Prostate Cancer

What is Prostate Cancer?

The prostate is a gland in the reproductive system of a male.  It is sited just below the bladder near the rectum.  It produced fluid that creates semen to carry the sperm as part of ejaculate. Prostate cancer is when abnormal cells form in the prostate.  Prostate cancer is usually a slow growing cancer that sometimes spreads.  Unfortunately, there are fast growing variants that can spread quickly to other parts of the body.  It becomes more common as a male gets older with 1 in 5 men having prostate cancer by the age of 85.  Most men in this age group die with the disease and not because of the disease.

How do I know if I have it?

As men get older it is not uncommon for the urinary stream to weaken, or to have trouble commencing or ceasing urination.  There may also be pain when passing urine or blood seen in the urine or semen.  These symptoms should be discussed with your GP, who will take a history from you, including if and close relatives have had prostate cancer and if you have any bone pains.  Your GP will examine you and should complete a digital rectal examination to assess the condition and size of your prostate. 

The GP will then arrange for further tests to clarify the cause of the symptoms.  The tests may include a blood test called Prostatic Specific Antigen (PSA) and an ultrasound of your prostate and bladder.  If the PSA or ultrasound tests are abnormal, they will refer you to a urologist who may arrange for an MRI of the prostate and conduct a biopsy of the prostate.  They will then talk you through a variety of treatment option as needed.

Should I have a screening test for Prostate Cancer?

There is currently some debate surrounding this question. This should be discussed with you in depth with your GP to assist you to make a final decision.

The Royal Australian College of General Practitioners advise that, based on the current evidence, which included large trials, screening an asymptomatic population is not warranted.  This is based of the lack of improved outcomes and the high rate of false positive findings and associated morbidity of investigation and treatment.  Such outcomes include impotence and urinary incontinence. 

For those who have a close relative who had prostate cancer at an early age (less than 65years), there may be some benefit of screening. This again should be discussed with you GP, who will assist you in coming to a decision.

Those with symptoms as above should have testing.

How do I fix it?

The treatment of prostate cancer depends on a wide variety of things.  Your age, the type of cancer, if there is any spread of the cancer, and, most importantly, your choice on the type of treatment you will accept.

Your options include

  • Watchful waiting: this is usually for older men with a slow growing type of cancer. If the man develops symptoms, then other treatment may be started.
  • Active surveillance: depending on the man’s age and the type of cancer found, regular PSA testing an biopsy may be enough.
  • Surgery: it may be suggested to remove the prostate. This surgery is called a radical prostatectomy.  While it is effective in removing the cancer and the prostate, it often results in urinary incontinence and impotence.  Recovery from this surgery takes about 7-10 days.
  • Transurethral resection of the prostate (TURP): this is another type of surgery where the prostate is trimmed form the inside. This enable the urethra to open and urine to pass unheeded.
  • Radiotherapy: this may be done by an external beam or via implanting radioactive material placed in the prostate
  • Hormone Therapy: this is often used in men when the cancer has spread beyond the prostate. It may be given as a tablet or injections.

Many of the treatments may have side effects, such as urinary incontinence, impotence, issues with the bladder including inflammation, loss of sexual desire, decreased mood and fatigue.  All these side effects and remedies for them should be discussed with your treating team.  Sometimes it is usual to talk with a therapist such as a counsellor to assist with identifying how you feel about the changes that may occur and support you in addressing the issues that arise.

Where can I get more information?