Prostate cancer Tirohanga whānui ki te mate pukupuku repe tātea
The prostate gland in men sits just below the bladder. It surrounds the outlet (urethra) that allows the bladder to empty. Prostate cancer is the most common cancer in men in Aotearoa New Zealand. It usually grows slowly but can grow rapidly and spread to other parts of the body, such as your bones, liver and lungs.
Causes of prostate cancer
You have an increased risk of prostate cancer if someone in your family has had it, especially if this is your father or brother.
The other risk factors for prostate cancer are:
- age — the risk of prostate cancer increases from age 50
- being a very unhealthy weight — this increases the risk of advanced prostate cancer
- Lynch syndrome (a rare genetic disorder).
Having one or more of these risk factors does not mean that you will develop prostate cancer.
Kupe is a tool is to help men in Aotearoa New Zealand make a decision about whether they should see their healthcare provider about a prostate check.
KupeSymptoms of prostate cancer
There may be no warning signs that you have prostate cancer. Some signs and symptoms may include:
- weak flow when weeing (urinating)
- a flow that stops and starts
- needing to wee urgently or more often than usual
- trouble starting or stopping weeing
- getting up often during the night to wee
- burning sensation when weeing
- blood in your wee or semen
- pain while weeing
- lower back or pelvic pain
- unexplained weight loss.
If you have these symptoms, see your healthcare provider. It is common to have problems weeing as you get older. This is usually due to an enlarged prostate gland and not cancer.
Diagnosing prostate cancer
The most common ways to check prostate cancer symptoms are by having a:
- prostate-specific antigen (PSA) blood test
- digital rectal examination (DRE).
The PSA blood test and DRE do not diagnose cancer. They can indicate you may need further investigations such as a prostate biopsy (taking a sample of prostate tissue) or a scan.
Prostate-specific antigen (PSA) blood test
The PSA blood test measures the level of PSA in your blood. PSA is a protein made by the prostate gland.
An increased level of PSA can be caused by:
- an infection of the prostate gland
- an enlarged prostate (not cancer)
- prostate cancer
- exercise
- sex.
Rarely, you can have prostate cancer with a normal PSA level.
PSA tests used for screening
A screening test is done when you do not have symptoms. Your healthcare provider may offer you a PSA blood test as a screening test from around the age of 50.
PSA levels can be raised for reasons that are not cancer. If you have an increased PSA level from a screening test you may be referred for more tests. Your healthcare provider will discuss the options with you.
Prostate cancer testing — Healthifyexternal link
Deciding whether to get checked — Kupeexternal link
Digital rectum examination (DRE)
A DRE is when a healthcare provider feels the prostate gland by putting a gloved, lubricated finger into your bottom (rectum). They will feel for any lumps or hard areas on the prostate. It usually only takes a few minutes.
Magnetic resonance imaging (MRI) scan
An MRI scan can show if there are any abnormal areas within your prostate.
The scan result can help decide whether you need to have a sample (biopsy) taken from your prostate. The scan can also guide where exactly to take the biopsy from.
MRI (magnetic resonance imaging)
Prostate biopsy
A prostate biopsy involves taking a sample from your prostate gland. The sample is looked at under a microscope to check for cancer cells.
For the biopsy, a needle is passed into the prostate either through your bottom (rectum) or through the skin behind your scrotum. Local anaesthetic is used to numb the area.
A prostate biopsy is usually safe and has minimal side effects.
- There is a slight risk of developing an infection from a prostate biopsy. Rarely, this can be severe.
- There is a risk of some bleeding after the procedure, but this is usually mild and goes away by itself. Very rarely, life-threatening bleeding can occur.
You will be given antibiotics before the biopsy to reduce the risk of an infection.
Investigations after a prostate cancer diagnosis
If you have been diagnosed with prostate cancer, you may have other investigations to check whether or not it has spread beyond your prostate.
Bone scan
Before a bone scan, a mildly radioactive substance is injected into a vein in your arm. The radioactive substance attaches to any abnormal cells in your bone. You then have a bone scan, which shows any areas where there are abnormal cells in your bone.
CT (computerised tomography) scan
A CT scan uses x-rays to create detailed images of the inside of your body. The scan may be used to check whether your cancer has spread beyond your prostate.
PSMA-PET scan
PSMA stands for prostate-specific membrane antigen. This is a protein found on the surface of prostate cells, including prostate cancer cells.
Before a PSMA-PET scan, a radioactive substance is injected into a vein in your arm.
The radioactive substance sticks to PSMA, wherever in your body there are prostate cells — this includes any prostate cancer cells. The scan will show if prostate cancer has spread around your body.
Treating prostate cancer
There are different options for treating prostate cancer. Your healthcare provider will discuss which ones are most suitable for you. The choice will depend on a number of things, including:
- the grade of the cancer, which predicts how quickly the cancer is expected to grow based on the biopsy result — low-grade cancers usually grow slowly and are less likely to spread
- spread, which shows if there are cancer cells in other parts of your body
- your age and general health
- what type of treatment you would prefer.
Common ways to treat prostate cancer
Active surveillance is an option if doctors consider your cancer to be low risk.
Active surveillance means that you will have repeat tests at regular times. The tests are likely to include PSA tests, DREs and biopsies.
Most men will have an MRI scan within 6 months of their diagnosis to confirm that it is safe for them to stay on active surveillance.
If the tests show that your cancer is getting worse, your doctor may recommend surgery or radiation therapy.
Watch and wait is an option if you only have a small amount of cancer and it appears to be slow growing.
It is also used if your age or medical condition makes it unlikely that the cancer will cause you any problems within your expected lifetime.
Watch and wait usually involves fewer tests than active surveillance. You may have check-ups from your usual healthcare provider rather than at the hospital. You are unlikely to have further prostate biopsies.
At some point, your healthcare provider might recommend hormone treatment. You are unlikely to have surgery or radiation to cure the cancer.
Radical prostatectomy is an attempt to cure your cancer.
In a radical prostatectomy operation, the surgeon removes your prostate.
The surgery can be done through a long cut in your stomach (open prostatectomy) or several smaller cuts (keyhole surgery).
Side effects from surgery include trouble controlling your bladder and erection problems (erectile dysfunction). These affect most men who have this surgery.
Radiation therapy is an attempt to cure your cancer by killing the cancer cells within your prostate.
You need to have the radiation therapy daily (for about 15 minutes) for 7 to 8 weeks. You can usually keep working while having the treatment and carry on with your normal activities.
Possible side effects from radiation therapy include trouble with your bowels such as runny poos (diarrhoea), trouble with your bladder and erection problems.
Hormone treatment aims to control your cancer rather than cure it.
Male hormones help prostate cancer grow. Reducing the male hormones in your body can slow down the growth of your cancer.
Hormone therapy comes in many forms, including oral tablets, injections and an injectable implant that you get every 1 or 3 months.
Side effects from hormone treatment include:
- weight gain
- mood changes
- hot flushes
- thinning of your bones
- loss of sexual desire
- erection problems.
Chemotherapy uses drugs to shrink the cancer cells and slow the growth and spread of the cancer. You may need it if the cancer has spread outside your prostate or if hormone therapies are no longer working.
Preventing prostate cancer
It may reduce your risk of getting prostate cancer if you:
- eat well
- stay physically active
- maintain a healthy weight.
Cancer support
Once someone has been diagnosed with cancer, we know there are some difficult days ahead. No matter where you are on the cancer pathway, there is always someone to connect with for support.
There are local services available to help make things easier for you and your whānau, and support groups.
Support we offer — Cancer Societyexternal link
There are a number of benefits of belonging to a support group.
Support and rehabilitation — Te Aho o Te Kahu - Cancer Control Agencyexternal link