An overview of Prostate Cancer

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Prostate Cancer

Prostate cancer is the abnormal growth of cells in the prostate gland. It occurs in men and is dependent on testosterone, a male hormone.

Prostate cancer, like all other cancers, ranges in level of aggressiveness. It is often referred to as the cancer that “men die with and not from”. This is true in some cases where prostate cancer can be monitored effectively with little chance of it spreading. In other cases, prostate cancer can be more aggressive and may spread to other areas of the body. Your specialist will be able to advise you about this. 

Prostate Specific Antigen, often referred to as PSA, is measured with a blood test. PSA is a measure of activity in the prostate and is one of the tests used to screen for prostate cancer. Other tests include a digital rectal exam and a biopsy if needed. PSA is not cancer specific and other things such as infection or inflammation can cause PSA to rise. This is why PSA is used in combination with other tests to check for prostate cancer. PSA is not used to diagnose prostate cancer, but rather to measure a patient’s risk of harbouring prostate cancer.

There are many treatments available for prostate cancer ranging from local treatment of the prostate gland to more general medical treatments. All treatments can result in side effects, but these can be treated or managed.

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Where is the prostate, what does it do?

The prostate is located in the pelvis, immediately below the bladder and just in front of the rectum. The prostate is about the size of a walnut and wraps around the urethra - the tube that passes urine from the bladder through the penis. The main function of the prostate is to produce a fluid which protects and enriches sperm and is involved in the ejaculate fluid.

Because of the position of the prostate, deep within the pelvis in an area that is important for bladder, bowel and erectile functioning, there may be significant implications for these functions when the prostate is treated.

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What is the average age of men diagnosed with prostate cancer?

As men get older, their risk of developing prostate cancer increases [6]. The most common decade for diagnosis is 65-75 years of age. In 2009, the average age for prostate cancer diagnosis in Australia was 67.4 years [1]. In 1993 the average age at diagnosis was 72.3 years [7]. In the USA between 2005 and 2009, the average age of men diagnosed with prostate cancer was 67.0 years [8].

Risk of diagnosis at age

Risk

75 years

1 in 7

85 years

1 in 5

1. AIHW & AACR, Cancer in Australia 2012: an overview.2012, AIHW: Canberra.
6. Baade, P.D., et al., Communicating prostate cancer risk: what should we be telling our patients? Med J Aust, 2005. 182(9): p. 472-5.
7. AIHW, Cancer in Australia 2006: an overview. 2007, AIHW: Canberra.
8. SEER, "SEER Stat Fact Sheets: Prostate." 2012 http:// seer.cancer.gov/statfacts/html/prost.html#incidence-mortality.

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What is prostate cancer?

Prostate cancer occurs when abnormal cell growth occurs in the prostate gland. 

This image reproduced with permission from: Localised Prostate Cancer Guide (2010), Cancer Council Australia, Australia Prostate Cancer Collaboration

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Local and metastatic prostate cancer

Prostate cancer originates in the prostate gland, but in some men it will develop the potential to spread outside the prostate to the tissue around the prostate gland, or even to distant sites such as lymph nodes, bone or other organs.

When prostate cancer is contained to the prostate gland, it is referred to as “localised prostate cancer”. Although this represents the early stages of disease, some men with prostate cancer will not progress beyond this stage as they have an indolent form of the disease. There are many curative treatment options for localised prostate cancer, but not all men will require treatment.

When prostate cancer spreads to the local tissue around the gland, it is known as “locally advanced” disease. This still represents curable disease in many cases, but spread to distant sites is more likely in men with “locally advanced” disease than it is with “localised disease”. This is true even when scans show no evidence of disease elsewhere in the body.

Once disease has spread to sites outside the prostate, such as lymph nodes, bones or other organs, it is known as “metastatic” disease. Currently, metastatic prostate cancer is incurable, but there are a number of treatments available to slow the growth and even shrink the prostate cancer.

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Different types of prostate cancer

Prostate cancer is graded according to how aggressive it appears under microscopic examination using the Gleason grading/scoring system. There may be more than one Gleason grade of cancer in the prostate gland or biopsy specimen. The pathologist will examine the specimen under a microscope and the two most common cancer grades are determined. The Gleason score is calculated by adding the two most common grades of cancer and can range from 2-10; tumours are now no longer assigned scores of 5 or below and a score of 6 is generally regarded as slow growing and not very aggressive. The predominant grade is listed first and may indicate how aggressive the tumour is (e.g.4+3=7 may be more aggressive than 3+4=7).

Gleason Score

Your Risk from Prostate Cancer

2-6

Low

7

Intermediate

8-10

High

 

The Gleason score, level of PSA, the number of positive biopsy cores or amount of cancer in the biopsy cores as well as the position of the cancer will be used together to determine the risk level of prostate cancer.

More and more research is being done in this area and there may be other factors that are used to determine risk in the future.

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How common is prostate cancer?

Prostate cancer is the most commonly diagnosed non-skin cancer in Australia. The latest Australian data published is from 2009, during which 19,438 men were diagnosed [1]. Age is the biggest risk factor in being diagnosed with prostate cancer and as men get older, the risk increases. However, prostate cancer is not just a disease of older men; of the men diagnosed in 2008, 470 men were under 50 years of age [2].

Prostate cancer accounts for about 30% of all cancer diagnoses in men [1]. This is above other cancers including bowel cancer (12.6%; 14,410 people diagnosed) and breast cancer (27.4%; 13,668 women diagnosed). Unfortunately prostate cancer is still the third most common cause of cancer-related death in Australia with 3,235 deaths in 2010 [1]. 

In 2020, prostate cancer is expected to remain the most commonly diagnosed cancer in Australia and the projected incidence is approximately 31,000 men diagnosed [3].

Australia, along with North America, New Zealand and Western Europe has the highest incidence of prostate cancer in the world [4]. Although prostate cancer survival is highest in these areas [5], it remains the third most common cancer related death in males. The number of prostate cancer related deaths in men is similar to the number of breast cancer related deaths in women.

1. AIHW & AACR, Cancer in Australia 2012: an overview.2012, AIHW: Canberra.
2. AIHW, Australian Cancer Incidence and Mortality (ACIM) books. 2011, AIHW : Canberra
3. AIHW, Cancer incidence projections, Australia 2011 to 2020. 2012, AIHW: Canberra.
4. Center, M.M., et al., International variation in prostate cancer incidence and mortality rates. Eur Urol, 2012. 61(6): p. 1079-92.
5. Coleman, M.P., et al., Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol, 2008. 9(8): p. 730-56.

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Signs and Symptoms of Prostate Cancer

Prostate cancer, when it is confined to the prostate, usually has no obvious signs or symptoms.

It is common for men to worry that urinary obstructive symptoms or blood in the urine (haematuria) is related to prostate cancer. However these symptoms are usually due to other causes including Benign Prostatic Hyperplasia (BPH), i.e. an enlarged prostate, or prostatitis (inflammation or infection of the prostate).

It is important to note, however, that if you are experiencing any of these symptoms (especially blood in the urine) you should have a thorough examination with a urologist or your local doctor.

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Who is getting tested?

The number of men undergoing PSA testing has remained relatively steady over the last 4 years with around 800,000 PSA tests conducted each year in Australia.

The number of men diagnosed with prostate cancer is increasing, in part because of increased testing over the past 20 years, but also due to the increase in life expectancy.

The majority of PSA tests are undertaken by men between 55 and 64 years of age [9].

9. AIHW, Cancer in Australia 2010: an overview. 2010, AIHW: Canberra.

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What are the risk factors of developing prostate cancer?

Age is the biggest risk factor associated with prostate cancer; as men age their risk of being diagnosed increases steadily. Aside from age, prostate cancer has two other known clinical risk factors – a family history of prostate cancer and certain ethnic groups [10].

10. Damber, J.E. and Aus, G., Prostate cancer. Lancet, 2008. 371(9625): p. 1710-21.

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Is prostate cancer lethal?

In Australia in 2010, 3,235 men died from prostate cancer (average age 80 years), making prostate cancer the third most common cause of cancer-related death after lung (8,099 deaths) and bowel cancers (3,982 deaths) [1] .

Currently more than 90% of men diagnosed with prostate cancer in Australia survive at least five years [1].

The risk of dying from prostate cancer is based on many factors, including the Gleason grade, the stage of disease, age and family history as well as other factors. Most men who do die from prostate cancer have higher risk disease - but the majority of men will die with prostate cancer, rather than from it.

1. AIHW & AACR, Cancer in Australia 2012: an overview.2012, AIHW: Canberra.

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Is prostate cancer hereditary?

Prostate cancer is a hereditary cancer in some cases. The risk of developing prostate cancer varies depending on which relatives have been diagnosed. A man is at a greater risk of being diagnosed with prostate cancer if he has a brother or brothers with history of prostate cancer; compared to if his father has a history of prostate cancer. Combined, father and brother, they pose a greater risk than a father or brother alone [12-14].

What is the risk of developing prostate cancer?

2-4 fold increased risk

One first degree relative diagnosed with prostate cancer

2-4 fold increased risk

Father diagnosed with prostate cancer when he was older than 60 years 

3-4 fold increased risk

Brother diagnosed with prostate cancer or father diagnosed aged less than 60

5 fold increased risk

2 or more first-degree relatives diagnosed with prostate cancer

11. Barratt, A.L. and M.R. Stockler, Screening for prostate cancer: explaining new trial results and their implications to patients. Med J Aust, 2009. 191(4): p. 226-9.
12. Brandt, A., et al., Age-specific risk of incident prostate cancer and risk of death from prostate cancer defined by the number of affected family members. Eur Urol, 2010. 58(2): p. 275-80.
13. Zeegers, M.P., A. Jellema, and H. Ostrer, Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: a meta-analysis. Cancer, 2003. 97(8): p. 1894-903.
14. Bratt, O., Hereditary prostate cancer: clinical aspects. J Urol, 2002. 168(3): p. 906-13.
15. McDowell, M.E., et al., Patterns of prostate-specific antigen (PSA) testing in Australian men: the influence of family history. BJU Int, 2012. 109 Suppl 3: p. 64-70.

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