Prostate cancer is the most common type of cancer in New Zealand men. Some prostate cancers are slow growing and will never cause problems. Others are faster growing, can cause serious symptoms or be life-threatening.
Prostate cancer is more common in men aged over 50, but is more likely to cause problems if it occurs in younger men. If caught early, prostate cancer can be managed well and can usually be cured. However, not all prostate cancer needs to be treated.
Choosing whether to have a prostate check is an important decision. Your doctor can help you decide whether a prostate test is right for you, by assessing your symptoms and risk factors such as your age and family history.
What is the prostate?
The prostate gland is only found in men.It is a small walnut-shaped gland the surrounds the bladder opening. It helps make semen. As men age the prostate gland increases in size (known as benign prostatic hyperplasia or BPH) . From age 50 years, men often experience problems with urination (peeing) due to this.
What is prostate cancer?
Prostate cancer is caused when some of the cells within the prostate gland start to grow out of control, invading and destroying healthy cells. Most commonly, prostate cancer grows slowly, but sometimes it can grow rapidly and spread to other areas, such as the bones, liver and lungs.
How common is prostate cancer?
In New Zealand, about 3000 men are diagnosed with prostate cancer every year and more than 600 die from the disease.
Maori men are more likely than non-Maori men to die of prostate cancer because it is often found too late to cure. Men who live in rural areas are at greater risk than those who live in urban areas because they have less access to health services.
What are the symptoms of prostate cancer?
Early prostate cancer causes no symptoms. As the cancer grows, it can cause urinary symptoms such such as problems with flow, dribbling, trouble stopping and starting and needing to go more often, at night or urgently.
As men get older, it is common to get urinary symptoms such as these. Most of the time these symptoms are due to other common prostate problems (such as benign enlargement of the prostate gland), however you should always have it checked.
See a doctor without delay if you have any of the following:
blood in your urine
pain with urination
burning with urination
inability to urinate.
Who should get checked for prostate cancer?
If you are a man aged 50 to 70 years old, or you are in your 40s and your father or brother has had prostate cancer, and you are having trouble peeing, see your doctor for a check up.
Having a prostate check is your decision. The check won’t tell you if you have prostate cancer, but it will tell you how likely you are to have it. Checks usually involve a blood test called a prostate-specific antigen (PSA) test and a digital rectal examination (DRE).
Your risk of prostate cancer increases as you age and also if your brother or father has it.
Age – the risk of prostate cancer increases as you age. It is rare in men under 50. Men under the age of 70 who get prostate cancer are more likely to need treatment. This is because younger men will live longer with their cancer, and it will have more time to progress and cause problems.
Family history – you are have double the chance of getting prostate cancer if your father or brother have prostate cancer.
What are the treatment options for prostate cancer?
Treatment options include active surveillance (no active treatment, but watch and wait), surgery, radiation therapy, hormone therapy and palliative care.
The choice of treatment depends on the size, type, growth and spread of the cancer, and on your age, general health, symptoms and personal choice.
Prostate cancer that has not spread can respond well to treatment. However, some of the treatments have side effects, such as incontinence and impotence, which can affect your quality of life. You can discuss the possible effects of treatment with your doctor.
Sometimes, your doctor may advise against treatment. This is because it may not be of benefit if the cancer is not affecting your quality of life (and it may never do so). This is often the best approach if the cancer is at an early stage and slow growing, or if you are very elderly. This is known as active surveillance, or watch and wait, as you will still need to be examined regularly to check that the cancer is not spreading.
How can I reduce my risk of prostate cancer?
You can reduce your risk of prostate cancer by finding the cancer early and by having a healthy lifestyle.
Healthy lifestyle choices include:
having a low-fat, high-fibre diet that include plenty of fresh fruits and vegetables
Routine testing for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Being tested for prostate cancer is your choice. Learning about the pros and cons of prostate testing can help you decide if it is right for you.
If your test results suggest you are high risk for cancer, you will be referred to a specialist who may recommend another test called a prostate biopsy.
The prostate-specific antigen (PSA) test
This test measures the level of PSA in your blood. The prostate make PSA and higher than normal levels can occur when there is a problem with the prostate, such as an infection, an enlarged prostate or prostate cancer.
Most men with raised PSA levels will not have prostate cancer and some men with prostate cancer will have normal PSA levels. However, high PSA levels are a risk factor for prostate cancer.
Digital rectal examination
This is a quick way for your doctor to check for prostate problems. Your doctor will feel the size and shape of your prostate by inserting a gloved finger into your rectum (bottom). A prostate which is rough, irregular or hard is more likely to have cancer. Some cancers may be too small to be detected by a rectal examination.
Specialist referral & biopsy
Your doctor will discuss your prostate check results with you. If the PSA and DRC results suggest you have a high risk for prostate cancer, your doctor will refer you to a specialist (urologist).
The specialist will discuss having a prostate biopsy, in which a small sample of your prostate gland cells are taken for examination. The aim of the biopsy is to confirm whether or not you have prostate cancer and, if so, whether it needs treatment. The treatment options will then be discussed with you.
If the biopsy shows no evidence of cancer you may be advised to attend future check-ups.
Should I have a prostate check?
See your doctor for a check up if:
you are a man aged 50 to 70 years old
you are in your 40s and your father or brother has had prostate cancer, and you are having trouble peeing.
Having a prostate check is your decision. The tests for prostate cancer can be uncomfortable but they may reduce your chance of being harmed or dying from prostate cancer.
If your test results suggest you are at risk of cancer, you will need to decide whether to have further testing and possibly treatment. In making this decision, you will need to consider whether your quality of life will be better living with a slow growing cancer than having treatments, which may cause you more harm than the cancer ever will.
Your doctor can help you weigh up the benefits and risks of being tested, by taking into considerations factors such as your age and family history.
Video: The prostate specific antigen test. To test or not to test? Michael Evans and Reframe Health Films Inc, 2014.
To help you and your doctor decide whether or not you will be tested for prostate cancer. Visit the Option Grid website and use their interactive guide or pdf verssion to help you and your doctor decide whether or not you will have a PSA test.
Every year 3000 men are found to have prostate cancer and 600 die from the disease. This publication will help primary care practitioners provide men and their family and whānau with consistent, culturally appropriate information on prostate cancer testing and treatment.
It includes an algorithm to help primary care practitioners have informed discussion with men who present with prostate-related concerns, and to support men to make informed decisions about prostate cancer testing. Explanatory notes provide more detailed information on each of the steps involved.
The guidance provides referral criteria including definitions of high suspicion of prostate cancer for the Faster Cancer Treatment Programme.
This guidance has been endorsed by the:
The Royal New Zealand College of General Practitioners
The Prostate Cancer Foundation
The Urological Society of Australia and New Zealand
The New Zealand Urological Nurses Society
The New Zealand Society of Pathologists.
Need for this guidance
New Zealand men currently receive conflicting advice about prostate cancer testing and treatment. Some men may benefit from early diagnosis and treatment, but have limited opportunity to access appropriate health services.
Unlike other cancers, prostate cancer often grows slowly. With routine prostate specific antigen(PSA) testing, many men can be diagnosed with a cancer that is not going to progress during their lifetime. Such a diagnosis may increase men’s exposure to unnecessary treatment-related harms.
On the other hand, some men will still develop aggressive and potentially life-threatening prostate cancer. These men may benefit from prompt diagnosis and treatment.