The prostate is a walnut sized gland that is situated just beneath the bladder in men. This gland produces the fluid that carries sperm in semen.
Facts and figures
- Prostate cancer is now the most common male cancer; however, it doesn’t always affect life expectancy.
- At some point in their lives, 1 in 8 men in the UK will get prostate cancer.
- It is quite rare in men under 50 and more than half of diagnosed cases are in men over 70.
Signs and symptoms
As well as age, a family history of breast or prostate cancer or being of afro-Caribbean descent may be risk indicators.
Very early prostate cancer does not usually cause any symptoms so awareness plays an important part in diagnosing it early.
The most common symptoms of prostate cancer are the same as for a non-cancerous, but enlarged prostate. They are:
- Having to rush to the toilet to pass urine
- Difficulty when passing urine
- Passing urine more regularly than usual, especially at night
- Pain when passing urine
- Blood in the urine or semen (but this is very rare)
With any symptoms it is important to see a doctor as most enlargements of the prostate are not cancer (they are benign) and can be easily treated.
A GP can do a physical examination to check for an enlarged prostate or recommend a prostate specific antigen test (PSA).
A GP will examine the prostate via the rectum and will do a blood test to measure your prostate specific antigen (PSA) level. PSA is a protein that is produced by the prostate (a small amount of which is usually found in the blood). Men with prostate cancer tend to have higher levels of PSA in their blood. However, this is not always accurate. A higher score in this test may indicate cancer but other factors, such as infection, can provide the same result and 2 out of 3 men with raised PSA scores do not have prostate cancer.
If symptoms persist or are suspicious a GP will refer a patient to a urologist who is likely to repeat these tests. At this stage careful examination is used to establish the size, location and character of a potential tumour. The urologist may then use other tests:
- bone scan (a scan to look for suspicious areas in the bones)
- CT scan or an MRI scan (to check the area around the prostate and the lymph nodes in the groin)
Metastases occurs when cancer cells break off and spread through the lymphatic channels or blood vessels to settle in other parts of the body. With prostate cancer it typically spreads to the bones.
Early prostate cancer that has not spread is very unlikely to grow or develop for many years. In this case, active monitoring (also known as active surveillance or watchful waiting) may be offered to see whether the cancer begins to develop. It also aims to avoid needless treatments that could cause side effects and ultimately affect your quality of life.
If cancer starts to develop or is already at an intermediate stage, a urologist may recommend surgery to remove the prostate gland, this is called radical prostatectomy. Patients may be suitable for this treatment if their cancer is thought to be contained within the prostate gland.
Radiotherapy for prostate cancer
Men who have high risk localised prostate cancer (cancer that hasn’t spread to other parts of the body) or cancer that has broken through the capsule surrounding the gland are usually offered treatment with surgery to remove the prostate gland or external beam radiotherapy to the prostate.
Brachytherapy involves implanting very small seeds into the prostate gland where they slowly release a low dose of radiation, for a few months. A higher dose alternative may be used which combines both brachytherapy and external beam radiotherapy. Radiotherapy may also be beneficial for treatment of metastases.
In order to grow, prostate cancer depends on the hormone testosterone, which is produced by the testicles. Reducing the amount of testosterone in the body can reduce the chance of an early prostate cancer coming back after treatment. Or it can shrink or slow down the growth of an advanced prostate tumour.
Hormone therapy may be given to men with locally advanced prostate cancer before radiotherapy (neo-adjuvant therapy), which can help make radiotherapy treatment more effective.It is also sometimes given after radiotherapy (adjuvant therapy), where the aim is to reduce the chance of the cancer coming back.