Prostate Cancer

Overview

What is it ?

Prostate cancer is an abnormal growth of cells in the prostate that form a cancerous tumour.

Who gets it ?

Most men who develop prostate cancer are over the age of 50. In Australia, about 20,000 men are diagnosed with prostate cancer each year, and about 3300 die from it. About one in nine men will develop prostate cancer at some point in life.

Who’s at risk

Some men are more at risk of getting prostate cancer than others, but the most important risk factor is ageing. If you’re in your 40s, your chance of getting prostate cancer is one in 1000; but if you’re in your 70s, your chances go up to 80 in 1000.

What causes it ?

We don’t know yet however the growth of cancer cells in the prostate is stimulated by male hormones, especially testosterone.

Diagnosis of prostate cancer

Digital Rectal Examination (DRE)

This is where doctor inserts a finger into the anus to exam the prostate through the wall of the rectum. The size, shape and contour of the prostate are checked.

Prostate specific antigen (PSA)

PSA is a small protein normally released into the blood by the prostate. Elevated PSA can be due to prostate infection, enlarged prostate as well as prostate cancer. The results from a PSA test may indicated the likihood of having prostate cancer, however, it alone cannot confirm the diagnosis.

Biopsy

A prostate biopsy is a procedure where small samples of prostate is obtained using a fine needle. The procedure is usually done using an ultrasound probe with sedation or general anaesthetic. Prostate biopsy, whether performed through the rectum or perineum, is the only method to confirm the presence of cancer and to determine their aggressive ness (Gleason Score)

How do you assess for prostate cancer

Gleason Scores

This score indicates how aggressive the cancer is. The sample obtained from prostat biopsy is examined by the pathologist and two numbers are given to the common cancer patterns seen under the microscope. The cancer is graded from 1 to 5 with 5 being the most aggressive cancer. The two scores are then added together to give a total Gleason Score.

PSA

How useful is it ?

PSA is only one of the parameters used in assessing both benign prostate condition and prostate cancer. Other important information such as how much it changes over time is equally important. Conditions such as prostatitis, benign prostate enlargement as well as prostate cancer can elevate the PSA reading. Other variables such as digital rectal examination, prostate volume, family history, ethnicity and risk prediction models can help to better risk stratify men, potentially reduction over-diagnosis and over-treatment of indolent prostate cancer

How often ?

The knowledge about the value of PSA tests has grown significantly in recent years and there are different opinions about the importance of PSA tests and how they are best used in the detection and monitoring of prostate cancer. The traditional view of annual PSA

What other test may be required

Whole body Bone scan

A bone scan produces a picture shows whether the cancer has spread to bone. During the scan, a very small amount of radioactive material is injected into your vein. These tracers will be taken up by prostate cancer cells, and thus the scan will become positive if there is cancer cells in the bone.

CT scan of the abdomen and pelvis

It is a scan that helps doctors to determine whether there is any prostate cancer cells in the lymph nodes in the abdomen and pelvis.

Clinical stages of prostate cancer

Stage T1

The cancer is confined to the prostate gland. It is usually not palpable during a digital rectal examination.
It is unlikely to cause any obstructive symptoms.

Stage T2

The cancer is still confined to the prostate gland but is large enough to be felt during a rectal examination.

Stage T3

Tumour has spread outside the prostate

Stage T4

Tumour is locally extensive and may invade adjacent organs.

Treatment Options for Localised Prostate Cancer Explained. (Stage T1 – T2)

Watchful Waiting

Active Surveillance

Active surveillance can be described as “a systematic program of periodic monitoring of men diagnosed with a prostate cancer judged to pose little immediate threat to life or health.6 The concept of AS stems from the watchful waiting protocol. Watchful waiting is a viable treatment option in managing elderly men with low-risk PCa and a limited life expectancy. They are treated conservatively until disease progression, at which point the patients can be treated with androgen deprivation or endoscopic resection, if required. The 15-year survival was noted to be as high as 82% in patients with a Gleason score of 6 who underwent watchful waiting.7

The aim of AS is to diagnose, monitor and then act with an intention to cure only when essential, limiting the morbidities associated with over-treating low-risk PCa. The essential features of AS, are: 1) selecting patients who have favorable-risk PCa, with a low risk of disease progression based on clinical and pathological features of the disease, as well as patient characteristics; 2) monitoring the disease rigorously 3) the use of safe triggers for curative interventions when the disease progresses, resulting in cure and limiting overtreatment.

Surgery

Open Retropubic Radical Prostatectomy
Laparoscopic Radical Prostatectomy
Tele-Robotic Radical Prostatectomy