Prostate cancer is one of the most common types of cancer in men.  It is located below the bladder and produces fluid which mixes with sperm produced in the testicle to make semen during ejaculation.  Although prostate cancer grows slowly initially, it may spread to the bone and the rest of the body if left untreated.   Majority of the cancer cell types are the Acinar Adenocarcinoma which comprise around 90-95% of all cases while the rest the aggressive Neuroendocrine Carcinoma and Ductal Carcinoma

Risk Factors for Prostate Cancer

• Increasing age
• Family history of prostate, breast, ovarian, colon or pancreas cancer
• Ethnicity (it is more common in Afro-Americans)
• Inherited genetic mutations of the BRCA1 or BRCA2 genes
• Chemical exposure of pesticides or herbicides

Symptoms of Prostate Cancer

• Early cancers may NOT have any symptoms at all except for elevated blood PSA levels
• Difficulty and increase frequency of passing urine (need to get up at night)
• Decreased flow of urine, dribbling and taking a long time to empty bladder
• Blood in the semen
• Discomfort or pain around the pelvic area
• Erectile dysfunction
• Loss or appetite and loss of weight
• Bone pain when the cancer has spread to the bone

Click to view Cancer Research UK video on Prostate Cancer

Diagnostic Tests

• Examination of the prostate by your doctor
• Blood tests (to detect your blood, liver and kidney profile and prostate tumour marker known as Prostate Specific Antigen or PSA) may be the first sign of prostate cancer
• Prostate tissue biopsy
• CT or MRI or PET scan (to check for cancer spread)

TNM Staging of Prostate Cancer

Staging of the cancer is one of the most important factors in deciding how to treat the cancer and in determining how successful the treatment might be.  The TNO staging depends on T (size of tumour), N (if lymph nodes are involved) and M (if there is spread to rest of the body known as metastasis)

Stage	Description
T1	The cancer is within the prostate but NOT large enough to be felt
T2	The cancer is within the prostate and large enough to be felt
T3	The cancer may have broken outside the capsule of the prostate
T4	The cancer has spread outside the prostate
N0	No lymph node involved
N1	The cancer has spread to more than 1 lymph node
M0	No metastasis
M1	The cancer has spread or metastasis to rest of the body

Gleason Grading Score for Prostate Cancer

The Gleason Grading Score is used to determine the aggressiveness of prostate cancer cells from 2 different areas in the tumour (a primary grade to describe cancer cells in the largest area of the tumour and a secondary grade to describe cancer cells from the next largest area).  The score ranges from 1-5 with a score of 1 being looking like normal tissue while 5 looks abnormal.   Most cancers usually have a score of grade of 3 or higher. 

The Gleason Score is the SUM of the PRIMARY + SECONDARY SCORES

Typical Gleason Scores usually range from 6-10 and the higher the Gleason Score, the more likely that the cancer is aggressive and will grow or spread quickly.

Click to view ProstateCancerCanada video on Understanding Prostate Cancer

Treatment Options for Prostate Cancer

Treatment depends on your age and health status as well as the tumour stage and Gleason Grading Score.  You should discuss with your Urology Surgeon and Oncologist the treatment options which include;

• Surgery to remove the prostate cancer such as Open, Laparoscopic or Robotic Assisted Laparoscopic Radical Prostatectomy
• Radiotherapy
• Hormonal therapy
• Immunotherapy
• Adjuvant treatment using Chemotherapy such as Docetaxel (Taxotere) and Cabazitaxel (Jevtana) given with Prednisone
• Radium-223 treatment for advanced prostate cancer

Issues after Treatment

You may experience some or all of the following

• Erectile dysfunction
• Urinary incontinence (inability to control your urine)
• Overactive bladder (sudden desire to go to urinate)

Surveillance after Treatment

You are encourage to have regular follow-up visits with your doctor.  It is important to have the following tests regularly (every 4-6 months) to detect any recurrences early

• Examination of the prostate by your doctor
• Blood tests (to detect your blood, liver and kidney profile and PSA)

See a Urologist if you have difficulty passing urine or have prostate issues

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If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.