Prostate Cancer

Prostate cancer is one of the most common forms of cancer. In New Zealand, around 4000 men are affected each year, and around 700 will die from the disease. On a positive note, although the diagnosis is increasing, the death rate due to prostate cancer is decreasing. This is due to an increased awareness of the disease, increased testing rates, earlier diagnosis and improved treatments.

The prostate is a small, walnut-shaped gland that produces seminal fluid to nourish and transport sperm. The gland is located deep inside the groin between the penis and bladder, just in front of the rectum. Cancer develops when abnormal cells in the prostate start to multiply and form a tumour.

Doctors and scientists don’t know what causes prostate cancer, but as men age, they have a higher risk of developing the disease. Other risk factors include having a father or brother diagnosed with prostate cancer before the age of 60, or a family history of breast, ovarian or prostate cancer, especially if any of these cancers involved the BRCA1 or BRCA2 mutation.

Cancer growth is influenced by the hormone testosterone, but the speed at which it grows can vary. In some men the cancer grows very slowly, while in others it can grow very quickly (termed “aggressive”).

Prostate cancer doesn’t always cause symptoms, especially if at an early stage. Symptoms to be aware of are:

• discomfort when urinating
• blood in the urine or semen
• difficulty urinating (hard to start, or not able to go when you need to)
• a weak urine stream
• frequent or sudden need to urinate especially at night
• lower back, upper thigh or hip pain
• bone pain
• unexplained weight loss.

There is no single specific test that can diagnose prostate cancer. If a doctor suspects you may have the disease, they will do a series of tests including a blood test called a Prostate Specific Antigen (PSA) test and a digital rectal examination (DRE). A DRE is when a doctor physically feels the prostate to check for any abnormalities in shape or size (using a gloved, lubricated finger inserted into the rectum).

Men will be referred to a urologist for further testing if the PSE and DRE tests seem to indicate prostate cancer. This will include a biopsy where a small piece of prostate tissue is removed from different parts of the prostate. Other tests may include an MRI, CT or bone scan to see if the disease has spread beyond the prostate.

Treatment depends on many factors – the age and overall health of the man, stage of the cancer, and personal preference for treatment type. Not every cancer requires treatment, some can be monitored by “watchful waiting” or “active surveillance”. These are both ways to keep an eye on prostate cancer symptoms. Watchful waiting is for men whose cancer won’t be cured but is not likely to progress or cause problems while they are alive, so generally for older men or those in poor health. Active surveillance monitors low-risk cancer that isn’t yet causing problematic symptoms. It is a way to delay or avoid treatments that cause significant side effects. If the disease does start to progress, treatments that can cure the cancer are offered.

A surgery called a radical prostatectomy can successfully cure cancer if the disease has stayed in the prostate gland. This surgery removes the prostate gland and some of the tissue around it. Radiation therapy kills cancer cells and stops their spread. Hormone therapy is used to decrease the production of testosterone, the main hormone that drives prostate cancer. Hormone therapy will slow cancer growth and a decrease in PSA blood levels show that this treatment is working. Chemotherapy won’t cure prostate cancer but it will shrink it and slow the growth. It is used for more advanced cancer that has spread around the body. Don’t put off seeking medical treatment for any niggling issues – prostate cancer can be treated successfully if caught early.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.