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What is Prostate Cancer?

With over 37,000 men diagnosed with prostate cancer in the UK every year, you need to know the facts.

Prostate cancer is caused when cells in the prostate gland grow abnormally and form lumps called tumours.

Over 40,000 men are diagnosed with prostate cancer in the UK every year and with 10,000 men each year dying from the disease, it is the second most common cause of cancer deaths in men in the UK.

Prostate cancer is more common in men over the age of 50 and the most common occurrence is in men over the age of 70. Recently there has been a 6-fold increase in men aged 40-59 being diagnosed with the condition.

At present there is no national NHS screening programme for prostate cancer.

What is the prostate and what does it do?

The prostate is a small sex gland about the size of a walnut that assists in the production of semen. It sits just below the bladder and envelops the urethra, the tube that carries urine to the penis from the bladder. This is why many men suffer with urination problems or sexual disfunction if there is a problem with their prostate.

What are the causes of prostate cancer?

The causes of prostate cancer are still unknown but there are a number of risk factors that have been identified including family history, diet, ethnicity, lifestyle and age.

Family History – Having a close male relative i.e. brother, father, uncle who has had prostate cancer does lead to an increased risk of developing the condition. Research has also shown that having a close female relative who has developed breast cancer may also slightly increase risk. New information about genetic relationships is becoming available.

Diet & Lifestyle - A diet high in fat and calcium and low in fruit and vegetables is thought to increase the risk of developing prostate cancer. There has also been recent research to suggest that obesity can increase the risk of developing the disease. Some research has shown that men who eat a diet rich in nutrients including lycopene (found in tomatoes and other red fruit) and selenium that is most commonly found in Brazil nuts may be at lower risk along with men who take regular exercise.

Ethnicity – Men from African or Afro-Caribbean descent are more likely to develop prostate cancer and for men of Asian and South and Central American descent the condition is found to be relatively rare.

Age – Age is a major factor in prostate cancer. Men under the age of 50 are at lower risk whereas men over the age of 50 have an increased risk as they get older.

What is PSA Testing?

Prostate Specific Antigen (PSA) is a protein produced by the prostate gland. Prostate cancer can increase the levels of PSA in the blood and so a blood test can be used to identify raised levels and hence may be able to detect early stage prostate cancer.

The PSA test is not, however, 100% accurate and some men with low PSA levels can have prostate cancer and others with higher levels may not.

Additionally, the PSA test can pick up prostate cancer that is small and low risk that may not require radical treatment. On other occasions it may pick up prostate cancers at an early stage when they are curable which, had they not been detected, may have resulted in a poorer outcome.

What happens if a PSA test does show a high reading?

Any PSA test that shows a high reading for your age group will require further investigation. You will be referred to a urologist for further tests that may include:

  • A digital rectal examination – due to the prostate being located close to the rectum (back passage) a doctor is able to feel for abnormalities by inserting a gloved finger into the rectum. This examination may feel a little uncomfortable but it is not painful.
  • A trans-rectal ultrasound scan – a small ultrasound probe is inserted into the rectum to produce an image of the prostate gland. This examination can measure the size and density of the prostate.
  • A high quality (3 Tesla) multi-parametric Magnetic Resonance Imaging Scan (MRI) - increasingly these scans are being used in the early detection and staging of prostate cancer. It involves going into a special magnetic tunnel and images are produced which can then identify areas suspicious for prostate cancer.
  • A biopsy – a biopsy is carried out by inserting a probe into the rectum and then a fine needle is passed through the wall of the rectum to take several (around 10-12) samples of tissue from the prostate. These samples are then examined for signs of cancer. If cancer is found further analysis will help to identify whether the cancer is likely to spread. A score, known as a Gleason score is given to the samples. The lower the score the less likely the cancer is to spread.
    A Gleason score of 6 or less means the cancer is less likely to spread
    A Gleason score of 7 indicates a moderate chance the cancer will spread
    A Gleason score of 8 or more means there is a significant chance the cancer will spread

What are the treatments for Prostate Cancer?

Treatment of prostate cancer is complex and will depend on many factors including:

  • General health and life expectancy
  • The stage of the prostate cancer (how far it has spread)
  • The size and type of cancer
  • What grade the cancer is

In many instances no action will be needed as the cancer is unlikely to grow and affect the lifespan of the individual. Careful monitoring involving regular PSA tests and biopsies will however be needed to ensure the cancer doesn’t develop further and become a fast-growing cancer.

Where treatment is necessary there are a vast variety of different methods and your consultant will determine which one is the best for you. Treatment methods include:

  • Radical Prostatectomy – Surgical removal of the prostate gland
  • Radiotherapy - Using targeted radiation to kill cancerous cells in the prostate
  • Brachytherapy – Using radioactive seeds implanted into the prostate to kill cancer cells
  • Hormone Therapy – Hormones control the growth of prostate cancer so hormone therapy, often used in conjunction with radiotherapy can reduce the growth of the cancer.
  • Trans-urethral resection of the prostate (TURP) – similar to a biopsy but where a larger piece of the prostate is removed often to relieve symptoms of prostate cancer i.e. difficulty urinating
  • Steroids – often used if hormone therapy no longer works if the cancer has become resistant to it.
  • Chemotherapy – often used if the cancer has spread to other parts of the body. Chemotherapy destroys cancer cells by interfering with how they multiply. Chemotherapy won’t cure prostate cancer but can control it.

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