Prostate cancer

The prostate is a gland that is found below the bladder in men.

The prostate's main function is to produce semen; the fluid that protects sperm. Also, running through the middle of the prostate is the urethra, a tube which carries urine from the bladder out through the penis.

The prostate enlarges naturally with age, and can progressively cause urinary symptoms such as hesitancy to pass urine.

Prostate cancer statistics

  • 35,000 men are diagnosed with prostate cancer each year and it is now the most common cancer in men in the UK.
  • It is mostly found in the over 65 year olds, affecting 1 in 12 men in the UK at some point in their life.

Risk factors for prostate cancer

The most significant risk factor is age as 60% of cases are in men over 70 years.
Others include:
  • Family history
  • You are of African origin - it is more common in black and mixed race men compared with white or asian men
  • Diet: there is some evidence that tomatoes may be protective and dairy products may increase your risk.
  • Some say that aspirin, non steroidal anti-inflammatory drugs (NSAIDs) and diabetes may be protective

Prostate Cancer Screening

At the present time, there is no national screening for prostate cancer.

Your GP can provide screening for you by performing clinical examination (of your prostate and urine) and a PSA blood test, as outlined below.

This is usually done for older men between 50 and 75 years of age.

Symptoms of prostate cancer

The symptoms of prostate cancer and a normally enlarged prostate (BPH, Benign Prostatic Hypertrophy) are very similar:
  • You frequently need to urinate, especially at night
  • You experience pain or burning on urination or ejaculation
  • There is blood in your urine or sperm
  • You need to rush to the toilet to pass urine
  • You have hesitancy, or difficulty in passing urine
  • You can only pass small amounts of urine
  • You have lower back/hip pain

Prostate cancer develops slowly, over about ten years.

Interestingly, prostate cancer does not always cause signs or symptoms, even if there are small areas of cancer within the prostate in older men, so sometimes it discovered at the time of death from other causes.

Assessment of prostate cancer

If you have symptoms, then your GP will examine you and most likely perform some basic investigations.

If your GP suspects prostate cancer, he or she may refer you immediately to a specialist.

Rectal examination

The method in which the prostate is examined is via rectal examination.

Your GP will be able to assess its size and if there are any abnormal lumps.

PSA, Prostate-Specific Antigen

PSA is a blood test to measure the proteins that are from the prostate.

The blood test is not 100% reliable, but if it is persistently high without any other signs, your GP will refer to a specialist for further investigation.

The aim is to diagnose disease early, even before symptoms start, so that treatment can be started if necessary and it is most likely to be cured.

The PSA level varies according to your age; the older you are, the higher the value.

However, the PSA can also be raised due to reasons other than prostate cancer:
  • A urinary tract infection (UTI)
  • Benign prostatic hypertrophy (BPH)
  • Recent sexual intercourse or ejaculation

A normal PSA level does not exclude prostate cancer. This is why it is combined with examination for more accuracy in diagnosis.

Further Investigations

Your specialist may request further tests including more detailed scans (e.g. MRI) or a biopsy under ultrasound guidance. A biopsy is essential to confirm the diagnosis.

Treatment and follow-up of prostate cancer

Treatment depends on the stage of the prostate cancer.

Options include hormone therapy, surgery to remove the prostate, radiotherapy, brachytherapy, and/or possibly chemotherapy, </gras > however this will be decided by your specialist.

Your specialist will review you regularly in clinic to either monitor treatment or to ensure there is no recurrence.

Follow-up is based on clinical examination and PSA tests.
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