News

12-11-2018

Prostate cancer occurs when abnormal cells develop in the prostate gland.  The abnormal cells can continue to multiply and can spread outside the prostate. It is generally a slow growing, low-grade cancer and many men live for many years without symptoms and without it spreading and threatening life. The cause of prostate cancer is unknown. It is the second most common cancer in men worldwide. High grade disease spreads quickly and can cause death. 

The prostate is a small gland, surrounding the urethra, sitting under the bladder and near the rectum. Only men have a prostate, it is part of the reproductive tract and produces most of the fluid that makes up semen to enrich sperm. The prostate needs testosterone to grow and develop.  It is normal to grow as men age, but it can cause problems, such as difficulty urinating.

The main risk factors for prostate cancer are age, obesity and family history.  The chance of developing prostate increases with age. If you have a first degree relative with prostate cancer, particularly if diagnosed at a younger age, your risk is also increased. Other risk factors include lifestyle, diet and genetics - men of African or Caribbean descent have an increased risk. There is some evidence that a high fat, high processed meat diet increases risk as does obesity.

A PSA test is a blood test measuring the Prostate Specific Antigen level. It may help detect prostate cancer, but is not specific for prostate cancer and can be raised by noncancerous conditions. There is no single test for prostate cancer, investigation following an increased PSA level may include a digital rectal examination, a MRI and a biopsy. Routine screening for PSA levels remains a controversial subject in the international medical community. About 75 out of 100 men with a raised PSA level do not have prostate cancer, and 15 out of 100 with a normal PSA level have prostate cancer.

When you are 50years , have a conversation with your doctor about PSA testing. If you have increased risk factors of family history or you are of African or Caribbean descent, have the conversation from 45 years.

PSA tests are unreliable and can suggest prostate cancer when no cancer exists, despite the introduction of MRI scans to help reduce unnecessary biopsies, some men may have invasive and painful biopsies for no reason.  The PSA test may find aggressive prostate cancer that requires treatment, it can also find slow growing cancers that may never cause symptoms or shorten lives. Some men must also make difficult treatment decisions as treating prostate cancer in the early stages can be beneficial, but the side-effects of the various treatments can be significant ( impotence and erectile dysfunction)

Testing still can't answer many of the important questions about what type of cancer, particularly whether aggressive or not.  Many prostate cancers grow very slowly and may not need surgery or radical treatment. The treatment options include active surveillance, prostatectomy, radiotherapy, hormone therapy and chemotherapy.

Discussing whether to have a PSA test done with your doctor allows you to fully discuss the potential risks of over diagnosis and overtreatment compared to the possible benefits for you.

The pros: It may reassure you if the test is normal

                 It can find early signs of cancer, allowing early treatment

                 PSA testing may reduce your risk of dying if you do have cancer

The cons: It can miss cancer and provide false reassurance

                  It may lead to unnecessary worry and medical tests when there is no cancer

                  It cannot tell the difference between fast-growing and slow-growing cancers

                  It may make you worry by finding an slow-growing cancer that may never cause problems

               

see the Prostate Cancer Foundation of Australia website for further details at  pcfa.org.au

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