Prostate cancer: causes and symptoms

Prostate cancer develops when the cells in the prostate gland grow more quickly than in a normal prostate, forming a malignant tumour. Most prostate cancers grow slower than other types of cancer.

Early (or localised) prostate cancer means cancer cells have grown, but they have not spread to other parts of the body, such as the bones and lymph nodes. This is called advanced prostate cancer.

What causes prostate cancer?

While the causes of prostate cancer are unknown, the chance of developing prostate cancer increases:

  • as you get older - it mainly affects men over 65;
  • if your father or brother has had prostate cancer;
  • if you have a strong family history of breast cancer.

In 5-10 per cent of men with prostate cancer, their family medical history may indicate they have an inherited gene that contributed to the cancer's development.

You may have an inherited prostate cancer gene if you have:

  • multiple relatives with prostate cancer or breast cancer on the same side of the family (either the mother's or father's side)
  • younger male relatives (under 50) with prostate cancer.

If you are concerned about your family history of prostate cancer, you may wish to ask your doctor for a referral to a family cancer clinic or a urologist to advise you on suitable testing for you and your family.

Men should discuss their individual need for prostate cancer screening with their GP.

Symptoms of prostate cancer

Early prostate cancer rarely causes symptoms. This is because the cancer is not large enough to put pressure on the urethra.

If the cancer grows and spreads beyond the prostate (advanced cancer), it may cause:

  • pain or burning when urinating;
  • increased frequency or difficulty urinating;
  • blood in the urine or semen;
  • pain in the lower back, hips or upper thighs.

Advanced prostate cancer can press on the urethra and cause urinary problems but by then it is probably causing other more serious symptoms.

These symptoms are common to other conditions and may not be a sign of advanced prostate cancer. If you are concerned about cancer and/or are experiencing any of these symptoms, speak to your general practitioner (GP).

Diagnosis

Your doctor will confirm the diagnosis with a number of tests. You may have some or all of the following tests.

Prostate specific antigen blood test

Prostate specific antigen (PSA) is a protein made by both normal prostate cells and cancerous prostate cells. Other factors can also increase PSA levels in your blood, including inflammation in the prostate, benign prostate enlargement or prostate cancer.

PSA levels are measured using a regular blood test. Because PSA levels can be variable, it is common for your doctor to use results from more than one blood test.

Some men with prostate cancer have normal PSA levels, and only one in 3 men with an elevated PSA level has cancer. As it is not a definitive test, a PSA test is normally used with other tests to diagnose prostate cancer.

Digital rectal examination

The digital rectal examination (DRE) involves a doctor inserting a gloved finger into your rectum to feel the back of the prostate gland. If your doctor feels a hardened area or an odd shape, further tests will be done. The DRE may be uncomfortable but is rarely painful. It is unlikely to pick up a small cancer or one the finger can't reach. Doing this test with a PSA test improves the chance of finding early cancer.

Biopsy

A biopsy is when a small piece of tissue is removed from the prostate for examination under a microscope. It is done if the PSA test or DRE show abnormalities. The biopsy determines whether you have prostate cancer, how abnormal the tissue is and how fast the cancer might grow (the grade).

Tell your doctor if you are on any medications, including herbal medicines, before your biopsy to reduce the risk of problems.

A biopsy is done with ultrasound guidance. An ultrasound probe called a transrectal ultrasound (TRUS) is passed into the rectum. The TRUS is about the size of a thumb. It shows the shape and texture of the prostate on a screen. The ultrasound picture helps guide the doctor to insert a small needle from the probe through the rectum into the prostate. About 6-18 samples of tissue are taken from different parts of the prostate.

Most biopsies are done with some form of anaesthetic. It may be uncomfortable and there may be some bleeding. You will be given antibiotics to reduce the possibility of infection.

Further tests

If the biopsy shows you have prostate cancer, other tests may be done to work out the stage of the cancer.

Blood tests

Blood samples may be taken regularly to monitor your PSA level, check your health and see if the prostate cancer has spread.

Bone scan

A bone scan can show whether the cancer has spread to your bones. A small amount of radioactive material (called technetium) is injected into a vein. Technetium is attracted to newly growing bone cells, which may indicate cancer spread.

After 1-2 hours, you will have a body scan. This painless scan will show where the technetium is. It will not make you radioactive.

MRI scan

The magnetic resonance imaging (MRI) scan uses radio waves and magentism to build up detailed cross-section pictures of the body. The scan involves lying on an examination table inside a metal cylinder - a large magnet - that is open at both ends. The MRI is sometimes performed using a probe inserted into the rectum.

If the prostate cancer is advanced, an MRI can help to confirm if the cancer is contained within the prostate.

The dye injected into your vein for a CT or MRI scan, called a contrast solution, may contain iodine. If you are allergic to iodine, fish, or dyes, let the person performing the scan know in advance.

CT scan

A CT (computerised tomography) scan is a type of x-ray procedure. It uses x-ray beams to take pictures of the inside of your body and can show if the cancer has spread to the lymph nodes of the pelvis and abdomen.

A dye is injected into a vein, probably in your arm, to help make the scan pictures clearer. This may make you feel hot all over for a few minutes. You will then lie flat on a table while the CT scanner, which is large and round like a doughnut, moves in and out of the scanner. The test is painless and takes about 10-30 minutes. Most men are able to go home when their scan is done.

Seeking support

When you are first diagnosed with cancer, and throughout the different stages of your treatment and recovery, it is normal to experience a range of emotions, such as fear, sadness, anxiety, anger and frustration. If sadness or anxiety is ongoing or severe, talk to your doctor.

It may help to talk about your feelings. Your partner, family members and friends can be a good source of support, or you might prefer to talk to:

  • members of your treatment team
  • a counsellor, social worker or psychologist
  • your religious or spiritual adviser
  • a support group
  • the Cancer Council Helpline

If you need assistance, such as help around the house, it may be hard to tell people what would be useful. Some people prefer to ask a family member or friend to coordinate offers of help.

You may find that while some people you know are supportive, others may not even know what to say to you. Cancer Council's booklet Emotions and Cancer may help if this happens to you. If you have children, the prospect of telling them you have cancer can be frightening and unsettling. The book Talking to Kids About Cancer can help you prepare for this conversation.

Call 13 11 20 for these booklets or download them from www.cancercouncil.com.au.

Practical and financial help

A serious illness often causes practical and financial difficulties. This can add to the stress and anxiety you may already be feeling about having cancer and going through treatment.

Many services are available to help so you don't have to face these difficulties alone:

  • Financial assistance, through benefits and pensions, can help pay for prescription medicines, travel to medical appointments and continence products.
  • Home nursing care is available through community nursing services or local palliative care services.
  • Meals on Wheels, home care services, aids and appliances can make life easier.

To find out more, talk to the hospital social worker, occupational therapist or physiotherapist, continence nurse or the Helpline.

Understanding Cancer program

If you want to learn more about cancer and coping with it, you may find Cancer Council's Understanding Cancer program helpful. It offers practical information and discussions about many cancer-related issues, such as symptoms, treatment, side effects, diet, palliative care and complementary therapies.

Programs are held at hospitals and community organisations throughout NSW. Call 13 11 20 for more information.

Talk to someone who's been there

Getting in touch with other people who have been through a similar experience can be beneficial. There are many ways to contact others for mutual support and to share information about your experience.

In these support settings, most people feel they can speak openly, share tips with others, and just be themselves. You will probably find that you feel comfortable talking about your diagnosis and treament, your relationships with friends and family, and your hopes and fears about the future.

Call the Helpline or ask your nurse of social worker about relevant support groups in your area. You can also contact the Prostate Cancer Foundation of Australia to find out how you can connect with others. Call 1800 220 099 or go to www.prostate.org.au.

Supoort services available in your community

  • Face-to-face support groups - often held in community centres or hospitals.
  • Online discussion forms - where people can connect with each other any time - see www.cancerconnections.com.au
  • Telephone support groups - for certain situations or types of cancer, which trained counsellors facilitate.
  • Cancer Council Connect - a program that matches you with a volunteer who has been through a similar cancer experience.

For more information on the Prostate Cancer Support Network, call the Cancer Helpline on 13 11 20.

For further information and advice, call the Cancer Helpline on 13 11 20.

Last Reviewed: 1 June 2011
Reproduced with the kind permission of The Cancer Council New South Wales.

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References

Cancer Council NSW. June 2011. Understanding Prostate Cancer. A guide for men with cancer, their families and friends. http://www.cancercouncil.com.au/wp-content/uploads/2011/07/Understanding-Prostate-Cancer-low-res.pdf (accessed Jan 2013).
The Cancer Council New South Wales

The Cancer Council New South Wales

To lead, empower and mobilise the community to beat cancer.