About prostate cancer

What is prostate cancer?

Prostate cancer begins when abnormal cells in the prostate start growing in an uncontrolled way.

How common is it?

Prostate cancer is the most common cancer in Australian men (except for skin cancer). About 1 in 12 men will get it by the age of 70, and 1 in 5 will get it in their lifetime. It’s estimated that almost 29,000 men are diagnosed each year and rates are increasing. This may be in part because the population is growing and people are living longer.

Anyone with a prostate can get prostate cancer – men, transgender women and people with an intersex variation. For information specific to you, speak to your doctor.

The prostate

The prostate is a small gland about the size of a walnut. It forms part of the male reproductive system. The prostate sits below the bladder and in front of the rectum (the end section of the large bowel).

Two glands called the seminal vesicles attach to the back of the prostate. The prostate is close to nerves, blood vessels and muscles that help control erections and urination (the pelvic floor and urinary sphincter).

What the prostate does

The prostate produces fluid that helps to nourish and protect sperm. This fluid forms part of semen. Semen also contains sperm made in the testicles (testes) and fluid made by the seminal vesicles.

Urethra – This is a narrow tube that runs from the bladder and through the prostate to take urine (wee or pee) out of the body. The urethra also carries semen during ejaculation.

Ejaculation – When an orgasm occurs, millions of sperm from the testicles move through 2 tubes near the prostate called the vas deferens. The sperm then join with the fluids produced by the prostate and seminal vesicles to make semen. The muscle around the prostate contracts and pushes the semen into the urethra and out through the penis.

How the prostate grows

The main male sex hormone, testosterone, is made by the testicles and controls how the prostate grows. It is normal for the prostate to become larger with age. This may lead to a condition known as benign prostate hyperplasia or BPH.

Non-cancerous changes to the prostate

A normal prostate often grows larger as you age and is called benign prostate hyperplasia (BPH). It is not usually due to cancer but BPH may press on the urethra and affect how you urinate (pee). You may:

• notice a weak stream of urine
• go to the toilet more often, especially at night
• need to pee urgently
• have trouble starting to pee
• dribble urine after peeing
• feel that the bladder is not empty.

Talk to your doctor if you have any of these urinary symptoms – because they can also happen in advanced prostate cancer.

What screening tests should I have?

Cancer screening looks for cancer in people with no symptoms. The benefit is that the cancer can be found and treated early. But benefits need to outweigh potential harm from treatment that’s not needed. Talk to your doctor about the benefits and risks of this for you.

The prostate specific antigen (PSA) blood test may find fast-growing cancers that can spread to other parts of the body and would benefit from treatment. It may also find slow-growing cancers unlikely to be harmful, leading to treatment that may cause significant side effects.

Guidelines for prostate cancer recommend that, after a discussion about the possible benefits and harms of testing, people:

• with a family history of prostate cancer have a PSA test from age 45, and then at least every 2 years
• aged 45 and over, who are not at higher risk but are interested in their prostate health and decide to undergo testing, are offered an initial PSA test
• aged 50–69, with no symptoms or family history of prostate cancer, who decide to undergo testing, have a PSA test every 2 years
• aged 70 or over, who decide to undergo testing after talking to their doctor, have a PSA test every 2 years.

People with an elevated PSA, risk factors or symptoms may be referred for an mpMRI scan.

A PSA test, requested by your doctor, should be free. Your doctor can explain what the results mean. At-home PSA test kits may be unreliable and can’t give qualified medical advice about the results.

For more information about the best screening options for you, visit Cancer Council's PSA Testing Clinical Guidelines.

Which health professionals will I see?

Your GP will usually arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, who will arrange further tests.

Prostate cancer is usually diagnosed by a urologist, who will talk to you about your surgical or other options. You will usually also see a radiation oncologist to discuss radiation therapy. You may also be referred to a medical oncologist, who will discuss drug treatments. It’s important to find out all your options before making a decision.

Your specialists will discuss treatment options with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you will see a range of health professionals who specialise in different aspects of your care (see below).

Health professionals you may see

• GP – assists you with treatment decisions and works in partnership with your specialists in providing ongoing care; may monitor PSA levels and administer treatment
• urologist – treats diseases of the urinary system and the male reproductive system, including prostate cancer; performs surgery
• radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy
• radiation therapist – plans and delivers radiation therapy
• medical oncologist – treats cancer with drug therapies such as chemotherapy, hormone therapy and targeted therapy (systemic treatment)
• endocrinologist – diagnoses, treats and manages hormonal disorders, including osteoporosis
• cancer care coordinator, prostate cancer specialist nurse – coordinate your care, liaise with MDT members, and support you throughout treatment; may be a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
• nurse – administers drugs and provides care, information and support throughout management or treatment
• nuclear medicine specialist – analyses bone scans and PET scans and delivers radionuclide therapies
• radiologist – analyses x-rays and scans; an interventional radiologist may also perform a biopsy guided by ultrasound or CT, and deliver some treatments
• pathologist – examines cells and tissue samples to determine the type and extent of the cancer
• continence nurse – assesses bladder and bowel control, and helps you find ways to manage any changes
• continence physiotherapist – provides exercises to help strengthen pelvic floor muscles and improve bladder and bowel control
• exercise physiologist – prescribes exercise to help people with medical conditions improve their overall health, fitness, strength and energy level
• occupational therapist – assists in adapting your living and working environment to help you resume your usual activities after treatment
• sex therapist, sexual health physician – help you and your partner with sex and intimacy issues; an erectile dysfunction specialist can give advice about erection problems
• psychologist, counsellor, psychiatrist – help you manage your emotional response to diagnosis and treatment; may also help with emotional issues affecting sex and intimacy
• Aboriginal and Torres Strait Islander liaison officer – if you identify as Aboriginal or Torres Strait Islander, supports you and your family during treatment and recovery
• social worker – links you to support services and helps you with emotional, practical and financial issues
• palliative care specialists and nurses – work closely with your GP and cancer team to help control symptoms and maintain quality of life