A/Prof Troy Gianduzzo, Brisbane Prostate Clinic, Urologist, Brisbane, QLD / Prostate / Prostate Cancer

Prostate Cancer

What is Prostate Cancer?

The prostate gland is a secretory gland situated around the bladder neck, and it releases seminal fluid to transport sperm.

Amongst the malignancies that affect men, prostate cancer is one of the most common types. The overall 5- year survival rate for this cancer is almost 99%, for all stages of cancer.

While many men die “with” prostate cancer rather than “of” prostate cancer it is important to note that more men die of prostate cancer each year in Australia than women die of breast cancer.

Who Does Prostate Cancer Affect?

Prostate cancer occurs only in men and is more common in men who are older than 50 years, but it can also occur in men as young as 40. Therefore, testing for prostate cancer should begin at age 50, or from 40-45 years of age depending on the risk factors.

A positive family history on the father’s side of the family (father, paternal uncles, brothers) is the main risk factor and are more likely to result in more advanced cases of the malignancy. Also, a strong family history of breast, ovarian or pancreatic cancer may indicate the presence of a BRCA gene defect which is also a risk factor.

The rate of prostate cancer also varies with race, with Asians having the lowest incidence, the Hispanics and Caucasians having higher incidence rates.

How Does Prostate Cancer Occur?

When the cells in the prostate gland become abnormal, this results in the uncontrolled division in the mutated cells, forming a tumour made up of the abnormal cells, which continue to grow and spread to surrounding tissues and potentially to the rest of the body.

What are the Causes of Prostate Cancer?

The causes of prostate cancer are still not fully understood. Genetic and racial factors play a role as do dietary factors such as a high-fat diet and obesity.

What are the Symptoms of Prostate Cancer?

The symptoms don’t appear in the earlier stages of the disease. Therefore, men should not rely on symptoms as a guide as to whether there is anything wrong. Only a PSA test and a prostate examination can indicate whether cancer is present.

As the malignancy progresses, it can cause the following symptoms:

Difficulty in urination, the need to push harder
A weaker stream of urine
Pelvic discomfort
Blood observed in ejaculation (semen)
Erectile dysfunction
Infertility
Fatigue,
Weight loss, bone pain

What are the Types of Prostate Cancer?

Prostate cancer occurs when a tumour develops in the prostate gland. A core distinction with prostate cancer is whether the cancer is localised only in the prostate, or if it has spread outside the prostate gland to the lymph nodes, bones, or other areas. This is called metastatic prostate cancer.

The most common type of prostate malignancy is adenocarcinoma, either acinar or ductal in nature (almost 98% of all cases).

Other rare types include small call cancers, sarcomas and others (roughly 1% of all cases).

What are the Stages of Prostate Cancer?

The prostate cancer can be graded based on its aggressiveness and spread.

Gleason Scale

Historically, a scale called Gleason score is used for this which gives a score out of 10.

Oddly, the lowest possible number is a score of 6 which means the cancer is non-aggressive. A score of 7 indicates intermediate cancer, and scores of 8-10 mean it’s very aggressive.

The Gleason score is now being replaced with a simpler system called the ISUP (International Society of Uropathologists) classification. This system is based on the Gleason score as follows:

ISUP 1 - Gleason Score 3+3 = 6
ISUP 2 - Gleason 3+4 = 7
ISUP 3 - Gleason 4+3 = 7
ISUP 4 - Gleason Score 8
ISUP 5 - Gleason Score 9,10

Nowadays, ISUP is preferred.

TNM Staging

TNM staging essentially describes how far cancer has spread within and/or beyond the prostate capsule. In cases where there is no distant secondaries and where curative treatment is being considered, the T stage is particularly important:

T1: Tumour is confined within the prostate and the prostate feels normal. It is usually diagnosed on the basis of a raised PSA.
T2: Tumour is confined to the prostate, but the prostate feels irregular to examination.
T3: Tumour has spread just beyond the shell of the prostate into nearby tissue and/or the seminal vesicles at the back of the prostate gland.
T4: Tumour has spread into adjacent organs such as the bladder, rectum, or pelvic side wall.

Prostate cancer can also spread to lymph nodes (N stage) and to other parts of the body such as to bone and other organs as metastases (M stage).

It is important to note that prostate cancer does not typically produce symptoms until it is advanced. This is why it is important for men to get PSA tests as this is the main way that prostate cancer will be diagnosed before it has spread.

How is Prostate Cancer Diagnosed?

There are certain medical institutes that recommend regular screening of healthy men over the age of 50, especially men with identified high-risk factors, as early prognosis is crucial in a more positive outcome.

Screening involves a

Digital Rectal Examination
Prostate Specific Antigen Test

The guidelines concerning screening are still not a universal standard. However, regular testing should start from age 50, or age 40-45 if there are risk factors. The exact age to stop PSA testing is unclear but is around 75 years.

If the digital rectal examination or prostate specific antigen test yields an abnormal result, to confirm malignancy and its stage the doctor may conduct an:

How is Prostate Cancer Treated?

The treatment of prostate cancer varies on a case to case basis. It depends on the general health of the patient, cancer’s progression, patient’s age and what the overall benefit would be if treatment is provided.

The treatment options range widely including

The patient is also recommended therapy for distress and depression that might result from this prognosis as well as group support.

What If Prostate Cancer Is Untreated?

If left untreated, the results would vary from case to case.

In some cases, the prostate cancer remains confined to the prostate and no other symptoms other than those mentioned earlier are seen. However, in other cases, it may spread to the bladder, lymph nodes and bones, resulting in further complications and making successful therapy more difficult. Also, while the risk of death from prostate cancer over 10-15 years may be low, there can still be considerable pain and suffering requiring intensive treatments in cases where it has spread. Furthermore, the objective of treatment is to cure the man of his prostate cancer so that he can live his normal full life expectancy.