What is prostate cancer?
Prostate cancer begins when abnormal cells in the prostate start growing in an uncontrolled way. In most cases, prostate cancer grows more slowly than other types of cancer. This might mean that you do not need treatment straightaway. However, some prostate cancers can grow and spread quickly, so it is important to investigate any symptoms or unusual test results promptly.
The prostate is a small gland about the size of a walnut. It is found only in men and forms part of the male reproductive system. It sits below the bladder, near 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.
The prostate produces fluid that helps to feed and protect sperm. This prostate 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 sit on the prostate gland.
The urethra is a thin tube that runs through the prostate. It carries urine from the bladder and out through the penis. The urethra also carries semen during orgasm.
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.
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 18,000 new cases in Australia every year. 2
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.
What are the 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 (see below).
Symptoms of advanced prostate cancer may include:
- unexplained weight loss
- frequent or sudden need to urinate
- blood in the urine
- pain 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)
In men over the age of 50, a normal prostate may grow and cause problems with the flow of urine. This growth of the prostate is called benign prostate hyperplasia (BPH). It is generally a normal part of ageing – it is not cancer.
BPH may cause symptoms that affect how you urinate, such as the stream of urine being weak; having to go frequently, especially at night; having to go urgently; trouble getting started; dribbling of urine after going; and the bladder not feeling empty. These are known as lower urinary tract symptoms (LUTS) and they 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.
What are the risk factors?
While the causes of prostate cancer are unknown, your risk of developing prostate cancer increases:
- as you get older – prostate cancer is most commonly diagnosed in men aged 60–793
- if your father or brother has had prostate cancer – your risk will be twice that of other men
- if you have a strong family history of breast or ovarian cancer, particularly BRCA1 and BRCA2 gene mutations.
While prostate cancer is less common in men under 50, men aged 40–55 are at particular risk of developing significant 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 men in the same age range.
You may have an inherited gene that increases your risk of prostate cancer if you have:
- multiple relatives on the same side of the family (either your mother's or father's side) with prostate, breast and/or ovarian cancers
- a brother or father 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 help to detect cancer in people who do not have any symptoms. Unlike for bowel, breast and cervical cancers, there is no national screening program for prostate cancer. There remains debate regarding the pros and cons of PSA screening and whether there is an overall benefit. 1
Some men without any symptoms of prostate cancer do choose to have regular PSA testing to screen for the disease. Before having a PSA test, it is important to talk to your GP about the advantages and disadvantages in your particular circumstances.
Which health professionals will I see?
Your GP will usually arrange the first tests. If these tests suggest that there could be cancer in the prostate, you will usually be referred to a specialist called a urologist.
The urologist can arrange further tests and advise you about your options. It is recommended that men with localised prostate cancer see both a urologist and a radiation oncologist before deciding on treatment.
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
||assists you with treatment decisions and works in partnership with your specialists in providing ongoing care; may monitor PSA levels and administer treatment
||treats diseases of the male and female urinary systems and the male reproductive system; performs biopsies and prostate surgery
||treats cancer by prescribing and coordinating the course of radiation therapy
||treats cancer with drug therapies such as chemotherapy and hormone therapy
||diagnoses, treats and manages hormonal disorders
|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
||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
||analyses x-rays and scans; an interventional radiologist may also perform a biopsy under ultrasound or CT, and deliver some treatments
||examines cells and tissue samples to determine the type and extent of the cancer
||provides exercises to help strengthen pelvic floor muscles and improve bladder and bowel controlan help you and your partner with sexuality issues before and after treatment
||assists people with medical conditions to exercise and improve their overall health, fitness, strength and energy levels
||assists in adapting your living and working environment to help you resume usual activities
|sexual health physician*/sex therapist
||can help you and your partner with sexuality issues before and after treatment; an erectile dysfunction specialist can give specific advice for erection problems
||help you manage your emotional response to diagnosis and treatment; may also help with emotional issues affecting sexuality
||links you to support services and helps you with emotional, practical or financial issues
* Specialist doctor
Expert content reviewers:
A/Prof Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC; Gregory Bock, Acting Coordinator of Nursing, WA Cancer & Palliative Care Network, Department of Health, WA; A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Dr Michael Lowy, Sexual Health Physician, Sydney Men's Health, NSW; Dr David Millar, Sexual Health Physician, Perth Men's Health, WA; Jennifer Siemsen, Clinical Nurse Consultant – Cancer Care, WP Holman Clinic, Launceston General Hospital, TAS; A/Prof David Smith, Senior Research Fellow and Cancer Epidemiologist, Cancer Council NSW; Dr Ben Tran, Medical Oncologist, Peter MacCallum Cancer Centre, Melbourne, VIC; Derek Wells, Consumer.
1. Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel, Clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer, Cancer Council Australia, Sydney, 2016.
2. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: prostate cancer, AIHW, Canberra, December 2017.