Prostate cancer is in the news and most of us already know someone who has experienced it. King Charles’ announcement that he has prostate cancer has provided momentum for awareness which is a good thing. Prostate cancer affects around twenty-five thousand men per year in Australia.
Doctor in the House, Associate Professor Magdalena Simonis AM, talks about at the symptoms of an enlarged prostate, early cancer symptoms, and the importance of greater awareness in the community, regular prostate checks, and how to talk to your doctor about prostate.
My observation is that men tend to visit their GP either when their partner makes an appointment, or when their symptoms get bad enough for them to worry. Prostate cancer can be slow, silent, and be life threatening, or it can spread rapidly to other parts of the body and become life threatening. So, it’s important to have a chat with your doctor. Here are key tips.
Prostate cancer tips for men:
1. Know the symptoms of prostate cancer.
2. At 40 and over, have an annual men’s health visit with your doctor – talk about prostate disease, disease prevention and mental health.
3. Know your family history – a father, brother son with prostate cancer increases your risk by 2.5 times. Some genes carry a higher risk too.
4. The PSA blood test is not perfect but a baseline test at age 50 is helpful.
5. Decide if you want to have a PSA test knowing that a higher reading does not always mean cancer and a normal reading might miss a cancer.
6. Symptoms can be silent, the same as benign prostate enlargement or different.
7. Blood in semen or urine is never normal and should be checked out regardless of age.
8. Prostate cancer is common but highly treatable when caught early.
9. 85 per cent of the cases occur after 60 but may occur earlier.
10. By the age of 86 years, one in six will be diagnosed with this.
11. Around 25,000 men are diagnosed annually in Australia.
12. A five-year survival rate is 96 per cent
13. A 10-year survival rate is 91 per cent
14. Tell your male friends and loved ones to check in with their GP at least once a year for a health check after 40.
Common prostate symptoms
The prostate gland is a chestnut sized gland prostate which sits at the base of the bladder and usually becomes bit bigger with age. As the prostate enlarges, it can affect the flow of urine because the drainage tube from the bladder, (called the ureter), passes directly through it. The changes men describe are:
– Urinating more than usual (day or night)
– Poor urine flow
– Dribbling at the end of passing urine
– Slow to start the urine flow.
– Feeling like you can’t fully empty your bladder.
– Blood in the semen or urine – never ignore this symptom.
– Pain on urination or ejaculation.
– Back or pelvic pain – this suggests the cancer might have spread to bone.
Common prostate symptoms with age – benign prostate hypertrophy (BPH) or prostate cancer?
Early, low grade prostate cancer changes may be a ‘benign prostatic hypertrophy’ BPH, which is why it is important to have the conversation with your doctor as soon as things change. For most men, this occurs after the age of 50 years.
Seeing your GP and the PSA test
The GP’s role is to assess the problem and help exclude prostate cancer. This is usually done by asking about your symptoms, your family history, checking the urine and after discussion, ordering a blood test called the ‘PSA’ which measures a protein called the ‘prostate surface antigen’. This protein is produced by cancerous and non-cancerous prostate cells and is not a perfect test, so this might take a few visits over time. If cancer has been excluded, a trial of oral medication might be offered to ease the moderate or even severe symptoms.
Having a PSA test can cause stress for some, especially if your doctor says they want to recheck this in a few months or starts you on a trial of antibiotics for suspected infection first, then repeats the test after the antibiotics. If the PSA climbs rapidly, with or without symptoms and cancer is strongly suspected, your GP will decide to refer you to a urologist to further investigate.
Prostate cancer risks
If there is a history of a close family member such as your father, brother, or son with prostate cancer, you should have this conversation with your GP much earlier than your 50th birthday. Discuss having a baseline PSA test from as early as 40, especially if the relative was young when their cancer was diagnosed.
Early testing is recommended in these settings:
– If your father or brother have ever been diagnosed with prostate cancer, you have twice the average risk of developing the disease.
– If you have two or more close male relatives who have been diagnosed, your lifetime risk of developing prostate cancer increases by five times (five-fold).
– Your risk increases if you have a strong family history of breast or ovarian cancer, especially if a BRCA1 or 2 gene mutation was involved.
Seeing a urologist
The urologist will perform a physical examination, a rectal examination, more blood tests, an MRI of the prostate gland and in many cases will order a biopsy of the prostate gland.
This is performed under ultrasound examination which involves removing tissue samples by passing a needle into the prostate gland through the rectum. As you can imagine, this is not a test that is ordered without having a strong suspicion that the cancer is growing and at risk of spreading.
The good news is that early detection and treatment in such cases prevents the spread of disease, which means living longer with cancer of the prostate or complete cure. Choice of treatment can look complicated as there are surgical and non-surgical procedures, radiation treatment options, hormone treatments and chemotherapy. Each has its own risks and benefits, so deciding can be difficult. It helps to talk to your GP and other men who have had similar treatment.
Prostate Cancer treatments
The treatment depends on the stage of disease, your age, your health and your wishes. Men sometimes avoid seeing the doctor about their prostate symptoms because they fear the side effects of treatment such as incontinence of urine or impotence. Small, localised cancers might be offered radiation therapy which is external or internal (brachytherapy), as opposed to surgery.
Surgery might be keyhole or through the abdomen and for extensive disease that has spread to other organs, hormone therapy or chemotherapy might be offered. Some cancers which are slow growing might be offered just regular blood tests with serial MRIs to measure growth and symptoms.
In much older men, neither treatment nor observation will be offered because its growth is so slow. It can be overwhelming news to be told that prostate cancer is suspected but keep in mind that early diagnosis is associated with better outcomes and when it comes to deciding on treatment options, it is best to ask as many questions as you can so that you can make an informed decision.
For further information there are some links below and remember to see your GP or health care provider for your men’s health and prostate check.
Here are some useful websites:
www.pcfa.org.au
www.canceraustralia.gov.au/cancer-types/prostate-cancer/symptoms-and-diagnosis
www.prostate.org.au/testing-and-diagnosis/psa-testing/
www.prostate.org.au/risk-and-symptoms/symptoms/
www.canceraustralia.gov.au/cancer-types/prostate-cancer/treatment
*Associate Professor Magdalena Simonis AM is a General Practitioner, government health advisor, and primary care researcher with the University of Melbourne, and a leading health expert and advocate.
