Prostate cancer is now the second most common cancer in the UK and the most common cancer in men, accounting for just over a quarter of all male cancer cases. So, how is it diagnosed? And what treatments are available? Before we answer those questions, it’s helpful to understand a little more about the prostate gland.
The prostate gland is a walnut-sized gland located below the bladder in men, around the top part of the urethra, a tube which drains urine out of the body. It is responsible for making seminal fluid, a fluid that nourishes, protects and transports sperm. The prostate gland grows as a natural part of ageing. However, in prostate cancer, the cells of this gland grow in an uncontrolled way.
There is no single cause of prostate cancer. However, your risk of prostate cancer is higher if you are aged over 50 or if a close male relative has had prostate cancer, such as your father or brother. Black men are also more likely to get prostate cancer although the reasons for this aren’t yet fully understood.
As with most diseases, maintaining a healthy weight by following a nutritious, balanced diet and exercising regularly will help reduce your risks of prostate cancer.
In the early stages, prostate cancer may have very few symptoms. However, common symptoms include a burning sensation when urinating, blood in your urine, blood in your semen and/or painful ejaculation. You may also have problems getting or keeping an erection, unexplained weight loss, back pain and/or pain in your hips or pelvis.
If you notice any of these symptoms, you should see your GP as soon as possible. This is because, as with any type of cancer, early detection and treatment reduces the chances of the cancer spreading to other organs.
Getting a diagnosis of prostate cancer usually involves a physical examination and several tests.
Based on your symptoms, your doctor may request a urine sample to check for signs of infection. If you are aged over 50 or are aged over 45 but have a higher risk of prostate cancer, you will have a blood test to check for levels of a protein called Prostate-Specific Antigen (PSA). Elevated levels of PSA are seen in most cases of prostate cancer. However, high PSA levels are also seen in benign prostate enlargement (BPE), which is the non-cancerous enlargement of the prostate gland that can occur with age. This means that a PSA test is not a definitive test for prostate cancer.
If you have elevated PSA levels, you will therefore need further tests such as an MRI scan and a biopsy to remove tiny sections of your prostate for examination in a lab. A biopsy is the only way to find out for certain if you have prostate cancer.
Your GP or a urologist (a consultant specialising in the male genital system and urinary system) may also perform a rectal examination of your prostate. You will be asked to lie down on your side on an examination table, with your knees drawn up to your chest. Your doctor will then gently slide a lubricated, gloved finger into your rectum. This will allow them to feel your prostate through the wall of your rectum, so they can check its size and for lumps.
If you have received a diagnosis of prostate cancer, there are several treatment options available. Your doctor will discuss them with you and explain which is most appropriate in your case based on the type of prostate cancer you have and how advanced it is. Treatment is tailored to the individual, as what works for one person may not necessarily be right for you.
Treatment options include surgery to remove the prostate, radiotherapy (either external beam radiotherapy or brachytherapy) or focal therapy (eg cryotherapy), which uses high energy to destroy cancer cells.
When caught and treated early ie when the cancer is limited to your prostate, treatment is usually very successful with most men living past the five-year mark, which is often used as a benchmark in cancer treatment.
Surgery or other treatment for prostate cancer can temporarily affect your ability to control when you pass urine (urinary incontinence). This is because the nerves and muscles that control your ability to urinate may have been damaged during your treatment. With time and, if needed, with pelvic floor exercises, your urinary incontinence should improve.
Surgery or other treatment for prostate cancer can also affect your ability to get and maintain an erection (erectile dysfunction). Make sure you speak to your doctor about this before your treatment. There are medications available that can help your erectile function.
After your prostate cancer treatment, you will need to attend several follow-up appointments with your urologist to monitor your recovery. This will involve further tests, including PSA blood tests. If your PSA levels continue to be high, you will need further investigations.
Your healthcare team will monitor you for several years, with appointments becoming less frequent if your results continue to show no signs of any problems.
Mr Utsav Reddy is a Consultant Urological Surgeon at Spire Norwich Hospital specialising in the investigation and management of female urinary symptoms (including urinary tract infections), cancer of the urinary tract (prostate, bladder and testicle), urinary tract stone disease and conditions of the penis and scrotum. He qualified from Imperial College London and underwent his urology specialist training in London and the South East, during which time he worked in centres with international reputations in benign and cancerous prostatic disease.