Prostate Cancer

 

Prostate cancer is the most common form of cancer in men in the UK but is highly treatable in the early stages. It develops in the prostate gland and develops gradually, possibly showing no signs for many years.

 

What is the Prostate?

The prostate is a small, walnut shaped gland situated in a man’s lower abdomen, located below the bladder and surrounding the urethra.  The prostate produces seminal fluid, which nourishes and protects sperm.

 

When an abnormal growth (tumour) forms in the prostate, it is known as prostate cancer.  This form of cancer can spread to other areas of the body; however, it will still referred to as prostate cancer as it is made of cells from the prostate.  The prostate has various functions, including:

 

  • Producing the substance that nourishes and transports sperm
  • Storing prostate specific antigen (PSA), a protein that helps semen retain its liquid state
  • Assisting urine control

 

 

 

Types of Prostate Cancer

Most cases of prostate cancer are known as an adenocarcinoma.  This refers to a cancer that grows in the tissue of a gland, such as the prostate gland.  It is also characterised by how fast it grows. It has 2 types of growths:

 

  • Aggressive – fast growing
  • Nonaggressive – slow growing

 

With nonaggressive prostate cancer, the tumour either does not grow, or grows minimally over time.  With aggressive prostate cancer, the tumour can grow rapidly and may move to other areas of the body, such as the bones.

 

Understanding the stage of your cancer will prepare you for what to expect and will help you make informed decisions about treatment.

 

Stage 0

Precancerous cells are present, but only affect a small area and are non-aggressive, slow growing cells.

 

Stage 1 (Localised)

Cancer only exists in the prostate gland. Treatment is effective at this stage.

 

Stages 2–3 (Regional)

Cancer has spread to nearby tissues.

 

Stage 4 (Distant)

Cancer has spread to other parts of the body, such as the lungs or bones.

 

Cause and Risk Factors

No exact cause has been identified for prostate cancer, although a number of factors can increase your risk of developing the disease. These include:

 

Age
Age is a primary risk factor. As you get older, the risk of developing prostate cancer increases.  The disease most often occurs in men over 65.

 

Family history
Your risk is increased if there is a family history.  Research has also shown that if a close female relative develops breast cancer, this may also increase your risk of developing prostate cancer.

 

Obesity
Research has shown that there may be a link between obesity and prostate cancer.  Obese men diagnosed are more likely to have the advanced disease that is more difficult to treat.  Maintaining a balanced diet and regular exercise may lower the risk of developing prostate cancer.

 

Ethnicity
Black men are more likely to develop to prostate cancer, with 1 in 4, compared to 1 in 8 white men.

 

Symptoms

In the early stages of prostate cancer, there are often no symptoms as they do not usually appear until the prostate is large enough to affect the urethra (the tube that carries urine from the body).  When symptoms occur, you may notice the following:

 

  • The need to urinate more frequently 
  • Straining whilst urinating 
  • A sensation that your bladder if not completely empty

 

However, these symptoms do not indicate that you have cancer but they should not be ignored.  Advanced prostate cancer symptoms include:

 

  • Difficulty urinating
  • Reduced force in the stream of urine
  • Blood in the semen or urine
  • Discomfort in the pelvic area, especially when sitting
  • Bone pain
  • Erectile dysfunction or pain on ejaculation
  • Weight loss
  • Fatigue
  • Changes in bowl routine

 

If you have any of these signs or symptoms, do not hesitate to call your doctor.  Certain symptoms of prostate cancer can be a result of other conditions, so you will need an assessment to confirm.

 

Diagnosis

Screening for prostate cancer usually depends on your personal preferences.  It is controversial to test healthy men with no symptoms as it can lead to unnecessary worry and unneeded treatment.  However, men over the age of 50 should have cancer screenings, or earlier for men who are at a higher risk of developing the condition.

 

If you are showing symptoms that indicate prostate cancer, the doctor will ask about your symptoms and take a detailed medical history.  They may carry out further tests to confirm the diagnosis. These include:

 

Digital Rectal Examination (DRE)
During a DRE, the doctor inserts a lubricated, gloved finger into the rectum and checks the prostate manually for any abnormalities.  A DRE can sometimes discover an enlarged prostate, lumps or nodules of prostate cancer, or tenderness from prostatitis.

 

Prostate-Specific Antigen (PSA)
The prostate produces a protein called PSA, which can be measured by a blood test.  If PSA is high, prostate cancer is more likely; however, a high PSA can also be the result of an enlarged prostate.

 

Prostate Ultrasound (Transrectal Ultrasound)
An ultrasound probe that sends out high-energy soundwaves is inserted into the rectum.  The sound waves bounce off internal organs and tissues, creating echoes that form a picture of the body tissue.  Transrectal ultrasounds are typically performed with a biopsy to test for prostate cancer.

 

Prostate Biopsy
A needle is inserted into the prostate to take a sample of tissue for analysis.  This is carried out via the rectum.  This is the only procedure that can confirm the form of cancer.

 

Once the doctor has confirmed a diagnosis of prostate cancer, they will need to define the stage of the cancer.  If your doctor thinks your cancer may have spread beyond your prostate, one or more of the following tests will be suggested:

 

 

Treatment

Prostate cancer treatment depends on the stage of cancer as well as your medical history and overall health.  For men diagnosed with low-risk prostate cancer, treatment may not be necessary.  Doctors may recommend active surveillance (the watch and wait approach).

 

With active surveillance, regular follow-up blood tests, possible biopsies and rectal examinations may be carried out to assess the advancement of your cancer.  If tests indicate that your cancer is progressing, you may be a candidate for treatment such as radiation or surgery.

 

When prostate cancer treatment is necessary, the goal is to cure or control the disease so it does not impact everyday life.  In some cases, if the cancer has already spread, the aim is not to cure, but to prolong life and delay symptoms.

 

If your cancer is aggressive and has metastasised (spread), it is likely it has spread to your bones.  Aggressive forms of cancer may be treated with:

 

  • Surgery
  • Radiation
  • Hormone therapy
  • Chemotherapy
  • Cryotherapy
  • Immunotherapy

 

Outlook

Prostate cancer is a risk for all men as they age, but if prostate cancer is diagnosed early and has not spread from the original tumour, the outlook is generally good.  Early detection and treatment are key to a positive result.  If you think you have symptoms of prostate cancer, you should schedule an appointment with your doctor immediately.  Even if you do not have symptoms, try embracing a healthy lifestyle to decrease your risk.

 

A diet high in vegetables and fish, and low in full-fat dairy and red meat, alongside an exercise plan approved by your doctor, could help reduce your risk of prostate cancer, as well as boost your health overall.

 

Need Help?

If you are concerned you may have developed prostate cancer, you can be seen by a Consultant Urologist at One Ashford Hospital, usually within 48 hours. 

 

One Ashford Hospital is well placed to see patients from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages.  To book an appointment, call the hospital direct on 01233 364 022 or email here.