Information about prostate cancer.
What is the prostate?
The prostate is a gland in the male reproductive system and is about the size of a walnut. It is found inside the body, in front of the rectum (bottom) and just below the bladder. It produces some of the fluid in semen.
What is prostate cancer?
Prostate cancer develops when cells in the prostate gland grow abnormally and spread either locally or around the body.
Who can be affected by prostate cancer?
The chances of getting prostate cancer increase from age 50 onwards. Prostate cancer affects people with a prostate: men, trans-women, non-binary people assigned male at birth and some intersex people.
Anything that can increase your risk is called a risk factor. Having one or more of these risk factors does not mean that you will develop prostate cancer.
Some of these risk factors can't be changed (e.g. ageing) and others can (e.g. being overweight).
The risk factors for prostate cancer are:
- Age: the risk of prostate cancer increases from age 50
- A close family member (e.g. father or brother) affected by prostate cancer
- Lynch syndrome (a rare genetic disorder)
- Being overweight or obese increases the risk of advanced prostate cancer
Signs and symptoms
There may be no warning signs that you have prostate cancer. Some signs and symptoms may include:
- Weak urine flow when urinating (peeing)
- A flow that stops and starts
- Needing to urinate urgently or more often than usual
- Trouble starting or stopping when urinating
- Getting up often during the night to urinate
- Burning when urinating
- Blood in urine or semen
- Pain during urination
- Lower back or pelvic pain
- Unexplained weight loss
It is important to note, problems with urination are common as men get older. This is usually due to prostate enlargement and not cancer.
Finding prostate cancer early
It's very important to discuss any signs and symptoms of prostate cancer with your doctor as soon as possible.
If you have no symptoms, deciding whether to get your prostate checked is a decision that should be based on your unique circumstances, including your age, family history and your preferences. You should understand the benefits and harms of testing and treatment and what they might mean for you and your whānau.
Talk with your doctor about the best options for you. The discussion could include:
- Harms and benefits of testing (see 'Impact of prostate cancer testing and treatment' section below)
- Whether you have a family history of prostate cancer
- If you are younger than 50: prostate cancer is rare in men under 50 years old
- If you are older than 70: testing for prostate cancer is usually not recommended for men over 70 years because it is unlikely to help them live longer
- Your health: some conditions such as Lynch Syndrome and obesity can increase the risk
Prostate cancer is common, and finding it early can save lives, but not all prostate cancer needs to be treated. Some men, such as those who are older, have other medical problems or whose cancer is slow growing, are more likely to die with prostate cancer than from it. This tool might help you decide what to do if you're unsure about getting tested: kupe.net.nz.
Testing and diagnosis
The most common tests used to investigate prostate cancer symptoms are the prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE).
A PSA blood test measures the level of PSA in your blood. The prostate gland makes PSA. Higher than normal levels of PSA can be caused by:
- An infection of the prostate gland
- An enlarged prostate (not cancer)
- Prostate cancer
A DRE is when the doctor feels the prostate (using a gloved, lubricated finger) through the wall of the rectum (bottom). They feel for any lumps or hard areas on the prostate. It usually only takes a few minutes.
The PSA test and DRE do not diagnose cancer. They can indicate that you may need further investigations. If there is an indication of any abnormality, you will most likely be referred to a specialist for an MRI scan (to takes 'pictures' of your prostate) or a biopsy. A biopsy involves taking tiny samples of the prostate tissue with a long fine needle. This tissue is then examined in a laboratory to see whether there is any cancer in your prostate.
Further tests will be recommended if there is a chance that cancer in your prostate has spread to other parts of your body. These tests may include:
- MRI scan
- CT scan
- Bone scans
Management or Treatment
The following are some common ways to manage or treat prostate cancer:
- Active surveillance: low-risk localised prostate cancer is monitored to make sure it does not grow. Active surveillance tests usually include the PSA test and DRE
- Radiation therapy
- Surgery to remove the prostate (radical prostatectomy) or remove prostate tissue (transurethral resection of the prostate (TURP))
- Hormone therapy (Androgen deprivation therapy)
- Cryosurgery (cold gases that destroy cancer cells)
- Immunotherapy (a drug that uses your white blood cells to destroy cancer cells)
The treatment for prostate cancer depends on the type and stage (how far it has spread) and your general health.
Follow-up tests after treatment to check whether cancer has come back include regular PSA tests.
Impact of prostate cancer testing and treatment
Prostate cancer testing and treatment can affect your quality of life and, your spiritual, mental, emotional, and physical wellbeing in many ways. These are also likely to impact upon your whānau.
Some tests, such as biopsy are invasive. There is a risk of:
- Blood in your urine and difficulty urinating
- Bleeding from the rectum
- Blood in your semen
There are also possible side effects of some treatments, such as:
- Problems getting and maintaining an erection
- Incontinence (leaking urine)
- Bowel problems
- Pain and tiredness
- Mental and emotional stress
- Forced lifestyle changes
These issues could be temporary or permanent.
Talking with your doctor
Your doctor wants you to have all the information you need to make the right choice for you. You may want to take a support person (partner, friend, whānau) with you when you visit. Your doctor can discuss any concerns and symptoms you may have and outline the known side effects of testing and treatment.