Diagnosing and treating the most common cancer in men
Prostate cancer is the most common cancer of men. There are two common tests used to look for prostate cancer, a digital rectal exam and a blood test to detect prostate specific antigen (PSA), however a diagnosis can only be confirmed by a biopsy. To tie in with Blue September, an awareness month dedicated to prostate cancer, we spoke to Associate Professor Ken Sikaris, Director of Chemical Pathology, Melbourne Pathology to find out more about the disease.
“Prostate cancer develops when abnormal cells develop in the prostate. The abnormal cells grow uncontrolled and do not stop growing. They can spread within the prostate, and also to the rest of the body. Because the prostate is hidden from view, parts of it can enlarge without the patient noticing and, in the past, used to be diagnosed incidentally. The most common way that we now find prostate cancer is through screening with the Prostate-specific antigen (PSA) blood test.
“PSA is a substance made by both normal and cancer cells in the prostate gland. PSA is meant to be in semen, but a very small amount also leaks into the blood. As prostate cancer grows the PSA level in blood rises. Once men are identified to be at risk, they should be sent for radiological imaging (MRI) of the prostate and if suspect areas are found they should be biopsied to see if prostate cancer is present,” said A/Prof Sikaris.
A biopsy will usually determine whether or not a person has prostate cancer. The pathologist examines the biopsy specimens under the microscope and assigns a histological grade to assist in predicting tumour behaviour and prognosis. Treatment will then depend on the stage of the disease, the location of the cancer, the severity of symptoms and a patient’s general health and wishes. For some people, treatment may not be recommended straight away – the patient may be monitored by PSA and prostate changes over time. If the tumour has not spread, a radical prostatectomy may be performed to remove the prostate and surrounding tissue. Other treatment options exist and include radiotherapy, cryotherapy, hormone therapy, chemotherapy and immunotherapy. Accurate anatomical and functional imaging of the prostate gland, and diagnosis of significant (intermediate- and high-risk) prostate cancer, is also now becoming available in Australia.
“We don’t understand the causes of prostate cancer. What we do know is that the rate of prostate cancer in rural China is amongst the lowest in the world, but when those Chinese workers move into the city, they have the ‘Western rate’ which is the highest in the world. Therefore, it seems likely that prostate cancer is mostly caused by environmental factors, however we know that around 15-20% of cases are due to inherited genetic factors,” said A/Prof Sikaris.
The risk of developing or dying from prostate cancer increases strongly with age. Around 90% of new prostate cancer cases occur in men aged 55 years and over, with 99% of prostate cancer deaths occurring in this age group. Men with a first-degree relative with prostate cancer have a greater risk of the disease. PSA testing recommendations will vary depending on family history.
“It is important that men know the risks of prostate cancer and from the age of 50, all men should consider routine screening. The Prostate Cancer Foundation recently released a guide for patients based on Australian and New Zealand guidelines which is a highly useful source of information, providing help to those who have questions and concerns about any matters related to prostate cancer,” said A/Prof Sikaris.
To learn more, visit https://www.prostate.org.au or https://prostate.org.nz
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This article appeared in the September 2019 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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