Prostate cancer is the most common type of cancer in men, and the chances of a positive diagnosis grow with age. Most cases crop up in men who are 50 years of age or older.
There is a huge variation in prostate cancers, with some very aggressive forms that require speedy treatment, and other slow-growing forms that don’t present a significant risk in the short or medium term.
Yet the outlook for the prostate cancer patient is often good. Unlike many other types of cancer, in the majority of cases it progresses so slowly that many men with prostate cancer die naturally of unrelated conditions.
If prostate cancer is treated early, it can often be cured.
What is the prostate gland?
Normally about the size of a chestnut, the prostate lies just beneath the bladder and surrounds the urethra (the tube that carries urine from the bladder through the penis to outside the body). The prostate helps to make semen, and is connected to the testicles.
Causes of prostate cancer
Symptoms of prostate cancer
- Starting to urinate may become difficult.
- The flow might be intermittent or weak.
- You have to strain to pass urine
- You feel you need to ‘go’ more often
- You wake up more frequently during the night needing to urinate
- You have a sudden urge to urinate, which can lead to incontinence
- You are unable to fully empty your bladder
- You find signs of blood in your urine (haematuria)
Diagnosis of prostate cancer
Prostate-specific antigen (PSA) test
This is a blood test to measure the level of the prostate-specific antigen (PSA) enzyme that the prostate gland produces. A very high PSA level suggests prostate cancer. [Read more at Prostate-Specific Antigen (PSA)]
A transrectal ultrasound (TRUS) is a scan that is specifically developed to study the prostate and surrounding area. An ultrasound probe is introduced through the rectum, sending out sound waves that construct a detailed image of the prostate on a computer screen. This can be used either to confirm or rule out a diagnosis of prostate cancer.
The next step is a biopsy. The tissues taken from the prostate are closely examined, and abnormal cells are given values, with reference to a grading system. The Gleason Score is a very reliable way of measuring your prostate cancer to determine how severe it is and predict the outcome. [Read More at The Gleason Score]
Treatment will depend on the complex reading of the results of the prostate examination, biopsy and scans, which together indicate the stage the prostate cancer has reached. Staging measures the size and spread of cancer cells, within or outside of the prostate.
A simplified staging reading is:
- Stage 1: the cancer is very small and entirely contained by the prostate gland
- Stage 2: the cancer is larger, but still contained by the prostate gland
- Stage 3: the cancer has spread outside the prostate and might have grown within the tubes that carry semen
- Stage 4: the cancer has spread into the lymph nodes or another part of the body, including the bladder, rectum or bones.
Around 20-30% of cases are diagnosed at stage 4.
- A more complicated staging reading is The TNM Stage
- T: this describes the tumour: whether it can be felt in a digital rectal examination (DRE), how much cancer was found in the tissue from the biopsy (the Gleason score calculation), and if it has spread from the prostate gland into nearby tissues.
- N: this shows whether your cancer has spread to your lymph nodes, which filter toxins from the body fluids. Cancers often spread to the lymph nodes first.
- M: this shows whether your cancer has spread (metastasised) to other parts of your body.
Treating prostate cancer
For many men, no treatment will be required but the cancer will need to be carefully monitored to ensure it doesn’t develop into a fast-growing cancer.
When treatment is necessary, the aim is to cure the disease if possible, or to control it, so that a normal life can be continued and life expectancy isn’t shortened.
If the cancer has already spread from the prostate gland to other parts of the body and there is no cure, in many cases life can still be prolonged and symptoms delayed or relieved.
- surgery to remove the prostate gland [read more at Radical Prostatectomy]
- radiotherapy to kill the cancerous cells
- medication to block the effects of testosterone (the hormone that stimulates prostate cancer)
However, these treatments often have considerable side effects including:
- loss of sexual desire
- the inability to obtain or keep up an erection
- urinary incontinence
Because of these, many men choose to postpone treatment, monitoring their cancer until there is a significant risk of it spreading. This depends on:
- the type, size and grade of the cancer
- age and general health and fitness
- whether the cancer has spread to other parts of your body
Our cancer specialist will recommend the best treatment options, but ultimately the decision is the patient’s.
Diagnosed at an early stage, the chances of survival are generally good. Around 90% of men diagnosed at stages 1 or 2 will live at least five more years and 65-90% will live for at least 10 more years.
Diagnosed with stage 3 prostate cancer, there is a 70-80% of chance of living for at least five more years.
Diagnosed with stage 4 prostate cancer, there is only a 30% chance of surviving for at least five more years.