Prostate cancer begins when abnormal cells in the prostate start growing in an uncontrolled way. In most cases, prostate cancer grows more slowly than other types of cancer. This might mean that you do not need treatment straightaway. However, some prostate cancers can grow and spread quickly, so it is important to investigate any symptoms or unusual test results promptly.

What is prostate cancer

Prostate cancer begins when abnormal cells in the prostate start growing in an uncontrolled way. In most cases, prostate cancer grows more slowly than other types of cancer. This might mean that you do not need treatment straightaway. However, some prostate cancers can grow and spread quickly, so it is important to investigate any symptoms or unusual test results promptly.

How common is prostate cancer?

Prostate cancer is the most common cancer in Australian men (apart from common skin cancers). There are about 18,000 new cases in Australia every year.

One in six men in Australia are at risk of developing prostate cancer by the age of 85. The risk of prostate cancer increases with age. It is uncommon in men younger than 50, although the risk is higher for younger men with a strong family history of prostate cancer, breast cancer or ovarian cancer, than for those without a family history.

What are the symptoms of prostate cancer?

Early prostate cancer rarely causes symptoms. Even when prostate cancer is advanced at the time of diagnosis, there may be no symptoms. Where symptoms do occur, they are often due to non-cancerous conditions, such as benign prostate hyperplasia (see below).

Symptoms of advanced prostate cancer may include:

  • unexplained weight loss
  • frequent or sudden need to urinate
  • blood in the urine
  • pain in the lower back, hips or pelvis.

These are not always signs of prostate cancer, but you should see your doctor if you have any of these symptoms.

Benign prostate hyperplasia (BPH)

In men over the age of 50, a normal prostate may grow and cause problems with the flow of urine. This growth of the prostate is called benign prostate hyperplasia (BPH). It is generally a normal part of ageing – it is not cancer.

BPH may cause symptoms that affect how you urinate, such as the stream of urine being weak; having to go frequently, especially at night; having to go urgently; trouble getting started; dribbling of urine after going; and the bladder not feeling empty. These are known as lower urinary tract symptoms (LUTS) and they also occur in advanced prostate cancer. If you are experiencing LUTS, speak to your doctor.

What are the risk factors?

While the causes of prostate cancer are unknown, your risk of developing prostate cancer increases:

  • as you get older – prostate cancer is most commonly diagnosed in men aged 60–79
  • if your father or brother has had prostate cancer – your risk will be twice that of other men
  • if you have a strong family history of breast or ovarian cancer, particularly BRCA1 and BRCA2 gene mutations.

While prostate cancer is less common in men under 50, men aged 40–55 are at particular risk of developing significant prostate cancer later in life if their prostate specific antigen (PSA) test results are above the 95th percentile. This means their PSA levels are higher than 95% of men in the same age range.

Family history

You may have an inherited gene that increases your risk of prostate cancer if you have:

  • multiple relatives on the same side of the family (either your mother’s or father’s side) with prostate, breast and/or ovarian cancers
  • a brother or father diagnosed with prostate cancer before the age of 60.

Your general practitioner (GP) can advise you on the suitability of PSA testing for you and your family. For more information, call Cancer Council 13 11 20.

Screening tests

Screening tests help to detect cancer in people who do not have any symptoms. Unlike for bowel, breast and cervical cancers, there is no national screening program for prostate cancer. There remains debate regarding the pros and cons of PSA screening and whether there is an overall benefit.

Some men without any symptoms of prostate cancer do choose to have regular PSA testing to screen for the disease. Before having a PSA test, it is important to talk to your GP about the advantages and disadvantages in your particular circumstances.

Which health professionals will I see?

Your GP will usually arrange the first tests. If these tests suggest that there could be cancer in the prostate, you will usually be referred to a specialist called a urologist.

The urologist can arrange further tests and advise you about your options. It is recommended that men with localised prostate cancer see both a urologist and a radiation oncologist before deciding on treatment.

Your specialists may discuss treatment options with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you will see a range of health professionals who specialise in different aspects of your care.

Health professionals you may see

GP: assists you with treatment decisions and works in partnership with your specialists in providing ongoing care; may monitor PSA levels and administer treatment

Urologist*: treats diseases of the male and female urinary systems and the male reproductive system; performs biopsies and prostate surgery

Radiation oncologist*: treats cancer by prescribing and coordinating the course of radiation therapy

Medical oncologist*: treats cancer with drug therapies such as chemotherapy and hormone therapy

Endocrinologist*: diagnoses, treats and manages hormonal disorders

Cancer care coordinator/ prostate cancer specialist nurse: coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; a clinical nurse consultant (CNC) or clinical nurse specialist (CNS) may also coordinate your care

Nurse: administers drugs and provides care, information and support throughout management or treatment

Urology care coordinator/ continence nurse: supports people with bladder and bowel management before and after cancer treatment

Radiologist*: that analyses x-rays and scans; an interventional radiologist may also perform a biopsy under ultrasound or CT, and deliver some treatments

Pathologist*: that examines cells and tissue samples to determine the type and extent of the cancer

Continence physiotherapist: provides exercises to help strengthen pelvic floor muscles and improve bladder and bowel control

Exercise physiologist/ physiotherapist: assists people with medical conditions to exercise and improve their overall health, fitness, strength and energy levels

occupational therapist: assists in adapting your living and working environment to help you resume usual activities

sexual health physician*/ sex therapist: can help you and your partner with sexuality issues before and after treatment; an erectile dysfunction specialist can give specific advice for erection problems

psychologist, counsellor: help you manage your emotional response to diagnosis and treatment; may also help with emotional issues affecting sexuality

social worker: links you to support services and helps you with emotional, practical or financial issues

* Specialist doctor

Caring for someone with cancer

You may be reading this because you are caring for someone with cancer. Being a carer can be stressful and cause you much anxiety. Try to look after yourself – give yourself some time out and share your worries and concerns with somebody neutral, such as a counsellor or your doctor.

Many cancer support groups and cancer education programs are open to carers, as well as people with cancer. Support groups and some types of programs can offer valuable opportunities to share experiences and ways of coping.

Support services such as Meals on Wheels, home help or visiting nurses can help you in your caring role. You can find local support services, as well as practical information and resources, through the Carer Gateway. Visit carergateway.gov.au or call 1800 422 737.

There are also many groups and organisations that can provide you with information and support, such as Carers Australia, the national body representing carers in Australia. Carers Australia works with the Carers Associations in each of the states and territories. Visit carersaustralia.com.au or call 1800 242 636 for more information and resources.

You can call Cancer Council 13 11 20 to find out more about carers’ services and support groups and to get a copy of the Caring for Someone with Cancer booklet.

Question checklist

You may find this checklist helpful when thinking about the questions you want to ask your doctor about your diagnosis, treatment and management. If your doctor gives you answers that you don’t understand, ask for clarification.

  • What type of prostate cancer do I have?
  • How far has the cancer spread? How fast is it growing?
  • What treatment do you recommend and why?
  • What happens if I do nothing or choose active surveillance or watchful waiting?
  • Are there other treatment choices for me? If not, why not?
  • What are the side effects of each treatment? How can these be managed? Will I have problems with continence?
  • How will my sex life, erections and fertility be affected?
  • Who should I see for help preserving the health of my penis?
  • Will I have to stay in hospital? If so, for how long?
  • How much will treatment cost?
  • How will I know if the treatment has worked?
  • When will I be able to get back to work and my usual activities?
  • After treatment, will I need check-ups? What will they involve?
  • What will happen if I need further treatment?
  • Is the cancer hereditary? If so, what do you recommend?
  • Are there any clinical trials that might be helpful?

Last Reviewed: 31/03/2018

Reproduced with the kind permission of The Cancer Council New South Wales.



References

Cancer Council NSW. March 2018. Understanding Prostate Cancer. A guide for men with cancer, their families and friends. https://www.cancer.org.au/content/about_cancer/ebooks/cancertypes/Understanding_Prostate_Cancer_booklet_March_2018.pdf. Understanding Prostate Cancer is reviewed approximately every two years, check the publication date via the Cancer Council website to ensure this copy is up to date.