September is Prostate Cancer Awareness Month in New Zealand. Blue September is a good time to learn more about one of the most common cancers affecting New Zealand men. There’s a good chance you know someone who has been affected by it. In this article, we look at what prostate cancer is, its symptoms, testing, diagnosis and treatment.
Prostate cancer develops when abnormal cells grow in the prostate, potentially invading surrounding tissues and spreading beyond the gland. The prostate is a small walnut-shaped gland that surrounds the opening of a man’s bladder. The prostate produces a fluid that makes up part of semen.
Prostate cancer is a serious and common disease. Every year over 4000 men in New Zealand are diagnosed with prostate cancer, and over 700 die from the disease. This makes it the second leading cause of cancer death in men, after lung cancer.
Some prostate cancers grow slowly, while others grow more quickly. If prostate cancer spreads to distant parts of the body, it is known as metastatic prostate cancer. If it spreads, prostate cancer most commonly spreads to your bones and lymph nodes. It can also spread to your liver, lungs, brain and other organs.
There are a range of risk factors for prostate cancer, these include:
In the early stages of prostate cancer there are often no symptoms. As prostate cancer progresses it can begin to cause symptoms. These symptoms that may appear are:
If you have any of these symptoms consult with your healthcare provider so they can assess your symptoms and provide a diagnosis.
Doctors use a combination of screening tests, physical exams, scans, and tissue biopsy to diagnose prostate cancer. Routine testing for prostate cancer without symptoms is not currently recommended in New Zealand – however if you’re over the age of 50 and have symptoms speak to your healthcare provider.
A prostate specific antigen (PSA) test and a digital rectal examination (DRE) are commonly used methods of detecting prostate cancer initially, or prompting further testing.
If your doctor thinks there may be a problem with your prostate they will recommend further tests such as scans using MRI or ultrasound and a prostate biopsy.
A prostate biopsy involves removing prostate tissue using a biopsy tool with a needle. It’s the only way to confirm whether there is cancer in the prostate.
The treatment recommended for your prostate cancer depends on multiple factors, including the grade and stage of the cancer. Your age, overall health, symptoms and preferences will also be taken into account.
Treatment options for prostate cancer can be separated into the following groups: surveillance, surgery, radiation therapy, systemic therapies and focal therapy.
Surveillance: If your cancer is in the early stages, hasn’t spread and is slow-growing, you may be recommended to monitor the cancer using active screening, where cancer growth is tracked using screening, scans and biopsies. In some cases treatment may never be required.
Surgery: for cancers that haven’t spread outside of the prostate, your specialist might recommend a radical prostatectomy to remove the diseased prostate gland. Robotic radical prostatectomy (also called robot-assisted laparoscopic prostatectomy or RALP) is minimally invasive using several tiny incisions and often used by specialists.
Radiation therapy: such as brachytherapy or external beam radiation therapy (EBRT) may be used as a standalone treatment or in combination with others. It targets cancer cells and kills them, while leaving healthy tissue alone.
Systemic therapies: If cancer spreads outside your prostate, your specialist may recommend these treatments which travel through your body. They include:
Focal therapy: is a newer form of treatment that precisely targets cancer inside the prostate and leaves healthy tissue intact. It may be available in private practice in New Zealand.
Palliative care: unfortunately, some later-stage or advanced cancer cases can’t be treated effectively or cured. The focus of treatment shifts to managing symptoms and improving or maintaining quality of life while living with the advanced disease.
Healthcare providers use the Gleason score and ISUP grading system to classify prostate cancer along with prostate cancer staging.
The Gleason score is used to determine how aggressive a prostate cancer is, how quickly it may grow, and how likely it is to spread. A pathologist will examine the cells of the prostate tissue under a microscope and give a score which is used to grade the cancer. The more abnormal the cells, the higher the score and the grade. High-grade cancers are more likely to grow and spread.
The ISUP grading system is a new simplified system which uses a Gleason score to determine a grade between 1 and 5.
Cancer staging allows your healthcare provider to determine how advanced your cancer is and how much it has spread using the Tumour, Node and Metastasis (TNM) system.
There is no guaranteed way to prevent prostate cancer. Healthy lifestyle choices support your overall health, and maintaining a healthy weight may help reduce the risk of advanced prostate cancer.
Steps you can take to support your health include:
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