Prostate cancer


Overview

Prostate cancer

Prostate cancer begins when abnormal cells in the prostate start growing in an uncontrolled way.

In some cases, prostate cancer grows more slowly than other types of cancer. In other cases, prostate cancer can grow and spread quickly, so it is important to see your doctor about any symptoms or unusual test results promptly.

 

Cancer care pathways

For an overview of what to expect during all stages of your cancer care, read or download the What To Expect guide for prostate cancer (also available in Arabic, Chinese, Greek, Hindi, Italian, Tagalog and Vietnamese – see details on the site). The What To Expect guide is a short guide to what is recommended for the best cancer care across Australia, from diagnosis to treatment and beyond.

The prostate

The prostate is a small gland about the size of a walnut. It forms part of the male reproductive system. The prostate sits below the bladder, in front of the rectum and close to nerves, blood vessels and muscles that control erections and bladder function. These muscles include the pelvic floor muscles, a hammock-like layer of muscles at the base of the pelvis.

What the prostate does

The prostate produces fluid that helps to feed and protect sperm. This fluid forms part of semen. Semen also contains millions of sperm made by the testicles (testes), and fluid made by a pair of glands called the seminal vesicles. The seminal vesicles attach to the back of the prostate gland. Lymph nodes are also found near the prostate.

Urethra

The urethra is a thin tube that runs from the bladder and through the prostate to carry urine (wee or pee) out of the body. The urethra also carries semen during orgasm.

Ejaculation

When a man has an orgasm and ejaculates, millions of sperm from the testicles move through tubes near the prostate called the vas deferens. The muscle around the prostate contracts and pushes the semen into the urethra and out through the penis.

Prostate growth

The male sex hormone, testosterone, is made by the testicles and controls the growth of the prostate. It is normal for the prostate to become larger as men get older. Sometimes this can cause problems, especially with urination.


How common is it?

Prostate cancer is the most common cancer in Australian men (apart from common skin cancers). There are about 19,000 new cases in Australia every year, according to the 2018 statistics on cancer collected by the Australian Institute of Health and Welfare.

One in six men in Australia are at risk of developing prostate cancer by the age of 85. The risk of prostate cancer increases with age. It is uncommon in men younger than 50, although the risk is higher for younger men with a strong family history of prostate cancer, breast cancer or ovarian cancer, than for those without a family history.

Who gets prostate cancer

Anyone with a prostate can get prostate cancer, so it mostly affects men. Transgender women, male-assigned non-binary people or intersex people can also get prostate cancer if they have a prostate. For information specific to your situation, speak to your doctor.

Symptoms

Early prostate cancer rarely causes symptoms. Even when prostate cancer is advanced at the time of diagnosis, there may be no symptoms. Where symptoms do occur, they are often due to non-cancerous conditions, such as benign prostate hyperplasia.

These are some possible symptoms of advanced prostate cancer:

  • unexplained weight loss
  • frequent or sudden need to urinate
  • blood in the urine or semen
  • pain bones, especially in the lower back, hips or pelvis.

These are not always signs of prostate cancer but you should see your doctor if you have any of these symptoms.

Benign prostate hyperplasia (BPH)

A normal prostate gland may grow larger as you age – it is usually not cancer. This growth of the prostate is called benign prostate hyperplasia (BPH).

BPH may press on the urethra and cause symptoms that affect how you urinate. These are some possible symptoms of BPH:

  • the stream of urine being weak
  • having to go to the toilet more often, especially at night
  • having to go urgently; trouble getting started
  • dribbling of urine after going
  • the bladder not feeling empty.

These symptoms are known as lower urinary tract symptoms (LUTS) and they can also occur in advanced prostate cancer. If you are experiencing LUTS, speak to your doctor.

For an overview of what to expect during all stages of your cancer care, visit Cancer Pathways – prostate cancer. This is a short guide to what is recommended, from diagnosis to treatment and beyond.

Risk factors

While we don’t know the causes of prostate cancer, there are some things that can increase the risk of getting prostate cancer:

  • older age – prostate cancer is most commonly diagnosed in people aged 60–79
  • a family history of prostate cancer – if your father or brother has had prostate cancer before the age of 60, your risk will be twice that of others
  • a strong family history of breast or ovarian cancer, particularly BRCA1 and BRCA2 gene mutations.

While prostate cancer is less common if you are under 50, people aged 40–55 are at particular risk of developing prostate cancer later in life if their prostate specific antigen (PSA) test results are above the 95th percentile. This means their PSA levels are higher than 95% of other people in the same age range.

Inherited prostate cancer gene

You may have an inherited gene that increases your risk of prostate cancer if family has been affected by cancer in either of these ways:

  • several relatives on the same side of the family (either your mother’s or father’s side) have been diagnosed with prostate, breast or ovarian cancers
  • your father or a brother has been diagnosed with prostate cancer before the age of 60.

Your general practitioner (GP) can advise you on the suitability of PSA testing for you and your family. For more information, call Cancer Council 13 11 20.

Screening tests

Cancer screening is testing to look for cancer in people who don’t have any symptoms. The benefit of screening is that the cancer can be treated early. It is important that this benefit outweighs any potential harms from treatment or its side effects.

Unlike for bowel, breast and cervical cancers, there is no national screening program for prostate cancer. There is still debate among doctors and other experts regarding the pros and cons of PSA screening and whether there is an overall benefit (according to the guidelines for PSA testing developed by Cancer Council Australia and the Prostate Cancer Foundation of Australia).

Some people without any symptoms of prostate cancer do choose to have regular PSA tests. Before having a PSA test, it is important to talk to your doctor about the benefits and harms in your particular circumstances.

For more information, see “Do You Need the Test?”

Health professionals you may see

Your doctor will usually arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, who may arrange further tests.

If you are diagnosed with prostate cancer, the cancer specialist leading your care may be a urologist or radiation oncologist. In some cases, the main specialist may be a medical oncologist.

Your specialists may discuss treatment options with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you will see a range of health professionals who specialise in different aspects of your care.

Health professionals you may see
GP (doctor) assists you with treatment decisions and works in partnership with your specialists in providing ongoing care; may monitor PSA levels and administer treatment
urologist* treats diseases of the male and female urinary systems and the male reproductive system; performs biopsies and surgery; requests scans
radiation oncologist* treats cancer by prescribing and coordinating the course of radiation therapy
medical oncologist* treats cancer with drug therapies such as chemotherapy and hormone therapy (systemic treatment)
endocrinologist* diagnoses, treats and manages hormonal disorders, including osteoporosis
cancer care coordinator/prostate cancer specialist nurse coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; a clinical nurse consultant (CNC) or clinical nurse specialist (CNS) may also coordinate your care
nurse administers drugs and provides care, information and support throughout management or treatment
urology care coordinator/continence nurse supports people with bladder and bowel management before and after cancer treatment
radiologist* analyses x-rays and scans; an interventional radiologist may also perform a biopsy under ultrasound or CT, and deliver some treatments
nuclear physician analyses bone scans and PET scans and delivers radionuclide therapies
pathologist* examines cells and tissue samples to determine the type and extent of the cancer
continence physiotherapist provides exercises to help strengthen pelvic floor muscles and improve bladder and bowel control
exercise physiologist/
physiotherapist
prescribes exercise to help people with medical conditions improve their overall health, fitness, strength and energy levels
occupational therapist assists in adapting your living and working environment to help you resume usual activities after treatment
sexual health physician*/sex therapist helps you and your partner with sexuality issues before and after treatment; an erectile dysfunction specialist can give specific advice for erection problems
psychologist, counsellor help you manage your emotional response to diagnosis and treatment; may also help with emotional issues affecting sexuality
social worker links you to support services and helps you with emotional, practical or financial issues

*specialist doctor

Expert content reviewers:

Dr Amy Hayden, Radiation Oncologist, Westmead and Blacktown Hospitals, and Chair, Faculty of Radiation Genito-Urinary Group (FROGG), The Royal Australian and New Zealand College of Radiologists, NSW; Prof Shomik Sengupta, Professor of Surgery and Deputy Head, Eastern Health Clinical School, Monash University, and Visiting Urologist and Uro-Oncology Lead, Urology Department, Eastern Health, Victoria; Assoc. Prof. Arun Azad, Medical Oncologist, Urological and Prostate Cancers, Peter MacCallum Cancer Centre, Victoria; Ken Bezant, consumer; Dr Marcus Dreosti, Radiation Oncologist, GenesisCare, and Clinical Strategy Lead, Oncology Australia, SA; Assoc. Prof. Nat Lenzo, Nuclear Physician, Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics and the University of Western Australia, WA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, and HeadwayHealth Clinical and Consulting Psychology Services, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia; Graham Rees, consumer; Kerry Santoro, Prostate Cancer Specialist Nurse, Southern Adelaide Local Health Network, SA; Assoc. Prof. David Smith, Senior Research Fellow, Cancer Research Division, Cancer Council NSW; Matthew Starr, consumer

 

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