Prostate cancer develops when abnormal cells in the prostate gland grow more quickly than in a normal prostate, forming a malignant tumour.
Prostate cancer is the third most common cancer diagnosed in Australia1 and the third most common cause of cancer death. One in 5 men will be diagnosed with prostate cancer by the age of 85. It is more common in older men, with 63% of cases diagnosed in men over 65 years of age.
In 2013, 19,233 new cases of prostate cancer were diagnosed in Australia.
The five-year survival rate for men diagnosed with prostate cancer is 95%. Nearly all patients who present with localised disease will live beyond five years.
In 2014, there were 3102 deaths caused by prostate cancer, accounting for 13% of all cancer deaths in Australian men.
The symptoms can include:
- frequent urination, particularly at night
- pain on urination
- blood in the urine
- a weak stream.
More widespread disease often spreads to the bones and gives pain or unexplained weight loss and fatigue.
Some factors that can increase your risk of prostate cancer include:
- age, increasing rapidly over 50 years
- family history of prostate, breast or ovarian cancer
- a diet high in fats and low in fresh fruit and vegetables
- men of African descent are at higher risk than men of European or Asian descent
- there is an association with high testosterone levels.
Early detection and treatment can significantly improve prostate cancer survival. There are, however, no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer.
The tests most commonly used to aid early detection of prostate cancer are the prostate specific antigen (PSA) blood test and digital rectal examination. These are not diagnostic tests as they can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
For more information see our page on early detection of prostate cancer.
If your doctor suspects you may have prostate cancer, you may have one or more of the following tests:
Digital rectal examination
Using a gloved finger, the doctor will feel the back of the prostate gland. If a hardened area or odd shape is felt, further tests will be done.
PSA blood test
A prostate specific antigen (PSA) blood test measures the PSA levels, the proteins made by both normal and cancerous prostate cells. Because PSA levels can be variable, it is common for your doctor to use results from more than one blood test, over time, to help determine your risk of prostate cancer.
Some men with prostate cancer have normal PSA levels, and only one in three men with an elevated PSA level has cancer. As it is not a definitive test, a PSA test is normally used with other tests to diagnose prostate cancer.
A biopsy removes small pieces of tissue from different parts of the prostate with the aid of a rectal ultrasound, for examination under microscope. It is used to detect the disease and determine its aggressiveness (the Gleason score of 1-5 is added from two samples to form a score out of 10; low scores of 6 or less, indicate slow growing disease).
If cancer is detected in your prostate, you may have other tests such as MRI, CT or bone scans to see if the disease is contained to the prostate or to help with management and treatment options.
Treatment depends on the extent of the cancer.
The staging system used for prostate cancer is the TNM system, which describes the stage of the cancer from stage I to stage IV. Ninety per cent of patients present with local disease. Bone and CT scans are used to determine spread.
Active surveillance monitors prostate cancer that is not causing symptoms and is considered low risk. Generally active surveillance involves PSA tests every 3-6 months, rectal examination every 6 months and MRI scans and biopsies at 12 months and 3 years.
Watchful waiting is another form or monitoring prostate cancer that involves regular PSA tests and check-ups. Watchful waiting can be suitable for older men where the cancer is not likely to cause a problem in their lifetime.
Surgery with curative intent removes the whole prostate (radical prostatectomy). The main side-effects may include impotence and incontinence.
Radical radiotherapy can also be given with curative intent, either with external radiation or by implanting radioactive seeds (brachytherapy). Side-effects are similar to surgery, however bowel problems may also occur.
Androgen deprivation therapy (hormone therapy)
Some cancers need certain hormones to grow. Prostate cancer needs testosterone. Androgen deprivation therapy or ADT (once called hormone therapy) is used to slow the production of testosterone. ADT is often used before, during and after radiotherapy and is sometimes given with chemotherapy.
ADT can be given with injections or in tablet form. Surgery to remove part or all of the testicles may be preferable in some cases.
Depending on your treatment, your treatment team may consist of a number of different health staff, such as:
- a GP who looks after your general health and treatment
- a urologist
- a radiation oncologist
- a radiation therapist
- a medical oncologist
- a cancer care coordinator or urology care coordinator
- continence nurse
- sexual health physician or therapist
- other allied health professionals, such as counsellors and continence physiotherapists.
In some cases of prostate cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.
As well as slowing the spread of prostate cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
There are no proven measures to prevent prostate cancer.
Understanding Prostate Cancer, Cancer Council Australia ©2016. Last medical review of this booklet: April 2016.
Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books: Prostate cancer. Canberra: AIHW.
Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.