Prostate Cancer
What is prostate cancer?
Prostate cancer is a malignant tumour in the prostate. It is the most common cancer in elderly men with an average age for diagnosis being 69. Most prostate cancers develop slowly and do not cause symptoms. Because of the development in PSA testing, diagnostic tools and longer life expectancy, more prostate cancers are now detected at an earlier stage and the survival rate is high.
What are the risk factors for prostate cancer?
The growth of prostate cancer cells is related to male sex hormones called androgens. The known risk factors for prostate cancer are:
Age
Family history of prostate cancer
Race - African descent and Caucasian
How is prostate cancer diagnosed?
Prostate cancer does not present with any symptoms in most cases. In most cases, symptoms are caused by benign prostatic enlargement (BPE), or an infection. If prostate cancer does cause symptoms, it is usually a sign that the disease has advanced. These may include urinary symptoms such as urinary frequency, leakage or a weak stream, blood in the urine or pain in the hips, back, bones or legs.
Because of this, it is important that you see a doctor to discuss screening for prostate cancer especially if you have the risk factors described above.
Screening for prostate cancer is done with a test called PSA and a digital rectal exam. If any of these are abnormal, your urologist may order a MRI scan which has approximately 80-85% chance of predicting significant prostate cancer.
None of these tools will provide a definite answer on whether or not you have prostate cancer. If based on your history, risk factors, rectal exam and the above tests the risk is high, you may need a biopsy of prostate tissue to confirm if you have prostate cancer or not.
What are the stages of the disease?
Prostate cancer is usually staged using scans such as PET scans, CT scans or bone scans. The different stages of prostate cancer are
Localised prostate cancer - the tumour is limited to the prostate gland
Locally-advanced prostate cancer - the tumour has grown out of the prostate into surrounding tissues
Metastatic prostate cancer - the tumour has spread to distant lymph nodes or other organs.
Prostate tumours are further classified according to the tumour stage and the grade of aggressiveness of the tumour cells, which is are the basis for your possible treatment pathway. The grade (called ISUP grade) is classified from 1-5, 1 being the least aggressive and 5 being the most aggressive.
How is prostate cancer treated?
There are many treatment pathways and each has their own advantages and disadvantages.
Your urologist will consider the cancer characteristics, your medical history and preferences and advise which pathway(s) may be best suited to you. The treatment options based on your disease stage are:
Localised prostate cancer
Active Surveillance - Your disease is carefully monitored with examinations, blood tests and MRI and if there are signs of progression of your cancer you will be offered curative active treatment
Active treatment
Radical prostatectomy - Surgical treatment option for where the aim is to remove the entire prostate and the seminal vesicles. This can be done via open incision or keyhole surgery (robotic surgery)
Radiotherapy -A dose of radiation is administered to the prostate through an external source or via radioactive seeds implanted in your prostate which kills cancer cells
Watchful waiting - Your disease is monitored because you have limited life expectancy and if there are signs of progression of your cancer you will be offered hormone treatment
Experimental techniques such as focal therapy
Locally-advanced prostate cancer
Active treatment
Radical prostatectomy - Surgical treatment option for where the aim is to remove the entire prostate and the seminal vesicles. This can be done via open incision or keyhole surgery (robotic surgery)
Radiotherapy -A dose of radiation is administered to the prostate through an external source or via radioactive seeds implanted in your prostate which kills cancer cells
Hormone therapy (injections or oral medications) - This is a part of a palliative care approach. The treatment will slow the growth of the primary tumour and the metastases, and help to manage the symptoms
Metastatic prostate cancer
Hormone therapy (injections or oral medications) - This is a part of a palliative care approach. The treatment will slow the growth of the primary tumour and the metastases, and help to manage the symptoms
Chemotherapy
Other new drugs as part of clinical trials