Prostate Cancer Information

Prostate Cancer – Background

Approximately 2,600 Australian men die annually due to prostate cancer, making it the second most fatal cancer in men. Advances in the early detection and treatment of this disease are believed to have sharply increased survival. Use of the blood enzyme marker, prostate specific antigen (PSA), and new methods for accurate biopsies of the prostate gland (Trans Rectal UltraSound or TRUS) have allowed earlier and more accurate detection. New advances in treatment range from short-stay surgery (2-3 days), with continence rates >90%, for surgery; to new radioactive non-surgical "seed" implants accurately placed by TRUS; and hormone therapies of greater ease, and choice of costs.

Ten-year disease specific survival rates of patients following radical prostatectomies are greater than 90% for low-grade adenocarcinomas, greater than 85% for medium-grade adenocarcinomas. Early detection of prostate cancer is strongly believed to significantly increase long term survival rates.

Who should have tests for prostate cancer?

It is recommended that all men from the age of 50 have an annual digital rectal exam (DRE), and a PSA blood test. However, there are some men who have been found to be at a higher risk for developing prostate cancer. Men who have a brother or father who have been diagnosed with prostate cancer have a 2 to 9 times higher risk of developing prostate cancer themselves. These men who are at high risk should have annual DRE exam and PSA from the age of 45.

What is the prostate gland and what does it do?

The prostate gland is normally the size of a walnut in the average adult male and will increase in size as men age. The urethra is the tube which delivers urine from the bladder through the prostate to the outside.

At the base of the bladder, the prostate gland surrounds the urethra. The prostate is an accessory part of the male ejaculatory system. Sperm are made and stored in the seminal vesicles until ejaculation occurs. The prostate gland provides 10-20% of the ejaculatory fluid. The precise function of the prostate is poorly understood. It is thought that its secretions may produce anti-bacterial substances to prevent urinary infection and possibly other secretions may play a role in fertilization. Nerves that control erection run alongside the gland, and may be carefully preserved in surgery to prevent impotence. This is called a nerve-sparing prostatectomy and is usually more successful in younger patients.

Prostate Cancer – who's at risk?

No one knows the exact causes of prostate cancer. Doctors cannot explain why one man develops the disease and another does not. Research has shown that men with certain risk factors are more likely than others to develop prostate cancer. (A risk factor is something that may increase the chance of developing a disease.)

Studies have found the following risk factors for prostate cancer:

  • Age: Age is the strongest risk factor for prostate cancer. This disease is rare in men younger than 45, but the chance of getting it goes up sharply as a man gets older. Most men with prostate cancer are older than 65.
  • Family history: A man's risk of prostate cancer is higher than average if his father or brother had the disease.
  • Certain prostate changes: Having abnormal cells called high-grade prostatic intraepithelial neoplasia (PIN) may increase the risk of prostate cancer. These prostate cells look abnormal under a microscope.
  • Diet: Some studies suggest that men who eat a diet high in animal fat or meat may be at increased risk of prostate cancer. Also, men who eat a diet rich in fruits and vegetables may have a lower risk.

 

Scientists have studied whether BPH, obesity, smoking, a sexually transmitted virus, or lack of exercise might increase the risk of prostate cancer. At this time, these do not appear to be important risk factors. Also, most studies have not found an increased risk of prostate cancer for men who have had a vasectomy (surgery to cut or tie off the tubes that carry sperm out of the testicles). Other possible risk factors are under study.

Many men who have known risk factors do not get prostate cancer. On the other hand, many who do get the disease have none of these risk factors. Men may want to talk with their doctor about factors that generally increase the chance of getting prostate cancer and about their own risk.

Symptoms

Prostate cancer itself, when confined within the prostate gland, does not have any symptoms.

Urinary symptoms of an enlarged prostate, due to benign i.e. non-malignant growth, are very common. These include:

  • Inability to urinate, or difficulty starting or stopping the urine flow
  • The need to urinate frequently, especially at night
  • Weak or interrupted flow of urine
  • Pain or burning during urination


In most cases, these symptoms are not due to prostate cancer. They may be caused by benign enlargement of the prostate gland (benign prostatic hypertrophy - BPH), infection or inflammation, or another problem. However, a man with these symptoms should see a doctor so that any problem can be diagnosed and treated as early as possible. He may go to see his primary care doctor or a urologist, a doctor who specializes in diseases of the urinary system.

Common Questions

Q: I have urinary symptoms, should I be worried about prostate cancer?

A: Symptoms of frequency, especially at night, urgency, stuttering of urine stream and waiting for urination increase with age. The most common cause is benign prostatic hypertrophy or BPH. This involves the benign enlargement of the prostate and is not associated with cancer. Treatment may start with oral medications to relax or shrink the prostate to improve the symptoms. Inflammation and infection of the prostate gland can also occur causing prostatitis, which will also cause urinary symptoms. Treatment for prostatitis is usually with a prolonged course of antibiotics. One should consult with their family physician to determine what the cause of symptoms may be.

Q: I have NO urinary symptoms, should I be worried about prostate cancer?

A: Prostate cancer does not usually cause urinary symptoms. The only means to identify prostate cancer early is a digital rectal exam and PSA. When symptoms are present in prostate cancer the disease is almost always advanced.