Condition: Prostate Cancer

Prostate cancer is generally a slow growing disease and rarely associated with symptoms in its early stages. Primarily,  the best way to look for prostate cancer remains the simple blood test, PSA. However, prostate cancer can present with symptoms when more advanced, including urinary problems such as a poor urinary stream, going to the loo frequently, both day and night, visible blood in the urine or semen or discomfort or pain. These symptoms are, however, very common and very much more usually associated with benign rather than cancerous disease of the prostate. As the disease progresses, symptoms of metastatic disease including lethargy, weight loss, loss of appetite, bone pain or even bone fracture can occur.

As with most cancers, the biggest risk factor for prostate cancer is getting older. Prostate cancer is most common after the age of 75 years. Some, 1 in 6 men will be diagnosed with prostate cancer, but the majority will never need treatment.

Established risk factors for the development of prostate cancer include obesity and some inherited or genetic factors. Prostate cancer is more common in the Afro-Caribbean ethnic group and there are some established genetic links in those with a strong family history of young onset of disease and BRCA2 gene abnormalities.

Once you have asked yourself this question, the next step is to seek professional advice with a view to the first line investigations of a digital rectal examination and a blood test for PSA (Prostate Specific Antigen). PSA receives much criticism as a diagnostic test. This is because some men with a normal PSA may still have prostate cancer and many with a raised test, will not have prostate cancer.  But interpreted thoughtfully and with open discussion, nearly 30 years on, it remains the best biomarker test we have. If the PSA is raised or the prostate feels abnormal on examination, the next step is generally a multiparametric MRI scan, which will be performed to see if biopsies of the prostate are required.

Many men diagnosed with prostate cancer do not require treatment for a disease which for them is unlikely to be the source of symptoms, let alone threaten life expectancy. These men adopt a programme of ‘active surveillance’ involving regular monitoring of PSA and potentially repeated MRI scans. Those with a more limited life expectancy, for other reasons, may follow a route of ‘watchful waiting’. For those men where there are concerns regarding the potential progression of their disease, treatment options include; radiotherapy, either in the form of brachytherapy ( the placement of radioactive seeds that deliver low-dose radiation within the prostate) or more standard external beam radiotherapy. Surgical removal of the prostate is known as a radical prostatectomy and in the modern era is nearly always a robotic assisted, minimally invasive procedure. In some cases, and when appropriate, men may opt for less invasive or focal therapy, looking to treat only the areas of cancer rather than the whole prostate gland, in an effort to minimise the side effects of treatment. Focal therapy can be delivered using a number of different technologies including HIFU, cryoablation and electo-poration. Where there is evidence or concern for the presence of spread of disease (metastases) then hormone therapy or chemotherapy treatments are offered, under the care of an oncologist.

For early or localised disease, where surgery or radiotherapy techniques are being considered, potential side effects of treatment include permanent dry ejaculation, loss of erectile function and incontinence of urine. Other potential side effects of radiation treatment include those related to the impact upon both bowel and bladder function. However, for both of these approaches, modern advances in delivery of treatment have seen a significant fall in the level of risk of these side effects. For those electing to receive focal treatment in an effort to minise the risks of whole gland treatment even further, the main risks relate to incomplete treatment of the cancer, with the potential of disease progression and the need for further treatment.

When there is evidence of metastatic disease, both hormone therapies and chemotherapy are associated with the risk of prolonged side effects of treatment; these maybe discussed with the treating oncologist.

As with all cancers, the earlier in its natural history prostate cancer is diagnosed the better the outcome. Overall in the UK, 80% of men will live 10 years or more after diagnosis. However, for men diagnosed at the very earliest stage, nearly 100% will live more than 5 years.