Prostate cancer
Not so secret men's business
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More men die with prostate cancer than from it.
But that doesn’t stop it being the most common male malignancy and the second-leading cause of male cancer-related death in the world.
Five '5' facts
1] Prostate cancer is a top five cancer worldwide (only beaten by skin, lung, breast and colorectal cancers)
2] About one in five Australian men will be diagnosed with prostate cancer before the age of 85
3] Almost all (92 per cent) will survive their prostate cancer for longer than five years
4] The Gleason Score and Grade Group classification systems to determine the severity of prostate cancer both have five levels (one to 5, with 5 being the most aggressive)
5] Although no measures have been proven to prevent prostate cancer, the Mayo Clinic recommends five lifestyle factors that may help include:
1] Choose a low-fat diet
2] Eat more fruit and vegetables
3] Eat fewer dairy products
4] Maintain a healthy weight
5] Exercise most days of the week.
So, what is prostate cancer?
Prostate cancer – as its name suggests – is cancer of the prostate, a walnut-sized gland located below the bladder and in front of the rectum that’s responsible for producing seminal fluid.
The cancer begins with small changes or abnormalities in the shape and size of the prostate gland cells, which eventually form tumours.
These tumours may be localised to the prostate gland only or may spread into surrounding tissue, including the pelvic lymph nodes – known as locally advanced prostate cancer.
Sometimes, the cancer can progress to other parts of the body including organs, lymph nodes and bones and is then considered to be advanced or metastatic prostate cancer. Fortunately, most prostate cancers grow very slowly, hence the saying ‘more men die with prostate cancer than from it’.
Where the prostate is located. Image: CLIPAREA.com/Adobe Stock
Where the prostate is located. Image: CLIPAREA.com/Adobe Stock
What are the symptoms of prostate cancer?
Because the urethra (the tube allowing urine and semen to flow out of the body) runs through its centre, one of the first signs of prostate cancer is often reduced urine flow – although this can happen anyway, as the prostate tends to enlarge as men age.
During the early stages of the cancer, no symptoms may be present at all. If they do occur, they may include:
– needing to urinate more frequently
– finding it hard to urinate, despite having the urge
– feeling discomfort when urinating
– finding blood in urine or semen
– feeling pain in the lower back, upper thighs, hips or bones
– losing weight unexpectedly.
However, any of these symptoms may indicate other non-cancerous conditions, so it’s best to check with your doctor if you are concerned.
How do I know I have prostate cancer?
The most common testing method is the PSA test, a blood test that determines the level of prostate specific antigen (PSA) protein. However, high levels do not necessarily indicate cancer – they could be caused by an infection or by the condition, benign prostatic hyperplasia (BPH), where the prostate becomes enlarged with age.
Further tests to confirm a cancer diagnosis can include digital rectal examination; biopsy; or MRI, CT, bone or PSMA-PET scans. These will confirm the extent of the cancer’s growth (slow-growing or aggressive) and what grade it is (levels one to five).
So, I’ve been diagnosed with prostate cancer: what next?
If you’re lucky, your cancer will be slow-growing and localised, and you may never need treatment. However, some localised and more advanced prostate cancers will require intervention.
Once again, it’s best to discuss all options with your doctor but briefly, each person is unique. You may be offered surgery to remove the tumours or prostate, radiation, hormone therapy or a place in a clinical trial for experimental therapy – or nothing. Surgery options may be ‘open’ or keyhole. Radiation options may be external beam radiotherapy (EBRT) or brachytherapy. All interventions will have benefits and side effects and so it’s best to discuss with your oncologist what will suit you the most.
What side effects can occur from treatment?
Regrettably, treatment that can fix your cancer can also ‘fix’ other cells in your body that don’t need fixing. All prostate cancer treatments have side effects – some temporary, some permanent – and will vary from person to person. You should try to find out as much as you can from your oncologist before treatment to help you prepare for any eventuality, such as erection problems, reduced sex drive, infertility, urinary and bowel problems, or fatigue.
How will I know I’m ‘cured’?
The main indicator of successful treatment is lower PSA levels six to eight weeks after surgery or therapy. However, as a cancer survivor, you may encounter new challenges that cause you to re-evaluate your life and perhaps apply more self-care than in the past. Support groups can be of great help.
Is anything being done to help prevent or better manage prostate cancer?
Of course! At The University of Queensland, several esteemed researchers, doctors and scientists are working on different projects to help mitigate the problem.
For example, Research Fellow in the School of Health and Rehabilitation Sciences Dr Ryan E Stafford is working on the issue of urinary incontinence, a problem that affects up to 30 per cent of men who undergo surgery for prostate cancer.
“After a man has surgery to remove the prostate, he actually loses part of the normal continence mechanism,” Dr Stafford said.
“Some men regain continence while others don’t, and the work of our team is beginning to understand why – the muscles of the pelvic floor are critical. On the basis of this new understanding, my team and I have developed an ultrasound imaging technique that allows patients and therapists to see how the muscles of the pelvic floor are working and whether this is related to the symptoms of incontinence.”
Along with his colleague and collaborator, Professor Paul W Hodges, Dr Stafford has used this information to design new treatments to manage incontinence using pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. Put simply, males have different pelvic floor muscles to women and so need a different kind of exercise regime to regain control of their continence.
Associate Professor Eric Chung from the Faculty of Medicine is examining, among other issues, the impacts of prostate cancer on male sexual function, including how treatment was affected during the COVID-19 pandemic. He has produced many papers on treating erectile dysfunction, determining rehabilitation strategies and assessing diagnostic scan technologies, and believes that overall, a comprehensive multidisciplinary approach is needed to optimally assist and manage men and their partners for better sexual health and activity.
Dr Olivia Wright, senior lecturer in the School of Human Movement and Nutrition Sciences and her former PhD student Brenton Baguley looked at a completely different prostate cancer issue: whether a Mediterranean-style diet can improve cancer-related fatigue and quality of life in men with prostate cancer who have received hormone therapy.
Their findings?
“The Mediterranean diet is safe and feasible, and has the potential to improve cancer-related fatigue and quality of life in overweight men treated with androgen deprivation therapy compared to usual care,” Dr Wright said.
UQ Centre for Clinical Research’s Dr Matthew Roberts, a consultant urologist, is currently investigating new biomarkers for the early detection and characterisation of prostate cancer and has done much work using imaging in the form of a new prostate-specific PET scan. In a recent paper, he also demonstrated how transperineal prostate biopsies were more cost-effective than transrectal biopsies.
Emeritus Professor Maree Smith, from the School of Biomedical Sciences, has researched pain management strategies for prostate cancer; Dr Harendra Parekh from the School of Pharmacy has investigated pharmaceutical treatment approaches; Professor Kristofer Thurecht from the Centre for Advanced Imaging and Australian Institute for Bioengineering and Nanotechnology has previously studied different methods for delivering drug therapies for men with prostate cancer; and several other UQ researchers are working on solutions to alleviate the problem of prostate cancer.
But perhaps one of the most surprising ‘experts’ is Associate Professor Chiara Palmieri from the School of Veterinary Science, whose research interests include the pathogenesis of prostate cancer in dogs. Yes, dogs get prostate cancer too! And actually, prostate cancer in dogs may be the best model to study human prostate cancer.
Her recent paper, Expression and prognostic significance of vascular endothelial growth factor-A (VEGF-A) and its receptor in canine prostate cancer, claimed that VEGFR-2 – a vascular endothelial growth factor receptor (VEGFR) involved in the formation of new blood vessels – is a potential prognostic factor in canine prostate cancer and a potential target for anti-cancer interventions. As canine VEGFR-2 is highly similar to human VEGFR-2, this reinforces the advantage of using dogs as preclinical cancer models.
So, dogs really are 'Man’s best friend'?
Maybe! But seriously, when dealing with prostate cancer, get checked! It could save your life.
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