Research suggests that there is a complex interplay of factors that have a causative role in prostate cancer. They include genetics, ethnicity, hormones, diet and the environment.

The influence of our genes on prostate cancer development is under active investigation, both at the Garvan and around the world. Prostate cancer often does not produce any symptoms in its early stages, which is why many cases are not detected until it has spread beyond the prostate.

Most men tend to accept the onset of one or more of these symptoms as being a natural consequence of ageing, but they may also indicate a problem with the prostate gland:

• Waking frequently at night to urinate or a sudden need to urinate
  
• Difficulty in starting or stopping urinating or a slow flow of urine
  
• Discomfort, pain or blood when urinating or ejaculating • Decrease in libido or reduced ability to get an erection.

Factors that increase the likelihood of developing prostate cancer are:

• Age - It is most common in men over the age of 50
  
• Genetics - Regular testing from the age of 40 is advised if you have at least one first degree relative who has had prostate cancer
  
• Ethnicity - e.g. European men have a much higher chance of developing prostate cancer than Asian men
  
• High levels of testosterone - testosterone naturally stimulates the growth of the prostate
  
• Diet - a high-fat diet and obesity may increase your risk of prostate cancer
  

As part of a regular check-up, in men over 45, a digital rectal examination (DRE) is recommended in order to detect any irregularities in the prostate. This may be an uncomfortable examination but is rarely painful. An enlarged gland will feel hard and possibly irregular in shape.

A Prostate Specific Antigen (PSA) test may be requested if any abnormality is found. This measures a protein in the blood which rises in concentration when there are prostate problems. In themselves, these two tests will not distinguish between cancer or a benign enlarged prostate and so, if an abnormality is found, an ultrasound scan will be carried out. A biopsy will then determine if the prostate is cancerous or benign.

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Information from diagnostic tests helps to determine the best treatment approach. Depending
on the stage of the cancer development, a number of treatment options may be offered:

• Observation only (called ‘watchful waiting’) – monitoring the disease through regular check-ups, but delaying treatment until the disease shows signs of progressing or symptoms become troublesome
• Radical prostatectomy – an operation to remove the prostate gland and the immediate surrounding associated organs, such as the seminal vesicles
• External beam radiotherapy
• Radiotherapy using radioactive ‘seeds’ of Iodine125, which are permanently inserted into the prostate
• An operation to reduce male hormone production by removal of one or both testicles
• Medicines to suppress the production and action of the male sex hormones

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We have taken a multidisciplinary approach that utilises the expertise of a number of cancer researchers within and outside Garvan, including clinicians and pathologists from a number of Sydney’s major teaching hospitals.

Thanks to collaborators from Melbourne, we have access to  DNA from over 4000 Australian men. Our cutting-edge technology enables us to investigate a large number of genes across the extensive collection of samples. This valuable resource helps enable us to identify the clinical and molecular markers of prostate cancer prognosis. This knowledge will enable future prostate cancer patients to be matched up more effectively with the best possible treatments, thereby improving the outcomes.

In addition to improving early prognostic markers of prostate cancer, we are researching predictive markers – clinical and molecular indicators that allow us to evaluate the potential success (or failure) of a treatment.

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