About Prostate Cancer

What exactly is prostate cancer?

When cells in the prostate multiply too quickly and grow out of control, this creates a cancerous tumour.

Often, this type of cancer grows slowly and doesn’t cause big problems right away. Sometimes, however, prostate cancer can be fast-growing and spread to other parts of the body, causing major damage.

Catching cancer early, so that your doctor can keep an eye on it and recommend next steps, is ideal. If the cancer is caught later, you may still have options to work through with your healthcare team that put your quality of life first.

Prostate cancer is the most commonly diagnosed cancer in men and is particularly common over the age of 50 years.

Where is the prostate? What does it do?

Where is the prostate located? The prostate gland sits just underneath the bladder and is usually about the size and shape of a walnut. The prostate also surrounds the urethra, which is the tube you urinate and ejaculate through. It’s normal for the prostate to grow with age, and sometimes a larger prostate can cause problems with passing urine (pee). This is not always a sign of cancer but should be checked with your doctor.

The main job of the prostate is to help make semen, the fluid that carries sperm.

Prostate cancer risk factors

Anyone with a prostate can get prostate cancer. And it’s important to have regular check-ups with your doctor to monitor your prostate health and prostate cancer risk factors related to your personal circumstances.

Not everyone has regular access to a doctor but, if possible, check if you can find support using the resources on our prostate cancer support hub.

What exactly causes prostate cancer is unknown, but some factors can increase your risk. The more common risk factors include age, ancestry, and family history. Carrying too much weight or having an unhealthy lifestyle can also increase your risk.

Age

Your risk of developing prostate cancer increases with age, but that doesn’t mean it’s a disease that only affects older people.

If you’re 50 years or over, it’s important to talk to your doctor about keeping yourself healthy and any ongoing tests you may need as part of your health check-ups.

You need to start that conversation earlier at 40 to 45 years if:

• You have a family history of prostate cancer.
• You're Black.

Guidelines can be different, depending on where you live, so check with your doctor.

Ancestry

Black men are more likely to develop prostate cancer and more likely to die from it, compared to men of different ancestry. Prostate cancer also tends to develop at a younger age and grow faster in Black men than in any other group.

Family history

If you’re worried about prostate cancer and considering having prostate cancer tests done, ask your doctor to discuss it with you. Just having the conversation can help you decide what’s right for you.

• If your father or brother had prostate cancer before the age of 60, you may be twice as likely to develop the disease yourself.
• If you have more than one male relative with prostate cancer, your risk could be 5 times more.
• If there is a strong family history of breast or ovarian cancer, especially on the same side of the family (mother’s or father’s side), your risk is increased.

Certain genes, passed on from your parents (or other relatives), can affect your prostate cancer risk.

How do you test for prostate cancer?

The first checks for prostate cancer are usually a blood test and a physical examination. What you have will depend on your doctor’s guidance.

The PSA test: Blood test for prostate specific antigen (PSA) levels.

For the PSA test you’ll have a small blood sample taken from your arm and sent off for lab testing. It is a simple test which does not require fasting or any other type of preparation.

PSA is a protein made by your prostate and found in the blood. It is found in both healthy cells and cancerous cells, so it’s quite normal to have some PSA in your blood. When problems with the prostate happen, the levels of PSA in the blood rise. Understanding how much PSA you have in your blood is important, especially if the levels go up. This is where PSA testing comes in.

PSA testing is one of the first checks to find prostate problems and a high PSA level does not always mean you have cancer. PSA levels can also increase if there is growth, inflammation (prostatitis), or infection of the prostate. Sometimes, even ejaculation can raise the PSA so your doctor may tell you to not to ejaculate for a few days prior to the test. It’s important to keep track of your PSA levels even after cancer treatment, as this can help indicate if the cancer has returned.

How is prostate cancer diagnosed or confirmed?

Biopsy

Transrectal ultrasound (TRUS) guided biopsy

A needle is inserted into the prostate through the back passage (rectum) guided by an ultrasound probe. This is a small device that is also passed into your back passage so your doctor can see an image of the prostate. TRUS first measures the size of your prostate, using sound waves to build up a picture of the prostate gland. It might be a little uncomfortable but should only take a few minutes. Then, the needle is used to take samples of tissue from the prostate.

Local anaesthesia is used for a TRUS. This type of anaesthesia numbs the area tissue samples will be taken from.

Transperineal biopsy

A needle is inserted into the prostate, through the skin between the back passage (rectum) and testicles. An ultrasound probe is then placed in the back passage to allow the doctor to see where to pass the needle to take small samples of tissue from your prostate.

So you don’t feel anything, general or local anaesthesia can be used for a transperineal biopsy, depending on your health and how many tissue samples are going to be taken. General anaesthesia puts you to sleep. Local anaesthesia may be used at some centres for a perineal biopsy. This type of anaesthesia numbs the area that tissue samples will be taken from.

Magnetic resonance imaging (MRI) scan

An MRI creates a detailed picture of your prostate (and the surrounding tissues) to help diagnose prostate cancer. It’s also used to detect problems in your prostate if you have a raised PSA level.

Not everyone requires an MRI, but your doctor may order one for you. An MRI can be used before or after a biopsy. If it’s used before, it’s to help target cancer found in a biopsy, or to see if cancer is present at all. If it’s used after a biopsy, it’s to help determine if the biopsy may have missed a cancer in the prostate.

Gleason score

Almost all prostate cancers are called adenocarcinomas. These types of cancers are given a 'grade' to help understand how aggressive the cancer is. The most commonly used grading system is known as the Gleason score, a number ranging from 6 to 10. It is named after Dr Gleason, a pathologist (a doctor who examines body tissues).

What are the types of prostate cancer?

here are different types of prostate cancer, the main difference being the type of the cell where the cancer starts growing.

Localised prostate cancer

When the cancer is only within prostate and has not spread to the tissue surrounding the prostate.

Locally advanced prostate cancer

When the cancer has spread to tissue immediately surrounding the prostate.

Advanced (metastatic) prostate cancer

If the cancer spreads outside the prostate, this is known as advanced (metastatic) cancer. Common places for the cancer to spread include the lymph nodes in your pelvis, tissue in and around your pelvis and abdomen, and bones in the hips and back.

Advanced prostate cancer can present as:

• Hormone sensitive or castration sensitive prostate cancer: This is prostate cancer that has spread to other parts of the body but still responds well to hormone therapy (otherwise known as androgen deprivation therapy or ADT).
• Castration resistant prostate cancer: This is prostate cancer that has spread to other parts of the body and can no longer be slowed down by low testosterone levels (from using hormone therapy). It’s usually defined by a rising PSA level, worsening symptoms or a CT or bone scan showing growing cancer.

How is prostate cancer treated?

Treating prostate cancer may be heavy on your mind, but what will work for each person is different. Fortunately, there's usually time to talk to your doctor and discuss your options before jumping into any decisions.

Before choosing a treatment option, take time to carefully think about the things that are most important to you. Each treatment comes with some sort of side effect, so understanding each treatment and any risks are critical. Asking some necessary questions and reviewing the options with your doctor will help you to make the right decisions for yourself.