What is prostate cancer?

When cells in the prostate multiply too quickly, this creates a cancerous tumour. For some men, this cancer grows slowly and may never cause any problems. However, if left untreated or unmonitored, this cancer may spread from the prostate and invade other parts of the body.

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In the USA, prostate cancer is the most commonly diagnosed cancer in men.
1 in 9 men will be diagnosed with prostate cancer at some point in their lives.

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African American men are more likely to develop prostate cancer compared to men without African ancestry, and twice as likely to die from the disease.
1 in 6 African American men will be diagnosed with prostate cancer in their lifetime.

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Nearly 192,000 men are diagnosed with prostate cancer each year.

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Over 3 million men are currently living with prostate cancer or experiencing life after it.

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What is the prostate? 

The prostate gland sits just underneath the bladder, and is usually about the size and shape of a walnut. Its main job is to help make semen (the fluid that carries sperm). The prostate surrounds the urethra, which is the tube men pee and ejaculate through. Take a closer look below.

1

Bladder

Organ in the lower stomach that stores urine.

2

Spermatic Cord

Tube to carry sperm away from the testes, towards the prostate.

3

Urethra

Tube that goes through the penis carrying urine and semen.

4

Penis

External male sex organ.

5

Testicles

Located in a pouch of skin called the scrotum; source of sperm and testosterone.

6

Seminal Vesicles

Produce fluid that will partly make up semen.

7

Prostate

Placed just below the bladder, it is a gland that surrounds the urethra and releases semen.

8

Anus

Opening of the rectum to the outside of the body for bowel movements.

Risk factors

Who’s at risk for prostate cancer?

Your risk of developing prostate cancer increases with age, but that doesn’t mean it’s a disease that only affects older men.

In fact, your chances of getting prostate cancer can depend on:

Age

The older you are, the greater the risk.

Race

Prostate cancer is more common in black men, although we’re not entirely sure why. It also tends to develop at a younger age, and grows faster in black men than in any other group.

Family history

While there are some things we’re proud to pass on in our families – book smarts, athletic abilities or a musical ear – some genes are less desirable. Certain genes, passed on from your parents (or other relatives), can affect your prostate cancer risk. If your father, brother or son had prostate cancer, you may be 2 or 3 times more likely to develop the disease yourself.

If you’re 45, it’s important to talk to your doctor about keeping yourself healthy and any ongoing tests you may need.  If you’re black, you need to start that conversation at 40. And if you have a family member (brother, father or son) with prostate cancer in their history, do it at 40.

If you're worried about prostate cancer and want to consider having a prostate specific antigen (PSA) blood test, ask your doctor to discuss it with you. 

 

What tests might my doctor do? 

The first tests to check for prostate cancer are usually either a PSA test or a Digital Rectal Exam (DRE). Which tests you have will depend on your doctor’s guidance.

PSA Test 

PSA, or prostate specific antigen, is a protein made by your prostate. PSA protein is found in both healthy cells and cancerous cells, so it’s pretty normal to have some PSA in your blood. When problems with the prostate happen, the levels of PSA in the blood rise. Understanding how much PSA you have in your blood is important, especially if the levels go up. This is where PSA testing comes in. 

Having a PSA test done is really just a blood test. You will have a small blood sample taken from your arm and sent off for lab testing.

PSA testing is one of the first checks to find prostate problems, but only a biopsy can diagnose prostate cancer for sure. Still, it’s important to keep track of your PSA levels even after cancer treatment, as this can help indicate if the cancer has returned.

 

Digital Rectal Exam (DRE) 

If your PSA has risen and you’re referred to a urologist, they’ll do a DRE to help diagnose prostate cancer. The back of the prostate sits close to the rectum, and prostate cancer is often found here. To get right to it, a doctor or nurse inserts a gloved, lubricated finger into the rectum. This helps them estimate the size of the prostate and feel for lumps or other abnormalities. Although this exam may sound painful, it’s usually just a bit uncomfortable or awkward.

 

How is prostate cancer diagnosed or confirmed? 

If your PSA test or DRE shows signs of cancer, your doctor will perform a biopsy. A biopsy takes some tissue from your prostate, to get a better look at what’s happening. A biopsy is the only way to diagnose prostate cancer.

There are a couple different types of biopsy used: 

Transrectal ultrasound (TRUS) guided biopsy

A needle is inserted into the prostate through the rectum.

A TRUS first measures the size of your prostate, using sound waves to build up a picture of the prostate gland. You’ll have a small device (called an ultrasound probe) passed into your back passage so your doctor can see an image of the prostate. It might be a little uncomfortable, but should only take a few minutes. Then, the needle is used to take samples of tissue from the prostate.

Local anesthesia is used for a TRUS. This type of anesthesia numbs the area tissue samples will be taken from. 

Transperineal biopsy

A needle is inserted into the prostate, through the skin between the rectum and testicles.

During the biopsy, an ultrasound probe is placed in the back passage. This allows the doctor or specialist nurse to see where to pass the needle to take small samples of tissue from your prostate.

General anesthesia is normally used for a transperineal biopsy, depending on your health and how many tissue samples are going to be taken. This type of anesthesia puts you into a deep sleep so you don’t feel anything.

Which biopsy you have depends on your current health, how many tissue samples are necessary and what your team believes will work best. Please speak with your doctor or care team to understand more.

MRI scan

An MRI creates a detailed picture of your prostate (and the surrounding tissues) to help diagnose prostate cancer. It’s also used to detect problems in your prostate if you have a raised PSA level.

An MRI can be used before or after a biopsy. If it’s used before, it’s to help target cancer found in a biopsy, or to see if cancer is present at all. If it’s used after a biopsy, it’s to help determine if the cancer has spread.

 

Gleason score 

If cancer is found, doctors give it a “grade” (from 1 to 5) to help them understand how aggressive it is. This grade is known as the Gleason score, and it’s named after Dr. Gleason, a pathologist.

Here’s how the Gleason score is put together:

After a biopsy, a pathologist uses a microscope to compare normal prostate tissue to any cancerous tissue found. Once they have the cancerous tissue, they’ll want to analyse it to see how it looks and identify any obvious patterns to it. They’ll measure two sections of cancerous tissue.

If the cancerous tissue looks close to normal prostate tissue, the doctor will typically give it a Gleason grade 3. This means that the tumour is not expected to be fast growing. If the cells look irregular and different from the normal prostate cells, then they are assigned a Gleason grade of 4 to 5.

From here, a Gleason score is determined. This can be done by adding together the grades of the two most common patterns found. This can also be done by adding together the most common Gleason grade found, plus the highest grade found. For example, the doctor may have assigned one grade of 3, and a higher grade of 4. This means the Gleason score is 7. Gleason scores tend to range from 6 to 10, with 6 being the lowest grade of cancer.

Types of prostate cancer

Localized prostate cancer 

When the cancer is only within prostate and has not spread to the tissue surrounding the prostate.

Locally advanced prostate cancer 

When the cancer has spread to tissue immediately surrounding the prostate.

Advanced (metastatic) prostate cancer

If the cancer spreads outside the prostate, this is known as advanced (metastatic) cancer. Common places for the cancer to spread include the lymph nodes in your pelvis, tissue in and around your pelvis and abdomen, and bones in the hips and back.

There are two different types of metastatic cancer:

Hormone sensitive
This is prostate cancer that has spread to other parts of the body but still responds favourably to hormone therapy.

Castration resistant prostate cancer
This is prostate cancer that has spread to other parts of the body and can no longer be slowed down by low testosterone levels. It's usually defined by a rising PSA level, worsening symptoms, and possibly a growing cancer seen on a scan.

 

How is prostate cancer treated?

Treating prostate cancer may be heavy on your mind, but what will work for each person is different. Fortunately, there's usually time to talk to your doctor and discuss your options before jumping into any decisions.

So before choosing a treatment option, take time to carefully think about the things that are most important to you. Asking some necessary questions, and reviewing the options below with your doctor will help lead you to make the right decisions for yourself.

 

Types of treatment 

Active surveillance

Closely monitoring prostate cancer with blood tests, imaging tests, and biopsies to determine if treatment is needed.

Watchful waiting

Less intense monitoring than active surveillance. Usually an option for older men or those with other serious health issues.

Surgery (radical prostatectomy)

Surgery to completely remove the prostate, and sometimes the surrounding nerves if the cancer has spread. In some cases, a surgeon will use a robot to assist with the surgery.

Radiation therapy

Use of high energy rays to destroy cancer cells. There are a few ways radiation therapy can be done:

External beam radiation therapy
A machine outside the body directs radiation at the cancer cells. 

Seed brachytherapy
Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells. 

High dose rate brachytherapy
Thin tubes are inserted into the prostate gland, and pass radiation down the tubes and into the prostate. 

Hormone Therapy

Lowers the level of testosterone in the body. This can help slow down the prostate cancer, but cannot cure it alone. It’s commonly used alongside other treatments, to help fight cancer cells.

Chemotherapy

Using special drugs to shrink or kill the cancer. These are sometimes taken by mouth, or can be given as an infusion.

High Intensity Focused
Ultrasound (HIFU)

This therapy directs high-energy sound waves (ultrasound) at the cancer, to kill cancer cells.

Cryotherapy

Placing a special probe inside the prostate cancer to freeze and kill the cancer cells.

Immunotherapy

Boosts your body’s natural defence system (immune system), to help target cancer cells.

Clinical trials

You might want to consider taking part in a clinical trial. Clinical trials often involve your doctors suggesting new therapies, drugs or treatments that have not been widely used yet, in hopes of effectively treating the prostate cancer. Your doctors will monitor your progress very closely to understand how and if the treatments are working. These trials vary from region to region, so it's best to consult your oncologist or urologist to discover which option may be best for you.