Prostate Cancer

The prostate is a small but important organ, that provides the fluid that protects and feeds sperm. Prostatic fluid makes up about 1/3rd of the fluid in our ejaculate.

In young men, the prostate is the size of a walnut, but grows normally with age.

Diseases of the prostate

Common prostate conditions are benign prostatic hyperplasia (BPH), prostatitis and prostate cancer

What is prostate cancer?

This is a problem where the cells within the prostate grow and divide abnormally, forming a tumour. It is more common in men aged over 50 years.

Prostate cancer cells tend to grow very very slowly, and may not cause any issues or symptoms at all. It may not even become life threatening.

In a few cases however the cells can grow quicker and spread to other parts of the body. We’re not sure why different people have prostate cancer that grows at different rates.

Is prostate cancer common?

Excluding skin cancer, prostate cancer is the most common diagnosed cancer in men in Australia, with 19,000 Australian men diagnosed each year.

What are some risk factors for prostate cancer?

While the specific causes for prostate aren’t known, there are certain risk factors that have been linked with the development of prostate cancer, including;

  • Family history – a father or brother with a family history of prostate cancer, or sometimes a relative with breast cancer
  • Older age (>50)
  • A history of subfertility
  • A diet high in animal fat and protein
  • Race: men with a caucasian background are more likely to get prostate cancer than Asian men (particularly Asian men with an Asian diet, as opposed to a western diet)

What kind of symptoms does prostate cancer cause?

Early prostate cancer rarely causes symptoms at all.
Disturbance in urine flow or stream is possible, but this is more often caused by benign prostate issues such as BPH or prostatitis.

How is prostate cancer diagnosed?

There are some tests that help us lead to a diagnosis of prostate cancer, but they do have their pitfalls. First and foremost a medical history is the most important factor. Family history plays a role in determining when we perform any tests.

If there are symptoms consistent with any prostate issues then a Digital Rectal Exam (DRE) will be performed to check the prostate physically. This is a good test when there are symptoms, but have not proven to be a good screening tool in the absence  of symptoms.

A PSA test, measuring levels of prostate specific antigen (PSA) can also be used. A raised level can indicate there is more prostate tissue, but most men who have a normal feeling prostate and only a slightly raised PSA do not have cancer at biopsy.

Should I have prostate cancer screening?

As a screening tool, testing for prostate cancer is not a perfect system. Screening is used to detect disease in someone with no signs or symptoms of that disease.

The RACGP advises against the broad use of screening for prostate cancer, but we understand that people will still ask about it, and things change if you have symptoms or a rich family history.

To help men reach a decision about screening the RACGP has made an information sheet that you can find here.

Prostate biopsy for diagnosis

As mentioned a PSA test, DRE or even imaging is not a diagnosis for prostate cancer. The only way to diagnose it, is to take a small sample of the prostate surgically and have it examined by a pathologist.

The biopsy is performed by a urologist.

How do we treat prostate cancer?

This depends on a multitude of factors including

  • Gleason score – this determines the aggressiveness of the cancer
  • State of cancer – localised or spread to other parts of the body
  • Level of PSA and the rate of change (PSA velocity)
  • Age and general health
  • Side effects of treatment
  • Personal preference

Depending on these there is a range of watchful waiting for otherwise healthy men above age 75 and low grade scores, surgery and radiotherapy, androgen deprivation therapy or other treatments.

If you have any concerns or questions about prostate cancer, speak to your GP at GS Health to see if any testing is right for you.

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