Prostate cancer

Little is known about the risk factors for prostate cancer and there is no clear prevention strategy to reduce the chances of developing this cancer.

There are a number of factors, including being a man, that mean you are at increased risk of developing prostate cancer. These include:

• Age – the main risk factor for developing prostate cancer is getting older. Prostate cancer is uncommon in men under 50.
• Family history – if your father or brother were diagnosed with prostate cancer at a young age, your chances of developing prostate cancer is increased. Having an elderly relative with prostate cancer is quite common and doesn’t increase your chances of developing the disease.
• Race – prostate cancer is slightly more common in people of African descent.
• Diet, physical activity and alcohol – despite considerable research examining the link between these risk factors and prostate cancer, we are not able to say with any certainty if there is anything a man can do to reduce his risk of prostate cancer. There are however plenty of other reasons to eat a diet rich in fruit and vegetables, be physically active and avoid alcohol.

Prostate cancer in the early stages rarely has symptoms. Symptoms usually develop later, in older men, but if you are experiencing the following you should contact your doctor promptly:

• a need to urinate more frequently
• a need to urinate frequently during the night (nocturia)
• a delay in starting when wanting to urinate
• a weak or hesitant stream when urinating
• dribbling at the end of urinating
• being unable to control the bladder (incontinence).

These symptoms are also very common in BPH which is far more common than cancer of the prostate.

Symptoms associated with advanced prostate cancer include:

• painful ejaculation
• blood in the urine
• bone pain, particularly in the lower back.

In some men prostate cancer can be slow growing (termed indolent), but in others it can grow very fast (termed aggressive).

Localised prostate cancer is cancer that grows within the prostate. These early cancers often don’t produce symptoms and may never spread outside the prostate.

Locally advanced prostate cancer is cancer that has spread outside the prostate to the surrounding tissues.

Metastatic prostate cancer is cancer that has spread from the prostate to other parts of the body, for example to the bones.

There is no single, simple test to detect prostate cancer. There is also no way to test whether your prostate cancer will grow slowly or fast.

Tests used to diagnose prostate cancer include:

• digital rectal examination
• prostate specific antigen test
• prostate biopsy.

Digital rectal examination

This involves your doctor inserting a gloved finger into your rectum to feel your prostate. It is possible to tell if the prostate is enlarged, but it is not possible to feel the entire prostate. A small cancer, or one that is out of reach, may be missed.

Prostate specific antigen (PSA) test

This involves a blood test to measure the amount of prostate specific antigen (PSA) in your blood. Most of the PSA in your body is made by the prostate and forms part of semen. When the prostate is damaged, PSA leaks into the blood. PSA levels typically increase with age, as the prostate ages. Generally, a value around 4 ng/ml or less is considered to be in the normal range.

The most likely cause of high PSA levels is some form of prostate disease. PSA can be raised in a range of benign (non-cancer) conditions, such as benign prostatic hyperplasia (BPH) and prostatitis (inflammation of the prostate). It is also raised in prostate cancer. However, most men with elevated PSA levels do not have prostate cancer and some men with prostate cancer do not have elevated PSA levels.

Prostate biopsy

If the digital rectal exam or PSA test indicate that prostate cancer may be present, a prostate biopsy will be carried out. In this procedure, a trans-rectal ultrasound (TRUS) probe is placed in the rectum to give a picture of the prostate. Then, using the ultrasound picture as a guide, a needle is inserted through the wall of the rectum into the prostate and several tissue samples are taken. The tissue samples are examined in a laboratory for signs of prostate cancer. There is a risk of infection and bleeding associated with having a prostate biopsy and it is normal for a course of antibiotics to be prescribed.

Is screening available for prostate cancer?

Presently, it is not clear from a number of international trials whether the benefits of population screening for prostate cancer outweigh any harm. Therefore, based on the current evidence, many experts do not support routine screening for prostate cancer.

Men need to make their own decision about whether to be tested or not, after weighing up the pros and cons of PSA testing.

If you have the symptoms of prostate cancer, there is no doubt you need to see your doctor straight away to be tested.

The decision on how best to treat prostate cancer will depend on your age, general health and how advanced your cancer is. Although nearly all treatments have side effects, most can be effectively managed. Ask your doctor to explain what side effects to expect and how best to manage these.

Treatments include:

• active surveillance
• prostatectomy (surgery)
• radiation therapy
• chemotherapy
• hormone therapy.

Find out more about common cancer treatments.

Active surveillance

Active surveillance (watchful waiting) is sometimes a valid treatment option. This is where your doctor will just watch and wait to see if the cancer grows. Some prostate cancers are slow growing and occur in older men. In this case, the cancer is not always a threat to life.

As the possible side effects of prostate cancer treatment (impotence and/or incontinence) may have more of an impact on your life than the effect of the cancer you may decide that you don’t want to have treatment unless it is necessary. If you choose active surveillance, you will still need regular prostate tests, which may include repeated biopsies, to make sure things haven’t changed.

Prostatectomy

Prostatectomy is the surgical removal of the prostate. Sometimes the surrounding tissue will also be removed. Surgery requires on average 3 to 6 days in hospital, followed by about a 6 week recovery period.

How can I decide what treatment is best for me?

There is no test available to tell the difference between prostate cancers that grow quickly and are life-threatening and those that grow slowly and don’t require treatment. This means you may end up having treatment you don’t need.

Diagnosis and treatment for prostate cancer is not without risk and can occasionally lead to complications, such as incontinence and loss of sexual function. Therefore, it is important to understand the risks and benefits involved. The decision should only be made when you are fully informed of all the facts.