Prostate cancer – symptoms and treatment

I am 50 years old – should I be worried about prostate cancer?

The prostate is a walnut-sized gland located in front of the rectum, just below the bladder and surrounding the urethra. Its main purpose is to produce fluid that transports sperm during the male orgasm. There are about 36,000 new cases of prostate cancer diagnosed each year in the UK and it is the second most common cause of death in men, after lung cancer.

Many men over 60 will have one or more prostate cancer lesions, but only 3 percent of them will die of the disease. The aim is to find those tumours early, which are likely to grow and affect the patient's life. Age-specific incidence rises sharply from around the ages of 50 to 54, reaching an overall peak in the 75 to 79 age group. So, does a man beyond 50 years of age should be concerned about prostate cancer? The answer could possibly be yes!

Symptoms

Unfortunately there are no symptoms to suggest early prostate cancer. Symptoms such as urinary frequency, urgency, poor flow and dribbling are mainly due to age-related benign (non-cancerous) enlargement of the prostate, however if you are more than 50 years of age and have these symptoms you must discuss this further with your GP.

Because this cancer rarely presents any symptoms until it spreads, many men were diagnosed with advanced and incurable disease outcomes prior to the 1980s. In the mid-1980s, the PSA test (prostate-specific antigen) was introduced.  This is a blood test that can detect the early signs of an enlarged prostate. Those men who had ‘at-risk’ results underwent prostate biopsies; this resulted in early detection and higher cure rates from prostate cancer.

There is controversy regarding the accuracy and benefits of PSA testing, and therefore there isn’t any national screening programme for prostate cancer available in the UK. However, all men over the age of 50 can access quality information about the PSA test and discuss the option of having this via their GP, under a scheme called the Prostate Cancer Risk Management Programme (PCRMP).

If you are aged over 50 and decide to have your PSA levels tested, your GP will be able to arrange for it to be carried out for free on the NHS. Based on the PSA level and the clinical examination of the prostate, patients are referred on an urgent referral system to a urologist, where in current practice a Multipara Metric MRI is used to plan a biopsy, this helps to identify the suspicious areas in the prostate for a more accurate biopsy.

Risk Criteria

Prostate cancer risk is 2.1 to 2.4 times higher in men whose father has/had the disease, 2.9 to 3.3 times higher in men whose brother has/had the disease and 1.9 times higher in men with a second-degree relative (grandfather, uncle, nephew or half-sibling) who has/had the disease.

The risk is also higher in obese men, Afro-Caribbeans and is up to 5 times higher in men with the BRCA2 gene.

Treatment

Deciding which cancer to treat and which to monitor is crucial. The PSA level and the MRI stage are the predictive indicators of cancer outcome. These help in making an informed choice between treatment options, such as surgery and radiotherapy.

If surgery is required, it will involve removing the entire prostate, a technique which has advanced greatly over the past decade. Traditional open surgery has now been replaced by the ‘key hole’ technique, where the patient benefits from minimal blood loss, less pain, speedy recovery from the operation and a low risk of incontinence.

Most patients are discharged the next day following the operation; the surgery is much more precise and therefore achieves an excellent cure rate. Radiotherapy, on the other hand, can also offer a cure for the early, and in some of the more advanced, cancers.

Cancer-Free Survival

The 10-year cure rate has now increased to a predicted level of 84 percent for early prostate cancer. Deaths from prostate cancer are much less common compared to the past and overall, more than 8 in 10 men diagnosed with prostate cancer today are predicted to survive their disease for at least 10 years.

Even for those with widespread cancer, not everything is lost. They can still be treated with hormonal injections, chemotherapy and novel agents to help them live for three years or longer, with a good quality of life.

Prostate cancer is not the dreadful disease as it used to be any more - the key is early diagnosis!

Mr Anand Kelkar (MS MCh FRCS (Urol)) is a consultant urologist and laparoscopic surgeon, specialising in prostate and renal cancer. He is based in Essex and works at Spire Roding Hospital, King George and Queens NHS Trust Hospitals.