The prostate is a walnut-shaped gland that is part of the male reproductive system that is involved in the production of semen. Prostate cancer occurs when abnormal prostate cells develop, often from mutations in the cell DNA and grow in an uncontrolled way, often multiplying and spreading. ¹

Approximately 5 –10% of all prostate cancer cases are thought to be hereditary (passed on from one family member to another).² Gene mutations that have been implicated in inherited prostate cancer include;

• HOXB13
  this gene is involved in the development of the prostate gland, mutations in this gene have been linked to early onset cases of prostate cancer, although this gene mutation is uncommon. ²
• BRCA 1 and BRCA 2
  mutations in these genes have been implicated in breast and ovarian cancers in women; however they are also implicated in prostate cancer in men, especially BRCA 2 gene mutations.²
• MSH2 and MLH1
  these genes help repair mismatched DNA, mutations in these genes can result in a condition called Lynch Syndrome, which increases the risk of prostate, colorectal and other cancers.²
• RNASEL (also known as HPC1)
  this gene helps to get rid of cells that begin to function abnormally. However mutations in this gene mean these abnormal cells are no longer destroyed, which can lead to an increased risk of prostate cancer. ²

However the majority of prostate cancer cases are thought to be due to an acquired gene mutation, which means cell mutations that occur during a man’s lifetime, rather than the mutations being passed down from generations.²

The TNM system is used to stage prostate cancer. A stage between 1 and 4 is given, with a higher number indicating a more serious stage of cancer.

The TNM stands for:⁴

• Tumour – the degree to which the tumour has affected other tissue.
• Node – is a measure of whether lymph nodes have been affected.
• Metastasis – the degree to which the cancer has spread to other organs of the body.

Along with the TNM information, your doctor will also take into consideration your PSA (prostate sensitive antigen) level from a blood test, as well as your Gleason score to help determine the stage of your cancer.  The Gleason score is usually based on the results of a biopsy of the prostate, and it provides an indication of how quickly the cancer will grow and spread.¹⁰

The stages of prostate cancer are;¹¹

The treatment for prostate cancer is dependent on the stage of the cancer and the individual. There is usually more than one ‘good’ option, so choice often comes down to patient preference. It is important that you consider the full range of options, including the no treatment option.

Talk with your urologist and your radiation oncologist to help you weigh up the advantages and disadvantages of different treatment options and possible side effects like incontinence and erectile dysfunction, availability and cost to help you make an informed decision about the best treatment for you.

Some of the treatment options include;

• Monitoring – either by active surveillance or by watchful waiting, these options are usually available to men who either have very slow growing prostate cancer, who don’t present with any symptoms, or for older men, where the cancer is unlikely to impact significantly on their quality of life, or lifespan. ³
  • PSA Blood Test – both active surveillance and watchful waiting will require regular PSA blood tests (usually every 3-6 months). A PSA test is a blood test which measures a prostate specific antigen in the blood.³
  • Digital Rectal Exam – active surveillance will also require a rectal exam every 6 months to monitor any changes in the prostate.³
  • MRI scans – take a picture of the body using magnetic fields and radio waves, these scans are usually required every year under active surveillance.

• Radiation Therapy – this type of treatment is often used in men with early prostate cancer that hasn’t spread, although it can also be used in combination with other treatments, or if the cancer has returned. ⁹

There are two main types of radiation therapy treatments used for prostate cancer:

• External beam radiation therapy (EBRT) which uses one or more beams to deliver high energy x-rays from outside the body to the cancerous area. Treatment is usually given over 4–8 weeks; each treatment is about 15 minutes.
• Seed brachytherapy (the insertion of radioactive seeds injected into the prostate that destroy the cancer cells). Read more about brachytherapy for prostate cancer in our Icon library here

You can learn more about radiation therapy and the specific techniques used for prostate cancer here

• Androgen Deprivation Therapy (ADT) – is a type of therapy used to reduce the amount of testosterone in the body.³
  • This type of therapy can be used before, during and after other treatments such as radiotherapy or chemotherapy.³
  • ADT can be given as a tablet or as an injection.³
• Chemotherapy – uses drugs that destroy cancer cells (and healthy cells too). This type of treatment is usually offered to men where their prostate cancer has spread to other areas of their body. Because chemotherapy destroys some healthy cells as well, there can be side effects such as; hair loss, nausea and vomiting, mouth sores and fatigue. ⁸
• Surgery – this treatment procedure usually involves the removal of the whole prostate (radical prostatectomy), in an attempt to cure the patient of prostate cancer.

Prostate Cancer research at Icon

Our research centre at Icon offers Australia the largest private clinical trials programme in cancer research, with over 35 clinical trials currently open for recruitment.  Clinical trials specific to prostate cancer research can be found here.

Icon’s collaborative approach to clinical trial research not only enables continual advancement and breakthroughs in prostate cancer research, but also enables the most up to date treatment options are available to all patients regardless of health insurance.