Prostate Cancer

Typically, there are no symptoms in the early stages of prostate cancer. Some advanced prostate cancers may include one or more of the following symptoms:

• Frequent urination, especially at night
• Sudden or urgent need to urinate
• Slow or weakened urinary stream
• Urine flow that is difficult to start or stop
• Pain or burning during urination
• Blood in the urine or semen
• Painful ejaculation
• Reduced ability to get an erection
• Decrease in libido
• Pain in the lower back, hips, chest and thighs
• Weakness or numbness in the legs or feet
• Unexplained weight loss and fatigue

While other diseases and disorders can cause many of these same symptoms, it is important to consult with your doctor if you experience any of these difficulties so that the cause can be found and treated.

The prostate is a gland forming part of the male reproductive system. It is located in front of the rectum and below the bladder. The main function of the prostate gland is to produce fluid which protects and enriches sperm.

Prostate cancer occurs when some of the cells in the prostate reproduce far more rapidly than in a normal prostate, causing a growth or tumor. Prostate cancer cells can then spread by breaking away from the prostate tumor and invading other parts of the body, producing secondary tumors. This process is known as metastatis. Once the cancer escapes from the prostate, treatment is possible but a cure becomes impossible.

What are the causes of prostate cancer?

The cause of prostate cancer is not yet known, but researchers have found several factors that might affect the risk of getting it. These include:

• Age: Prostate cancer is very rare in men younger than 40, but the chance of having prostate cancer rises significantly after age 50.
• Ethnicity: This cancer occurs more often in African-American men than in men of other races. African-American men are also more likely to be diagnosed at an advanced stage, and are more than twice as likely to die of prostate cancer than Caucasian men.
• Nationality: The World Cancer Research Fund shows that prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands. It is less common in Asia, Africa, Central America, and South America.
• Family history: Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease.
• Diet: Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. 

Caught in its early stages, prostate cancer can be cured. Regular testing offers the best opportunity to diagnose the cancer at its onset. An early diagnosis also means you have more treatment options with potentially fewer side effects.

When should I get tested for prostate cancer?

When to start testing for prostate cancer is different from person to person, and is generally based on your individual risk. But the Prostate Cancer Foundation of Australia recommends including it as part of your annual health check-up in:

• Men from the age of 40 with genetic predispositions or strong family histories of prostate cancer
• All men from the age of 50
• Men experiencing a recent onset of urinary problems or other symptoms commonly associated with prostate cancer

What are the tests for prostate cancer?

There are two main tests for prostate cancer:

The Prostate Specific Antigen (PSA):

The PSA is a blood test that measures the blood level of PSA, a protein that is produced by the prostate gland. As a general rule, the higher the PSA result, the greater the chance that prostate cancer is present. However, there are other conditions that can cause an elevated PSA level, and some men who have prostate cancer do not have elevated PSA.

The Digital Rectal Examination (DRE):

The DRE is a physical examination of the lower rectum. The doctor inserts a gloved finger in the rectum to feel part of the surface of the prostate and check for abnormal enlargements or other signs of the cancer. The drawback to this test is that the doctor can feel only part of the prostate, so may miss abnormalities beyond reach.

How is prostate cancer diagnosed?

Prostate cancer is diagnosed from the results of a biopsy of the prostate gland. If the results of the DRE or the PSA blood test are abnormal, a prostate cancer is suspected and a biopsy is usually then recommended by your doctor. A biopsy is a surgical procedure to remove a small sample of tissue from the prostate gland using a spring-loaded needle. It is performed with a Transrectal Ultrasound (TRUS), which generates an image of the prostate on a computer screen and guides the doctor to insert the needles into selected areas of the prostate. The procedure takes around 15 minutes and local anesthetic is usually used. The biopsy samples are then analysed by a pathologist to determine the outcome. There are four likely results:

• Normal: The tissue is normal benign prostate tissue
• Atypia or Dyspalasia: The cells do not look typical of either normal or cancerous cells
• Prostatic interpitelial neoplasia (PIN): The cells appear to be in the transitional stage between normal and cancer
• Prostate cancer: The stage and severity of the cancer will be scored and graded using the Gleason and TNM system

What does my diagnosis mean?

If the results of your biopsy show the presence of cancer, the next thing you will need to find out is the grade and stage of your cancer. Understanding your diagnosis is one of the most important factors in choosing a treatment option that’s right for you. The systems below are the most widely used.

The Gleason score:
Based on the patterns of the prostate cells, the pathologist looking at the biopsy sample assigns a Gleason score between 2 and 10. Cancers with lower Gleason scores (2 - 4) tend to be less aggressive, while cancers with higher Gleason scores (7 – 10) tend to be more aggressive.

TNM system:

The TNM system is the most widely used staging system for prostate cancer, and is the standard way for the cancer care team to describe how far a cancer has spread. The overall stage is expressed in Roman numerals from I (the least advanced) to IV (the most advanced).

• Stage I: The cancer is very small and completely within the prostate gland. It can’t be felt on a Digital Rectal Exam and isn’t seen on imaging the prostate
• Stage II: The tumor has grown within the prostate but hasn’t extended beyond it
• Stage III: The cancer has spread outside the prostate, but only barely. It may have grown into nearby tissues like the seminal vesicles
• Stage IV: The cancer has spread outside the prostate to other tissues. Most commonly it spreads to the lymph nodes, the bladder, rectum, bones, liver or lungs.

There is no "one size fits all" treatment for prostate cancer. Once your prostate cancer has been diagnosed, graded and staged, there is a lot to consider before you and your doctor choose a treatment plan. It is important to learn as much as possible about the many treatment options available and to weigh the benefits of each treatment against its possible outcomes, side effects, and risks.

It is recommended to consult with all three types of prostate cancer specialists—a urologist, a radiation oncologist, and a medical oncologist—to give you the most thorough assessment of the available treatments and expected outcomes.

What should I consider when choosing a treatment plan?

The treatment you choose for prostate cancer should take into account:

• Your age and expected life span
• Any other serious health conditions you may have
• The stage and grade of your cancer
• Your feelings, as well as your doctor's opinion, about the need to treat the cancer
• The likelihood that each type of treatment will cure your cancer or provide some other measure of benefit
• Your feelings about the possible side effects from each treatment

What are my treatment options?

Treatments are generally used one at a time, although in some cases they may be combined. Depending on your individual situation, your treatment options may include:

• Watchful waiting or active surveillance is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given tests, including biopsies, on a regular basis.
• Surgery is a common prostate cancer treatment for early-stage localised cancer. There are different types of surgical procedures that include the removal of the prostate, removal of tissue in the prostate or removal of lymph nodes in the pelvis.
• Radiation therapy involves the killing of cancer cells with directed radioactive exposure. There are two types of radiation therapy – external and internal. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
• Cryosurgery (also known as Cryotherapy) is a treatment that uses an instrument to freeze and destroy prostate cancer cells. As a minimally invasive procedure, cryotherapy for prostate cancer is sometimes used as an alternative to surgical removal of the prostate gland.
• Hormone therapy is designed to stop testosterone from being released or to prevent it from acting on the prostate cells.  Because the hormone testosterone serves as a main fuel for prostate cancer cell growth, drugs, surgery, or other hormones are used to reduce testosterone levels or block its effect.
• Chemotherapy uses chemicals to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
• Vaccine treatment stimulates the immune system to recognise and fight certain proteins specific to cancer cells. Each of the vaccines currently being tested in men with advanced prostate cancer works in a slightly different way, but all are designed to harness the immune system's ability to fight off disease and teach it to fight off prostate cancer cells.

Because the exact cause of prostate cancer is not known, it is not yet possible to prevent most cases of the disease. While most risk factors like age, race, and family history can’t be controlled, there are some things you can do that might lower your risk of prostate cancer.

Weight, physical activity and diet

Based on cancer research, the following is recommended:

• Achieve and maintain a healthy weight: Men who are overweight may have a higher risk of developing prostate cancers that are likely to be fatal.
• Exercise regularly: Men who engage in regular physical activity may have a slightly lower risk of prostate cancer. Vigorous activity may have a greater effect, especially on the risk of advanced prostate cancer.
• Eat more fish and veggies: Diets high in fish and certain vegetables (including tomatoes, broccoli and soy beans) may be linked with a lower risk of prostate cancer, especially more advanced cancers.
• Avoid too much red meat and dairy: Diets high in red meat, dairy foods and calcium may cause an increase in the risk of prostate cancer.

Medicines – Finasteride and Dutasteride

Finasteride and Dutasteride are drugs used to lower the amount of male sex hormones made by the body. Studies show that men taking either drug were less likely to develop prostate cancer after several years than those who did not. However, in men who took these drugs, there were more cases of prostate cancer that looked like they might grow and spread quickly. As such, it is not yet known whether these drugs lower the risk of death from prostate cancer. These drugs can also cause side effects such as lowered sexual desire and impotence. Men who would like to know more about this option should discuss it further with their doctors.

Regular testing for prostate cancer

Early diagnoses can be made by testing men for prostate cancer regularly. The purpose of the screening is to detect tiny or even microscopic cancers that are still within the prostate gland. Early treatment of these cancers can stop the growth, prevent the spread, and possibly cure the cancer.