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 can 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, some intersex people.

Risk factors

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. older age); 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, like a father or brother, had 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 pee
• getting up often during the night to pee
• 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 that is not cancer.

Finding prostate cancer early

It's crucial 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 and what it 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
• your age is below 50: prostate cancer is rare in men under 50 years old
• your age is above 70 years: testing for prostate cancer is usually not recommended for men 70 years and older 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).

PSA test

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) or
• by prostate cancer.

DRE

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 (that 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 ascertain whether there is any cancer in your prostate gland.

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
• chemotherapy
• 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 the person's 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

Helpful websites

www.kupe.net.nz

www.prostate.org.nz