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Prostate cancer frequently asked questions

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I am 40 years old and recently noticed blood in my sperm. Could this be a sign of prostate cancer?

Blood in the semen (haematospermia) is not uncommon and may affect men of any age after puberty. It may be caused by inflammation, infection, blockage, or injury anywhere along the male reproductive system. Sometimes this happens only once and a cause is never determined. As a symptom on its own, it is rarely associated with cancer. We do however suggest you make an appointment to see your GP so he or she can physically examine you and carry out some simple tests.

My Father has been diagnosed with prostate cancer. Does this increase my chance of developing prostate cancer?

Having a close family member diagnosed with prostate cancer does increase your chance of developing the disease.

You are two and a half times more likely to get prostate cancer if your father or brother has been diagnosed. The risk increases to about four times the average if your relative was under the age of 65 when they were diagnosed.

The younger a man is when diagnosed or if several members from the same side of the family have been affected, then it could be a sign that there is a faulty gene running in the family. However, only a small number of prostate cancers (5-10%) are thought to be due to an inherited gene. Researchers continue to work trying to identify faulty genes that could cause an increased risk of developing prostate cancer. Currently several genes are known to cause an increased risk of prostate cancer but it is known that there must be others which haven’t been identified yet. Men with a family history of prostate cancer may want to discuss their risk of developing prostate cancer with their GP.

There is currently no genetic test for prostate cancer available on the NHS.

In a few families who have a strong history of breast cancer, a change (mutation) in the breast cancer genes BRCA1, and particularly BRCA2 may be identified. In these families male members may be at an increased risk of developing prostate cancer. So if there is a strong history of breast cancer in your family or if a BRCA gene mutation has been found, you may want to discuss your risk of developing prostate cancer with your doctor. Your GP can refer you to a genetics clinic for further advice if necessary.

Where does prostate cancer spread to?

Sometimes prostate cancer cells will spread outside of the prostate to other parts of the body.

Prostate cancer can spread to the area just outside the prostate gland. This is known as locally advanced prostate cancer. Cancer may spread to:

  • The seminal vesicles (glands near the prostate gland that store and produce some of the fluid in semen)
  • The nearby lymph nodes (small bean-shaped structures that are part of the body's lymphatic system, and which help the body to fight disease and infection)
  • The bladder or rectum (back passage) but this is less common

Prostate cancer can also spread to other parts of the body. This is known as advanced or metastatic prostate cancer. Cancer may spread to:

  • The distant lymph nodes
  • The bones
  • The lungs and liver (but this is less common)

Looking to see how far the cancer may have spread is known as staging. Tests used to stage the cancer may include a CT or MRI scan and bone scan.

Why is there no screening programme for prostate cancer?

The UK National Screening Committee has decided that the disadvantages of regularly screening every man over 50 for prostate cancer using the PSA test outweigh the possible advantages. It has been found that screening can reduce the number of deaths from prostate cancer. But screening also leads to the over-diagnosis and possible over treatment of 'harmless' prostate cancers that wouldn't harm a man in his lifetime.

Although there is no organised screening programme in the UK, there is an informed choice programme called The Prostate Cancer Risk Management Programme (PCRMP).

The aim of the PCRMP is to ensure that men who are concerned about their risk of prostate cancer receive clear and balanced information about the benefits and limitations of the PSA test and treatment for prostate cancer. This will help men to decide whether they want to have the test.

All men are entitled to have the test on the NHS if they want it.

Can you tell me more about the PCA3 test?

Before the urine specimen is collected for the PCA3 test the prostate gland needs to be massaged to release prostate cells. This is done in a similar way to a digital rectal examination. The man is then asked to pass water and a sample containing the released prostate cells is collected. The sample is send to the laboratory to be tested and a PCA3 score is then given.

Early studies have suggested that the higher the PCA3 score the higher the probability of prostate cancer being found on biopsy. It is not a replacement for the PSA test or biopsy but it may provide further information for men suspected of having prostate cancer. Like the PSA test the PCA3 test cannot diagnose prostate cancer, but it may help to predict how likely it is. This further information may help the specialist decide whether a prostate biopsy is necessary.

Is there anything I can do to help prevent me developing prostate cancer?

We don't know for sure how to prevent prostate cancer. Prostate cancer is complicated and researchers are still trying to understand its causes as well as looking at ways to prevent it.

There are several factors that may increase your risk of being diagnosed with prostate cancer including age, ethnicity and family history. Although these factors cannot be changed there are changes that can be made in your diet and lifestyle that may be important in protecting you against the disease. However we need very large population studies to confirm this.

Men living in Western countries are more likely to get prostate cancer than men in South and Eastern Asian countries such as China and Japan. Researches think that this may be because the typical western diet is high in dairy, red meat, saturated fat, sugar and processed meat, and contains less fruit and vegetables. Eating a balanced diet with plenty of fruit and vegetables, some meat and dairy and a small amount of food and drinks high in fat or sugar, you may lower your risk of developing prostate cancer.

Research also suggests obese men may have a higher risk of advanced prostate cancer and that men who exercise regularly have a lower risk.

Many studies have looked at individual nutrients that may offer protection from prostate cancer. Unfortunately these trials have either not been large enough, have shown no proven benefit or have been conflicting. This can be very confusing.

Some studies have shown that a diet high in antioxidants may protect men against prostate cancer. Antioxidants protect cells from the damage caused by unstable molecules known as free radicals. In particular, lycopene (an antioxidant found in tomatoes) has in some studies been linked to a decreased risk of prostate cancer but in other studies has not. Some studies suggest that cooked and processed tomatoes, such as tomato sauces, soups and pastes may be more helpful than fresh tomatoes.

Some studies have suggested that selenium and vitamin E supplements (both antioxidants) may help to protect against prostate cancer. However, a recent large study looking at selenium and vitamin E showed they did not reduce the risk of prostate cancer.

You may be able to help reduce your risk of prostate cancer by:

  • Eating a wide range of fruit and vegetables.
  • Cutting down on dairy products if you eat a very high calcium diet.
  • Reducing the amount of red and processed meat in your diet.
  • Maintaining a healthy weight.
  • Exercising regularly.

Research into diet and prostate cancer continues. But whilst current evidence may be a little unclear remember that a balanced diet, a healthy weight and an active lifestyle will have health benefits. It will reduce your risk of developing heart disease and diabetes and may reduce your risk of developing prostate and other cancers.

It’s not serious, so I can just ignore the symptoms, can’t I?

Most men living with BPH who do not receive treatment will experience only a gradual deterioration in symptoms. However, as the prostate continues to enlarge, the muscular wall of the bladder has to work harder to push urine through the urethra. This extra work makes the muscles of the bladder wall thicker and stronger. The pressure inside the bladder also increases and this causes diverticula to form within the bladder walls. Occasionally, the pressure is great enough to result in kidney problems.

Bladder stones can also develop. If BPH isn’t treated, it can lead to acute urinary retention or chronic urinary retention. Both of these conditions require hospital admission. Acute urinary retention is a medical emergency.

What is a prostate biopsy and how is it performed?

A prostate biopsy is a diagnostic test that collects samples of prostate tissue to look for prostate cancer cells.

An ultrasound probe is inserted into the rectum, which guides an automated needle to the prostate. You may be given a local anaesthetic to reduce any discomfort during the biopsy. You may feel a sharp needle prick as 8-12 tiny samples of prostate tissue are taken. These samples are sent to a laboratory for examination under a microscope. You will be given antibiotics before and after the procedure and told to continue taking the prescribed antibiotic for several days afterwards.

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