Prostate cancer is one of the most common cancers affecting Australian men. Raising awareness this month could mean a father, brother, partner or son is diagnosed earlier, when survival rates are far higher. Right now, only 36 per cent of cases are found at stage one.
Predominantly a disease of older age, prostate cancer develops when abnormal cells in the prostate gland begin growing uncontrollably. The prostate is a small gland, roughly the size of a walnut, located below the bladder. It forms part of the male reproductive system and produces some of the fluid found in semen.
Cancer Council Australia estimates that about one in five men will develop prostate cancer during their lifetime, with almost 29,000 cases expected to be diagnosed in Australia in 2025. The average age at diagnosis is around 70.
One of the challenges with prostate cancer is that it often produces no symptoms in its early stages. Even some people with more advanced disease may have few or no obvious warning signs. When symptoms do occur, they can include difficulty starting or maintaining urination, a weak urine stream, needing to urinate frequently or urgently, particularly at night, and a feeling that the bladder hasn’t completely emptied.
Blood in the urine or semen and unexplained pain in the lower back, hips or pelvis can also occur. These symptoms don’t necessarily mean someone has cancer, however, and can be caused by other prostate or urinary conditions.
Genes
Family history is a significant risk factor. Men with a close relative who has had prostate cancer, particularly if the relative was diagnosed at a younger age, should get checked more often. Certain inherited gene changes, including mutations involving BRCA1 and BRCA2, can also increase risk. Prostate cancer is slightly more common among men of African ancestry.
Currently there’s no national population-wide screening program for prostate cancer in Australia, unlike bowel cancer. Men can discuss their individual risk with GPs and consider whether testing is appropriate.
One of the main tests is the prostate-specific antigen (PSA) blood test. PSA is a protein produced by the prostate, and an elevated level can sometimes be a sign of prostate cancer. However, PSA can also rise for reasons unrelated to cancer, and some men with prostate cancer have normal PSA levels.
If tests suggest that cancer may be present, doctors may use magnetic resonance imaging (MRI) and, when appropriate, a biopsy to establish a diagnosis. The cancer is then assessed according to factors including its grade and whether it’s spread beyond the prostate.
Treatment of prostate cancer
This depends on the type and extent of the cancer, as well as a person’s age, general health and preferences. Some low-risk cancers may be managed through active surveillance, involving regular monitoring rather than immediate treatment.
Other options include surgery, radiation therapy, hormone therapy and, for some advanced cancers, chemotherapy or newer drug treatments.
An important consideration is that treatment can have side effects, including urinary problems, bowel problems and sexual difficulties. This is one reason doctors carefully weigh the potential benefits and harms of treatment, particularly when dealing with slow-growing cancers.
The outlook for prostate cancer has improved considerably in recent years. Awareness of risk factors, paying attention to persistent symptoms and having an informed discussion with a doctor about PSA testing can make all the difference.
You can find out more about Prostate Cancer Awareness Week and get involved here.
