Prostate cancer is a common disease affecting men most commonly in their sixties and seventies.
The incidence of prostate cancer is higher with increase age. It can still affect men in their forties and fifties especially if there is a family history.
Localised prostate cancer
is cancer confined within the prostate gland (Stage 1 and 2). It has not spread to distal organs or locally into adjacent organs. This form of prostate cancer is most likely curable. It does not usually present with any symptoms.
Locally advanced prostate cancer and metastatic prostate cancer
are forms of prostate cancer that have spread outside the prostate (Stage 3 and 4). Prostate cancer usually spreads initially to the pelvic lymph nodes and onwards to bone. These forms of prostate cancer are mostly incurable. It can present with local urinary symptoms or other symptoms related to distal spread.
Prostate cancer has the highest chance of cure if it is detected at an early stage.
PSA (Prostate Specific Antigen) blood test and
prostate examination with a finger in the rectum are ways of determining if a patient needs to have a prostate biopsy to confirm the diagnosis of prostate cancer.
An abnormality on prostate examination (eg. lump, firmness) should be investigate with a prostate biopsy.
Abnormalities of the PSA blood test can be caused by:
- Benign prostate enlargement
- Urinary tract infections
- Prostatitis (which can be non specific)
- Prostate trauma, recent instrumentation or surgery in the urinary tract
- Prostate cancer
- Some men have elevated PSA without prostate cancer
Normal levels of PSA depend on the age of the patient.
Age 40 - 49
PSA 0 - 2.5
Age 50 - 59
PSA 0 - 3.5
Age 60 - 69
PSA 0 - 4.5
Age 70 - 79
PSA 0 - 6.5
Abnormal PSA that occur outside the setting of other causes that affect the PSA level should be investigated with a prostate biopsy to exclude prostate cancer. In general the chance of detecting prostate cancer on a biopsy for an abnormal PSA is about 30%.
There is also rare forms of prostate cancer and high grades of prostate cancer that can have a normal or low PSA level.
The decision for a patient to have a PSA or Prostate examination for early detection of prostate cancer must be determined by taking into account the patient's likelihood of benefiting from early treatment of the cancer if it is detected.
For moderate grade of prostate cancer it may take up to eight years to gain benefits from early treatment of prostate cancer. Therefore most patient needs to have at least a ten year life expectancy to benefit from early diagnosis and treatment.
Patients that have significant medical problems and those would are of advanced age in general will not benefit from early prostate cancer detection and treatment.