Prostate cancer is a malignancy of the prostate gland, and is one of the most common cancers in men. In most cases, these tumours are adenocarcinomas (cancers arising from mucus-producing glands), however it can also develop as sarcomas (cancers arising from bone or soft tissue), small cell carcinomas (cancers arising from the tissues that line organs) or neuroendocrine tumours (tumours that develop from neuroendocrine cells that produce hormones and peptides).
The prostate is a walnut-shaped gland in the male reproductive system. It sits below the bladder, and in front of the rectum (end of the small bowel). The prostate is responsible for producing semen, a bodily fluid that acts as a vessel for sperm transport during ejaculation, and nourishment to keep the sperm alive outside of the body. It also has a small role in the urinary system, as the thin tube (ureter) that runs through the bladder to the penis is passed through the prostate.
Prostate cancers are most commonly found in men over 55 years of age. However, anyone with a prostate – including teenagers, transgender women, non-binary individuals, and intersex people – can develop this disease at any age.
If prostate cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for prostate cancer may include:
- Surgery to remove the prostate (radical prostatectomy), potentially including:
- Retropubic prostatectomy (prostate is removed through an incision in your abdomen).
- Perineal prostatectomy (prostate is removes through an incision made in the skin between the anus and the scrotum).
- Radiation therapy, potentially including:
- External beam radiation therapy.
- Internal radiation therapy.
- Hormone therapy, such as androgen deprivation therapy (ADT).
- Watch and wait.
- Clinical trials.
- Palliative care.
Prostate Cancer Treatment and Fertility
Treatment for prostate cancer may make in difficult to conceive a child. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
While the cause of prostate cancer remains unknown, the following factors may increase your risk of developing the disease:
- Being over 55 years of age.
- Having a family history of prostate cancer.
- Having a family history of breast and/or ovarian cancer.
- Having BRCA1 and/or BRAC2 genetic mutations.
- Being if African American descent.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms of prostate cancer may include:
- Changes in urination, such as:
- Frequent need to urinate.
- Feeling like your bladder isn’t empty after urination.
- Slow urine flow.
- Weaker bladder.
- Loss of bladder control.
- Loss of bowel control.
- Blood in urine and/or semen.
- Erectile dysfunction.
- Pain when ejaculating.
- Unexplained weight loss.
- Bone pain.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
If your doctor suspects you have prostate cancer, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment.
Pelvic examination – Digital Rectal Examination (DRE)
A digital rectal examination (DRE) is an exam conducted by a urologist (a doctor specializing in issues pertaining to the kidneys, bladder, prostate, and male reproductive system). In this exam, the doctor will insert a finger (or ‘digit’) into your rectum to feel the back of your prostate. If it feels hard or is an odd shape, further testing may be required.
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), transrectal ultrasound, bone scan and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis.
A blood test may be taken to assess your overall health and help guide treatment decisions. Additional blood tests may be conducted to check for tumour markers, which are indicative of cancer cells. The most common tumour marker for prostate cancer is elevated levels of prostate specific antigen (PSA). PSA can be caused by healthy and cancerous prostates, however an elevated level of PSA in the blood may be indicative of disease.
Once the location of the cancer has been identified, the doctor will perform an diagnostic procedure to determine your diagnosis. In many cases, diagnosis is confirmed after surgical removal of the affected ovary. However, if it is suspected the cancer has spread, the doctor will perform a biopsy to remove a section of tissue using a needle. This is often done by a fine needle aspiration (FNA), a core needle biopsy (CNB), or by surgical means (excisional or incisional biopsy).
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage prostate cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.