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Prostate cancer develops in the walnut-sized prostate gland below the bladder – the gland responsible for making and storing seminal fluid (the liquid that nourishes sperm). When prostate cancer develops, cells in this gland grow more quickly than they should, forming a malignant lump or tumour. Over time, cancer cells can break away from the tumour and invade other parts of the body, such as the bones and lymph nodes, forming secondary tumours.
Prostate cancer is the most common cancer diagnosed in Australian men. The risk of being diagnosed with prostate cancer by the age of 85 is about 1 in 5. Fortunately the disease is normally not fatal and has a survival rate of over 90%.
In most cases of prostate cancer, the cause is unknown, and it is not known how the disease may be prevented. However, it is known that the chance of developing prostate cancer increases with age. A family history of prostate cancer is also a risk factor.
Men with a father, brother or son with prostate cancer have a significantly higher risk of developing this disease than other men, and the risk is even higher for men with several affected relatives.
Nationality is also relevant; for example, prostate cancer is more common in Australian men than Asian men, and more common in black Americans than white Americans. The reasons for this are not known, but lifestyle factors are likely to be important. Links have also been found between prostate cancer, eating a high fat diet, and drinking alcohol.
Research is continuing to improve our knowledge of the causes and prevention of prostate cancer.
The symptoms of prostate cancer can include:
• frequent urination, especially at night
• sudden or urgent need to urinate
• weak or interrupted flow of urine
• difficulty in starting or stopping urinating
• pain or buring when urinating
• blood in the urine or semen.
• pain in the back, hips or pelvis
• shortness of breath, tiredness, fast heartbeat, dizziness, or pale skin.
As men age, their prostate may get bigger, and this may block the flow of urine from the bladder and cause problems with sexual function. This condition, called benign prostatic hyperplasia (BPH), is not cancer, but can cause similar symptoms to prostate cancer.
Most prostate cancers are found during a rectal examination (when a doctor feels for an enlarged prostate gland with his/her finger), and/or a type of blood test called the prostate-specific antigen (PSA) test. Other tests include a trans-rectal ultrasound (inserting a probe into the rectum), and trans-rectal MRI, an imaging test that takes pictures of the prostate and nearby tissue.
In some cases, advanced cases of prostate cancer may be detected because of the symptoms they cause. A definitive diagnosis is made with a prostate biopsy (taking a small piece of the tumour for laboratory testing).
At the time of diagnosis, prostate cancer may be Stage I, II, II or IV. In Stage I, the cancer is found only in the prostate gland. In stage II, the cancer is more advanced, but has not spread outside the prostate. In Stage III, cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. In Stage IV, the cancer has spread further, sometimes to other areas of the body such as the bones.
If the cancer is found at an early stage, is slow-growing and is not causing any symptoms, active surveillance (watchful waiting) may be considered appropriate. For other men, other types of treatment may be given, including:
• radiation therapy
• hormone therapy
• biologic therapy
• bisphosphonate therapy.
Patients in good health whose tumour is confined to the prostate gland may be treated with surgery . Surgery for prostate cancer may involve either removing part of the prostate gland, or the entire prostate (radical prostatectomy).
Radiation therapy may be applied either externally (beams of radiation are directed towards the prostate from outside the body) or internally (by implanting radioactive ‘seeds’, a treatment called brachytherapy). The way the radiation therapy is given depends on the type and stage of the cancer being treated.
If the cancer has spread from the prostate to other parts of the body, other treatment options may include hormone therapy, chemotherapy and biologic therapy. Additional types of treatment are currently being tested in clinical trials.
After treatment for prostate cancer, regular follow-up examinations need to be done to look for any signs of the cancer returning, as well as to check for any late effects caused by treatment.
Follow-up normally includes regular PSA blood tests as well as physical examinations if the prostate hasn’t been removed. Imaging tests may also be done.