cancer is to grow and spread to the rest of your body
• the stage of the cancer — is it only in the prostate or has it already spread?
• your PSA level and how fast it is rising
• your age and general health
• potential side effects of treatment
• your personal preferences

Your doctor may discuss these options for treatment:

• active surveillance: this means monitoring your cancer without having treatment. Regular checkups can identify if the cancer is progressing. If it gets worse, you might then consider having treatment. This approach may be suitable for people who have a low risk of the cancer affecting their health. It can help you to avoid potential side effects of treatment.
• radical prostatectomy: surgery to remove the prostate gland and some of its surrounding tissue. It can be an open procedure or may involve laparoscopy.
• radiation therapy: uses low doses of radiation to treat the cancer. Radiation can be delivered from outside your body, known as external beam radiation therapy, or from an internal implant known as brachytherapy.
• hormone therapy: uses medicine to stop the production of testosterone, a male hormone, to stop the cancer growing. This is also known as androgen deprivation therapy (ADT).
• chemotherapy: anti-cancer medicines may be used if the cancer has spread to other parts of your body

Each treatment has its benefits and risks. It is important to speak with your doctor or specialist if you have any questions or concerns about your surgery or treatment.

What are the complications of prostate cancer and its treatment?

Treatments for prostate can cause side effects and other complications. You might experience the following effects:

• erectile dysfunction: more than 3 in 4 males have trouble getting and keeping an erection after surgery, radiation therapy, or ADT. There are effective treatments for erection problems that you can discuss with your doctor.
• poor bladder control: urine leakage, also known also urinary incontinence, can occur after prostate surgery
• urinary and bowel problems: radiation therapy can cause your bladder and rectum to become inflamed. You might have difficulty holding in your urine and need to get to a toilet quickly. You might notice blood in your urine or bowel motions.
• hormonal effects: ADT may reduce your sex drive or cause hot flushes, tiredness, sweating, hair loss, breast enlargement and muscle weakness. ADT can also increase your risk of developing osteoporosis, heart disease, diabetes and memory loss.

Living with prostate cancer

Being diagnosed with prostate cancer can be worrying. If you’re feeling anxious about how prostate cancer might impact your life, talk to your doctor about getting support.

Resources and support

For more information and support, visit the following organisations:

• The Prostate Cancer Foundation of Australia has information about prostate cancer and offers advice on living with it.
• Healthy Male (Andrology Australia) has a range of videos and other resources on what to ask your doctor.
• The Royal Australian College of General Practitioners (RACGP) has a factsheet explains the pros and cons of PSA testing and can help you decide whether to have a test.

Do you prefer languages other than English?

These websites offer translated information about prostate cancer:

• Health Translations Victoria has an article on prostate cancer support groups translated into various community languages.
• The Cancer Council provides a best care guide for prostate cancer and support services in multiple languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

Read more on cancer in Aboriginal and/or Torres Strait Islander People on the Our Mob and Cancer website.