Demystifying prostate cancer

One in every 11 men will develop prostate cancer by the age of 70. What if it’s you? It can be difficult to start thinking about prostate cancer, and even harder to do something about it. Catching prostate cancer early is the best way to ensure it is ‘curable’.

Should I get tested?
The Prostate Cancer Foundation of Australia suggests that all men over 50, and men over 40 with a family history of prostate or breast cancer, should have an annual PSA test.

What is a PSA test?
The initial prostate cancer test is called a Prostate Specific Antigen (PSA) test. This is just a simple blood test which your local GP can send you for. It only indicates whether or not you might have prostate cancer – it is not conclusive. If you do have a PSA reading it will also indicate to your doctor the likelihood that the cancer is contained within the prostate.

What if I do have a PSA reading?
There are a few possible follow-up tests to confirm that you do have prostate cancer, and to determine what type it is and how far it has spread. The most accurate one is a biopsy. This is most often carried out as a day procedure, where you will be put under a general anaesthetic. The doctor will insert a small probe into the rectum which will photograph your prostate through the rectum wall and a series of small spring-loaded needles will take samples of the cancer in different areas of the prostate. The results of this test will come in the form of a Gleason Score.

What is a Gleason Score?
The Gleason Score is made up of a number of different factors. The specialist will assess your age, the aggressiveness of the cancer and how far it has already spread. They will then use this to suggest the best possible range of treatments for your particular case.

What happens next?
Depending on your Gleason Score you will have a number of different treatment options available to you. Prostate cancer can often be non-aggressive, so in older men sometimes the only recommended treatment is active surveillance. Active surveillance simply means PSA tests every six months and a yearly biopsy to make sure the cancer hasn’t changed. Some other options are external beam radiotherapy, surgery and brachytherapy.

External beam radiotherapy (EBRT)
External beam radiotherapy has been a very successful method of ‘curing’ cancer confined to the prostate, and has a track-record similar to surgery or brachytherapy, the other two most successful prostate cancer ‘cures’. EBRT is sometimes coupled with hormone therapy, which can have some unpleasant side effects such as bone loss and weight gain.

Surgery
Surgery involves a radical prostatectomy, or the removal of the whole prostate. This is also a very effective method when the cancer is confined to the prostate. It involves four or five days in hospital, then about six weeks of recuperation at home.

Brachytherapy
Brachytherapy is a newer treatment where radiation is delivered from inside the prostate. Radioactive seeds are placed inside the prostate to kill the tumour. The process generally only takes a few days of recovery after the hospital stay.

How do I choose?
The above are only some of the more popular treatments available. Your doctor will advise you on the most effective options based on your Gleason score. He or she will also discuss the pros and cons, including recovery time and side effects.

Where can I get more information?
The Prostate Cancer Foundation of Australia has very detailed information about prostate cancer and treatments on its website. It also provides information about new research and offers support services for those with prostate cancer and their families.

Does prostate cancer frighten you? Do you think men should be routinely tested?

*We have chosen to put the word ‘cured’ in inverted commas as cancer survivors are generally considered to be in remission, not cured. This is because there may still be a small number of undetected cancer cells in the body, and a recurrence is possible.