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, in front of the rectum and close to nerves, blood vessels and muscles that control erections and bladder function. These muscles include the pelvic floor muscles, a hammock-like layer of muscles at the base of the pelvis.
What the prostate does
The prostate produces fluid that helps to feed and protect sperm. This fluid forms part of semen. Semen also contains millions of sperm made by the testicles (testes), and fluid made by a pair of glands called the seminal vesicles. The seminal vesicles attach to the back of the prostate gland. Lymph nodes are also found near the prostate.
Urethra
The urethra is a thin tube that runs from the bladder and through the prostate to carry urine (wee or pee) out of the body. The urethra also carries semen during orgasm.
Ejaculation
When a man has an orgasm and ejaculates, millions of sperm from the testicles move through tubes near the prostate called the vas deferens. The muscle around the prostate contracts and pushes the semen into the urethra and out through the penis.
Prostate growth
The male sex hormone, testosterone, is made by the testicles and controls the growth of the prostate. It is normal for the prostate to become larger as men get older. Sometimes this can cause problems, especially with urination.
How common is it?
Prostate cancer is the most common cancer in men (apart from common skin cancers). There are about 19,000 new cases in Australia every year, according to the 2018 statistics.
One in six men in Australia are at risk of developing prostate cancer by the age of 85. The risk of prostate cancer increases with age. It is uncommon in men younger than 50, although the risk is higher for younger men with a strong family history of prostate cancer, breast cancer or ovarian cancer, than for those without a family history.
Who gets prostate cancer
Anyone with a prostate can get prostate cancer, so it mostly affects men. Transgender women, male-assigned non-binary people or intersex people can also get prostate cancer if they have a prostate. For information specific to your situation, speak to your doctor.
Symptoms
Early prostate cancer rarely causes symptoms. Even when prostate cancer is advanced at the time of diagnosis, there may be no symptoms. Where symptoms do occur, they are often due to non-cancerous conditions, such as benign prostate hyperplasia.
These are some possible symptoms of advanced prostate cancer:
- unexplained weight loss
- frequent or sudden need to urinate
- blood in the urine or semen
- pain bones, especially in the lower back, hips or pelvis.
These are not always signs of prostate cancer but you should see your doctor if you have any of these symptoms.
Benign prostate hyperplasia (BPH)
A normal prostate gland may grow larger as you age – it is usually not cancer. This growth of the prostate is called benign prostate hyperplasia (BPH).
BPH may press on the urethra and cause symptoms that affect how you urinate. These are some possible symptoms of BPH:
- the stream of urine being weak
- having to go to the toilet more often, especially at night
- having to go urgently; trouble getting started
- dribbling of urine after going
- the bladder not feeling empty.
These symptoms are known as lower urinary tract symptoms (LUTS) and they can also occur in advanced prostate cancer. If you are experiencing LUTS, speak to your doctor.
Risk factors
While we don’t know the causes of prostate cancer, there are some things that can increase the risk of getting prostate cancer:
- older age – prostate cancer is most commonly diagnosed in people aged 60–79
- a family history of prostate cancer – if your father or brother has had prostate cancer before the age of 60, your risk will be twice that of others
- a strong family history of breast or ovarian cancer, particularly BRCA1 and BRCA2 gene mutations.
While prostate cancer is less common if you are under 50, people aged 40–55 are at particular risk of developing prostate cancer later in life if their test results are above the 95th percentile. This means their PSA levels are higher than 95% of other people in the same age range.
Inherited prostate cancer gene
You may have an inherited gene that increases your risk of prostate cancer if family has been affected by cancer in either of these ways:
- several relatives on the same side of the family (either your mother’s or father’s side) have been diagnosed with prostate, breast or ovarian cancers
- your father or a brother has been diagnosed with prostate cancer before the age of 60.
Your general practitioner (GP) can advise you on the suitability of PSA testing for you and your family. For more information, call Cancer Council 13 11 20.
Screening tests
Cancer screening is testing to look for cancer in people who don’t have any symptoms. The benefit of screening is that the cancer can be treated early. It is important that this benefit outweighs any potential harms from treatment or its side effects.
Unlike for bowel, breast and cervical cancers, there is no national screening program for prostate cancer. There is still debate among doctors and other experts regarding the pros and cons of PSA screening and whether there is an overall benefit .
Some people without any symptoms of prostate cancer do choose to have regular PSA tests. Before having a PSA test, it is important to talk to your doctor about the benefits and harms in your particular circumstances.
Health professionals you may see
Your doctor 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 may arrange further tests.
If you are diagnosed with prostate cancer, the cancer specialist leading your care may be a urologist or radiation oncologist. In some cases, the main specialist may be a medical oncologist.
Your specialists may 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.
| Health professionals you may see | |
| GP (doctor) | 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 male and female urinary systems and the male reproductive system; performs biopsies and surgery; requests scans |
| radiation oncologist* | treats cancer by prescribing and coordinating the course of radiation therapy |
| medical oncologist* | treats cancer with drug therapies such as chemotherapy and hormone therapy (systemic treatment) |
| endocrinologist* | diagnoses, treats and manages hormonal disorders, including osteoporosis |
| cancer care coordinator/prostate cancer specialist nurse | coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; a clinical nurse consultant (CNC) or clinical nurse specialist (CNS) may also coordinate your care |
| nurse | administers drugs and provides care, information and support throughout management or treatment |
| urology care coordinator/continence nurse | supports people with bladder and bowel management before and after cancer treatment |
| radiologist* | analyses x-rays and scans; an interventional radiologist may also perform a biopsy under ultrasound or CT, and deliver some treatments |
| nuclear physician | analyses bone scans and PET scans and delivers radionuclide therapies |
| pathologist* | examines cells and tissue samples to determine the type and extent of the cancer |
| continence physiotherapist | provides exercises to help strengthen pelvic floor muscles and improve bladder and bowel control |
| exercise physiologist/ physiotherapist |
prescribes exercise to help people with medical conditions improve their overall health, fitness, strength and energy levels |
| occupational therapist | assists in adapting your living and working environment to help you resume usual activities after treatment |
| sexual health physician*/sex therapist | helps you and your partner with sexuality issues before and after treatment; an erectile dysfunction specialist can give specific advice for erection problems |
| psychologist, counsellor | help you manage your emotional response to diagnosis and treatment; may also help with emotional issues affecting sexuality |
| social worker | links you to support services and helps you with emotional, practical or financial issues |
*specialist doctor