What is Prostate Cancer?

The prostate is about the size of a walnut and lies at the base of your bladder.

The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis. Any change in the size or shape of the prostate can narrow this tube, making it difficult for you to urinate. The back of your prostate presses against your rectum.

A prostate tumour is a lump created by an abnormal and uncontrolled growth of cells. It can either be malignant (cancerous) or benign.

Cancerous tumours can grow through your prostate and spread to other parts of your body (through the bloodstream or the lymph system) where they may grow and form secondary tumours. This is called a metastasis.

The outer part of the prostate is most likely to get a cancerous tumour.

Symptoms

Prostate cancer often has no symptoms, particularly in the early stages.
Some men may never have any symptoms or problems from the disease.
Some types of prostate cancer can be slow growing and may not become a serious threat to your health. Whereas others are a faster growing and aggressive form and can be more harmful.
You are more likely to get symptoms if and when your cancer grows in the prostate gland and narrows the urethra. Symptoms then include problems urinating such as difficulty in starting to pass urine, a weak, sometimes intermittent flow of urine, dribbling of urine before and after urinating, a frequent or urgent need to pass urine or a need to get up several times in the night to urinate; a feeling that your bladder is not completely empty; pain when you orgasm; rarely, blood in the urine.

These symptoms are similar to those produced by a common non cancerous disease where the prostate becomes enlarged (benign prostatic hyperplasia).
If you experience any of these symptoms, you should visit your GP for advice. If prostate cancer is found early, it can often be cured.
If prostate cancer spreads to other parts of your body, other symptoms can develop. The most common site for prostate cancer to spread to is one or more bones, especially the lower back, pelvis and hips. These bones can become painful and tender.

Risk

The cause of prostate cancer isn’t fully understood at present. But there are certain factors that can make prostate cancer more likely:

Most men with early prostate cancer don’t have any symptoms. That’s why it’s important to know about your risk.
In the UK, about 1 in 8 men will get prostate cancer in their lifetime.
Prostate cancer is the most commonly diagnosed cancer in the UK
Prostate cancer mainly affects men over 50 and your risk increases with age. The most common age for men to be diagnosed with prostate cancer is between 65 and 69 years.
You are two and half times more likely to get prostate cancer if your father or brother has been diagnosed with it, compared to a man who has no relatives with prostate cancer.
Your risk of getting prostate cancer may be higher if your mother or sister has had breast cancer.
Black men are more likely to get prostate cancer than other men, and at a younger age.
In the UK about 1 in 4 black men will get prostate cancer in their lifetime. If you are a black man, your risk may increase once you’re over 45.

Diagnosis

Your doctor will ask you about your symptoms and will examine you. They may carry out some of the following tests or refer you to a specialist (urologist) for them.

A digital rectal examination (DRE). This is an examination of your prostate. Your doctor will insert a lubricated, gloved finger into your rectum and feel your prostate through the wall of your rectum. If there is prostate cancer it may feel harder than usual, or knobbly.
A PSA blood test will test the amount of prostate specific antigen (PSA) in a sample of your blood. PSA is a chemical which is made by both normal and cancerous prostate cells. If you have an abnormally high level of PSA, prostate cancer is a possibility. However, a high PSA score does not always indicate cancer and can be caused by other prostate diseases.
In a prostate biopsy, your doctor will surgically remove a small piece of tissue using a needle. The sample will be sent to a laboratory for examination to find out if it is a tumour and how fast it is growing.
CT (computerised axial tomography), MRI (magnetic resonance imaging) and bone scans can help your doctor see how far the cancer has spread (if at all). A bone scan involves injecting a small amount of radioactive liquid into your vein. This can show if the cancer has spread to the bone.

Treatment

Your treatment for prostate cancer will depend on a number of factors such as your age and whether the cancer has spread and if so, how far. There are a number of treatments which are described below. Some can have serious side effects, so it is important to discuss them in more detail with your doctor who will explain options available to you.

Active monitoring / watchful waiting:

Sometimes, particularly for slow growing tumours, no treatment is the best course of action. Your condition will be monitored closely with routine check ups. You can start treatment at any time and will be advised to do so if tests show the cancer is growing.

Surgery:

It is most suitable for otherwise healthy men whose cancer has not spread beyond the prostate. The most common technique is a radical prostatectomy. This is a major operation, which removes the whole of the prostate, seminal vesicles and nearby lymph nodes.

External Beam Radiotherapy:

Uses high-energy X-ray beams targeted at the prostate, from outside the body, to destroy cancer cells. Techniques used for treating prostate cancer with radiotherapy include high resolution intensity modulated radiotherapy (IMRT) and stereotactic ablative radiotherapy (SABR).

Brachytherapy:

This involves implanting radioactive seeds into, or next to, the tumour in your prostate. Radiation can be released slowly over time. The seeds lose their radioactivity over about a year. This therapy is more effective if the tumour is small and you have early prostate cancer.

Hormone Therapy

This blocks the action of male sex hormones that help cancer grow. This can slow the growth and spread of prostate tumours but will not kill the cancer cells. Medical hormone therapies include goserelin (Zoladex) and bicalutamide (Casodex). Alternatively, surgical hormone therapy involves removing your testicles, which permanently gets rid of the main source of testosterone. This operation is called an orchidectomy. It is possible for you to keep your scrotum and just have the testes (the organs inside it) removed. This treatment is less common than it used to be as many men prefer to take drugs to block their testosterone instead.

New treatments:

There are new treatments being developed such as cryotherapy. This is surgery to freeze the prostate with liquid gas and kill cancer cells. High intensity focused ultrasound (HIFU) is a treatment given using a machine that gives off high frequency ultrasound energy. Some cancer cells die when this is focused directly onto them.

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