Prostate Cancer

Kidney Cancer :: Prostate Cancer
Bladder Cancer :: Testicular Cancer

Prostate cancer is the most common (non-skin) cnacer in men. It affects approximately one in every six men in Australia and is the cause of death in around 2-3%.

It represents a wide spectrum of risk. Some prostate cancers can be left a long period of time before it poses any risk to the patient but some prostate cancers are aggressive and will cause problems if left untreated.

Prostate cancer can be cured if detected and treated while the cancer is still confined to the gland. Once it has spread it cannot be cured BUT there are many options available even in this situation.

There are two tests that are done to look at a patients risk for prostate cancer. The digital rectal examination (DRE) and the prostatic specific antigen blood test. These tests do not tell us if a patient has prostate cancer but the risk of having prostate cancer. A prostate biopsy is the only sure way of diagnosing prostate cancer.

Treatment for prostate cancer mainly depends on the type and stage of cancer. Early screening of prostate cancer is beneficial as effective treatment can be provided timely. Screening of prostate cancer can be done by the following tests:

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or firmness, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis.

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate. While this test is not specific for cancer there many ways to improve its accuracy.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).
PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is present.

An elevated PSA usually (in the absence of an abnormal DRE) is usually repeated to ensure there is no mistake. Often this may be done up to 3 months later or a course of antibiotics are prescibed prior to the repeat PSA to ensure there is no infection present that may lead to an elevated level. A free to total ratio is often used as that can improve the specificity of the PSA test. Newer tests such as the prostatic health index (PHI) and PCA3 test are becoming available and the usefulness of these tests are being looked at in clinical practice.

When there is a high level of suspicion based on the DRE or the behavior of the PSA then a prostatic biopsy may be performed.

Prostate biopsy

Staging and Grading

The tests performed are used to determine the stage of the prostate cancer. Biopsy specimens are analysed to find out how aggressive the cancer is.
The staging system describes how far the cancer has spread within and/or beyond the prostate capsule.

Stage 1/A: There are no symptoms and the tumour is confined within the prostate. It is usually found during the investigation of a different complaint.

Stage 2/B: Again the tumour is confined to the prostate and although symptoms may not be apparent, it can be felt during a DRE.

Stage 3/C: The tumour has spread just outside the prostate gland and may effect nearby tissue.
A common symptom is difficulty in urinating.

Stage 4/D: Also known as Metastatic cancer, the tumour has spread to other parts of the body. Bones and Lymph nodes are commonly afflicted and symptoms may include fatigue, weight loss, bone pain and difficulty urinating.

The Gleason Score indicates how aggressive the cancer is. The Gleason Score (or Sum) is something that the pathologist tells about the cancer in terms of its aggressiveness on the basis of careful inspection under the microscope. The Gleason Score is actually made up of 2 numbers known as Gleason Grades. When a pathologist looks at the prostate cancer under the microscope, a number grade from 1 to 5 is assigned to the areas most representative of the cancer present (the primary Gleason Grade). A second number grade from 1 to 5 is given to the second most representative area within the cancer (The secondary Gleason Grade). These two numbers are added together to give the Gleason Score, the maximum Gleason Score is 10 and the minimum Gleason score is 2. The higher the score, the more aggressive the tumour is likely to be and this will impact on the likely success of treatment.

Staging
Staging refers to tests done to determine if a cancer has spread. Typically in prostate cancer a CT scan of the abdomen and pelvis and a Bone scan are performed. Recently MRI scans are being utilised to look more closely at the local staging of the prostate cancer.

Bone Scans

Your doctor may want to see if the cancer has metastasised and has affected your bones. A small amount of radioactive material is injected into your arm, which is then absorbed by your bones as they heal. Your arm will then be scanned an hour later to view the activity of the bone and ascertain whether the cancer has spread.

CT scans

A CT scan is performed to determine if the lymph nodes in particular are enlarged that may represent spread of the prostate cancer. I takes about 30 mins to do.

MRI scans

MRI scans are becoming more important in the localised staging of prostate cancer. It can also be used to help in the management of patients undergoing active surveillance. It can take around 45 minutes to perform.