A beginner’s guide to prostate cancer

14 Jul 2015

Awareness, living a healthy life and having regular prostate checks are the only ways to stay one step ahead of prostate cancer.

Prostate cancer is the most commonly diagnosed cancer in Australia, with 20,000 men diagnosed with it annually. But unfortunately we don’t know why. “We’re not sure why this is the case,” explains CEO of Prostate Cancer Foundation of Australia (www.prostate.org.au), Associate Professor Anthony Lowe. “Diagnoses have doubled over the last decade and much of this comes down to testing. Basically, if you look for something, you tend to find it.” And this seems to be the case with prostate cancer.

 Causes and risks

“We don’t know what the causes of prostate cancer are,” says Professor Lowe. “We do believe it is associated with western lifestyles and an ageing population.”

The two biggest risk factors for prostate cancer are unavoidable: being male and ageing. The older you get, the greater your risk, with your chance of developing prostate cancer by your 75th birthday being one in seven, yet by your 85th birthday, your risk increases to one in five. The average age of diagnosis is 68. 

“Most cancers are diseases of ageing,” states Professor Lowe. “All cancer diagnoses increase after the age of 50.” A family history of the disease also bumps up your risk. 

To counter western lifestyles, it’s all about making healthy choices. “We know that a balanced diet, maintaining a healthy weight and staying physically active can make a difference because it is good for your health and reduces your risk of other cancers,” says Professor Lowe. “We also know that exercise in particular can help improve your wellbeing in a number of ways if you are diagnosed with prostate cancer.”

 Early detection is key

“If caught in the early stages, prostate cancer is curable,” says Professor Lowe. Yet, the problem here is that in the early stages, there are often no signs or symptoms of the disease. 

“Symptoms often arise only after the cancer has spread beyond the prostate and when it gets to this stage it can’t be cured,” explains Professor Lowe. Symptoms of a more advanced degree of prostate cancer include needing to urinate frequently, suddenly having the urge to urinate, having difficulty urinating, finding blood in the urine or semen, and suffering from pain in the lower back, hips and upper thighs.

The only way to stay one step ahead of cancer is to get your prostate checked annually.

“Men are often hesitant to talk about their prostate because it is part of the reproduction system and for many years this has been perceived as a taboo topic,” says Professor Lowe. “Men are often reluctant to have a check-up as they don’t want to have a digital rectal examination (DRE) because they feel it is very invasive.”

A DRE is when the doctor inserts a gloved, lubricated finger into the rectum to feel for any abnormalities of the prostate.

“The good news is that before long, it may not be necessary to have digital rectal exams, as the prostate specific antigen (PSA) blood test may be able to offer adequate first screening,” he explains. The PSA blood test should be conducted annually and can be done at the same time as when you have your annual cholesterol and glucose blood tests.

If the PSA and DRE results are abnormal such as a high PSA level or a lumpy or hard prostate, your GP will refer you to a urologist who will take another blood test to double check things. If the results still appear abnormal, a biopsy will be done. The tissue sample is then sent to a pathology lab where it is investigated and a diagnosis is made.

Treatment and survival

Depending on the grade of the cancer, treatment options differ.

“If a low volume, low grade disease is diagnosed, your urologist may suggest active surveillance, which means regular check-ups to see how the cancer progresses. Prostate cancer tends to grow quite slowly,” says Professor Lowe.

If the prostate cancer is more aggressive, it may be removed surgically, treated with external beam radiotherapy, or brachytherapy, which involves implanting radioactive seeds into the prostate region.

Other options include androgen deprivation therapy – which reduces hormones in the body – and chemotherapy.

Side effects of prostate cancer are varied and can be different for each man. 

Emotional and psychological side effects may include anxiety and depression. 

Physical side effects of treatment can include:

•          Urinary incontinence

•          Sexual dysfunction

•          Possible bowel problems.

Lifestyle impacts may include:

•          Not wanting or feeling like you can go to work or go outside

•          Increased social isolation.

“There are solutions for all of these potential side effects,” explains Professor Lowe. They include pelvic floor exercises or an operation to help reduce urinary incontinence and bowel problems; medication, vacuum pumps, injections or prosthesis to assist with sexual dysfunction; and medication and counselling to help with anxiety and depression. 

Prostate cancer is the third most common cancer-related death in Australia. Over 3000 men die from it each year. The average age of death is 79 years old. 

However, according to Professor Lowe, survival rates are “quite good” and improving, largely due to early detection, advances in treatment and making healthy changes to your lifestyle.