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Prostate cancer

Prostate cancer is a lump in the prostate gland created by an abnormal and uncontrolled growth of cells. It’s the most common cancer in men in the UK.

Your prostate is a gland that produces the liquid part of semen. It also produces prostate-specific antigen (PSA), which is a protein that’s involved in turning your semen into a liquid. Your prostate gland 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 to the size or shape of your prostate can narrow this tube, making it difficult for you to pass urine.

Each year about 40,000 men in the UK are diagnosed with prostate cancer, making it the most common cancer in men. Three out of four men diagnosed with prostate cancer are aged 65 and over.

Prostate cancer can spread to other parts of your body (through your blood or your lymphatic system) where cancer cells may grow and form secondary tumours. This spread of cancer is called metastasis.

Prostate cancer is different from most other cancers because small areas of cancer inside the prostate are very common and can be inactive for many years. This means that in men over the age of 50 a significant number may have cancer cells in their prostate. But these cells usually grow very slowly, and for many men never cause any problems. In others, however, the cells may grow more rapidly and treatment is therefore required.

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How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the position of the prostate gland and surrounding structures

Details

  • Symptoms Symptoms of prostate cancer

    The symptoms of prostate cancer are similar to those produced by a common benign (non-cancerous) condition called benign prostatic hyperplasia, where your prostate becomes enlarged. Although these symptoms aren't always caused by prostate cancer if you have them, you should see your GP.

    You may have:

    • difficulty passing urine
    • a sudden need to rush to the toilet to pass urine
    • a frequent need to pass urine, especially at night
    • blood in your urine or semen
    • pain when passing urine

    If prostate cancer spreads to other parts of your body, other symptoms can develop, such as:

    • tiredness, loss of appetite and feeling generally unwell
    • pain in your bones, such as your back and hips
    • weight loss
    • difficulty getting an erection (impotence)

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  • Diagnosis Diagnosis of prostate cancer

    Your GP will ask about your symptoms and examine you. He or she may do some of the following tests, or refer you to a urologist (a doctor who specialises in identifying and treating conditions of the urinary system).

    • A blood test to measure the amount of PSA in your blood. PSA is a protein that is made by both normal and cancerous prostate cells. The test can be unreliable as a high PSA level doesn't always mean that you have cancer – it can be caused by other prostate conditions.
    • A digital rectal examination (DRE) – an examination of your prostate. Your doctor will feel your prostate through the wall of your rectum (back passage). If you have prostate cancer, it may feel harder than usual, or knobbly.
    • A prostate biopsy. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign or cancerous.
    • An ultrasound to examine your prostate gland, using a small device inserted into your rectum.
    • CT scan, MRI scan and bone scans can help your surgeon see how far the cancer has spread (if at all).
  • Treatment Treatment of prostate cancer

    Your treatment will depend on a number of factors, including your age, whether the cancer has spread, and if so, how far. There are various treatments available. Your surgeon may use one treatment or you may have a combination of different treatments.

    Watchful waiting

    Some men with prostate cancer have a very slow growing tumour that may never need treatment. If this is the case your doctor may suggest monitoring your cancer closely, but not treating you. Because the cancer is growing slowly you may never have symptoms, whereas treating the cancer may cause side-effects which can make you feel unwell and cause long-term health problems. Watchful waiting means keeping any treatment to control your prostate cancer in reserve. Your condition will be closely monitored by your doctor with routine check-ups. If tests show that the cancer is growing or causing symptoms, your doctor may suggest that you start treatment to control it.

    Active surveillance

    Active surveillance is like watchful waiting, in that your doctor will monitor your cancer and how it develops without treating you. However, if your cancer starts to grow or you develop symptoms, your doctor will start treatment which aims to cure the cancer, rather than controlling it. During active surveillance your doctor will take regular blood tests to check your PSA levels and do regular rectal examinations. You should also have a biopsy at least every three years.

    Surgery

    An operation to remove your prostate gland is, along with radiotherapy, one of the main treatments for prostate cancer. You may be offered surgery if you’re otherwise healthy and if your cancer hasn't spread beyond your prostate.

    Surgery to remove the whole of your prostate is called a radical prostatectomy. Your surgeon may do this by making a cut in your abdomen, or by doing keyhole surgery. This means making small cuts and using special equipment or even by manipulating a robot to remove the prostate.

    Some men also have their testicles removed (an orchidectomy) to control the cancer and shrink the tumour. Your testicles produce the hormone testosterone and your tumour needs this to grow. By having your testicles removed this stops the testosterone, which stops the tumour from growing. This treatment isn’t used very often, as there are now hormone treatments that can do this without the need for surgery.

    Sometimes, if part of the cancer is pressing on your urethra, you may have an operation called transurethral resection of the prostate (TURP) to relieve your symptoms and make it easier for you to pass urine.

    Non-surgical treatments

    There are a number of other treatments for prostate cancer that can be used on their own or following surgery.

    Radiotherapy can be used on its own to treat prostate cancer that hasn’t spread outside the prostate gland, as an alternative to surgery. It can also be used to treat cancer that has spread and to control pain. Radiotherapy uses radiation to destroy the cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. There are various techniques used to target the radiotherapy accurately. Radiation can also be given directly by putting radioactive beads or wires into your prostate gland – this is known as brachytherapy.

    Hormone therapy blocks the action of testosterone. This can slow the growth and spread of prostate tumours. This type of treatment is used to reduce the chances of early prostate cancer coming back after you've had treatment. Hormone therapy can also shrink an advanced prostate tumour or slow its growth.

    Chemotherapy uses medicines to destroy cancer cells. It’s sometimes used as a treatment if the cancer has spread to other parts of your body. It can also be used if hormone therapy isn’t working.

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  • Causes Causes of prostate cancer

    The exact reasons why you may develop prostate cancer aren't fully understood. But you're more likely to develop it if:

    • you're over 50
    • you have close relatives who have had prostate cancer
    • several women in your family have had breast cancer – you may have inherited a gene which can increase your risk of prostate cancer
    • you're black Caribbean or black African
    • your diet is high in dairy products
  • Prevention Prevention of prostate cancer

    Research suggests that you may be able to reduce your risk of developing prostate cancer through certain lifestyle changes, such as:

    • stopping smoking
    • eating a healthy, balanced diet with at least five portions of fruit and vegetables a day – especially tomatoes, which contain a substance called lycopene that may be protective
  • FAQs FAQs

    I have a high PSA level. Does that mean I have prostate cancer?

    Answer

    A blood test to measure your prostate-specific antigen (PSA) level can be used to detect prostate cancer. However, having a high PSA level doesn't necessarily mean you have prostate cancer – it can be raised for several other reasons.

    Explanation

    PSA is a protein produced by both normal and cancerous cells in your prostate. It’s measured with a blood test. It’s normal for all men to have a small amount of PSA in their blood.

    PSA levels vary from person to person and increase as you get older and as your prostate gets bigger. Your GP uses the following levels as a guide to decide if you need further tests:

    • 3ng/ml or below is considered normal for men aged 50 to 59
    • 4ng/ml or below is normal for men aged 60 to 69
    • 5ng/ml or below is normal for men aged over 70

    A high PSA level doesn't necessarily mean that you have prostate cancer. The level can be raised for several other reasons, such as:

    • benign prostatic hypertrophy – an enlarged prostate
    • prostatitis – inflammation of your prostate
    • a urinary tract infection
    • your age
    • recent intensive exercise, such as cycling
    • a recent prostate biopsy
    • some medicines
    • recent ejaculation

    PSA tests can give results that are difficult to interpret, which is why prostate cancer is never diagnosed based on the PSA test alone. Two out of three men with a raised PSA level don’t have prostate cancer. However, in general, the higher your PSA level is, the more likely you are to have prostate cancer. Occasionally, you can be diagnosed with prostate cancer and have a normal PSA level.

    PSA blood tests are also used to monitor the growth of a prostate tumour and how well you’re responding to your treatment. A PSA level that remains steady usually means that your tumour is stable and isn't growing. A PSA level that decreases shows that your tumour is shrinking and responding to treatment.

    What is the Gleason score? How does it grade prostate cancer?

    Answer

    The Gleason score is a grading system that allows doctors to predict how quickly a cancerous tumour in your prostate may grow and spread. This information is often used to plan your treatment.

    Explanation

    The Gleason system is the most commonly used grading system for prostate cancer. It's a system that looks at cells from your prostate to predict how your tumour will behave. Usually, a biopsy (a small sample of tissue) is taken from your prostate and sent to a laboratory for testing and grading.

    Grading is done by looking at the patterns of cells within each sample taken and how abnormal they look. There are five different types of pattern, which are graded from one to five. One is the least aggressive type of cancer and five is the most aggressive. All the biopsy samples taken are graded, then the two most frequently occurring patterns or the two areas with the highest grade are added together to get a Gleason score of between two and 10.

    The lower the score, the more slow-growing your cancer is and the less likely it is to spread. A low score is usually six or less. Tumours that score highly are more likely to grow quickly and spread to other parts of your body. A high score is between eight and 10. When biopsies are taken from your prostate the tissue samples are usually small. This means that it’s difficult to show grades one and two, so it’s most common to get scores between six and 10.

    The Gleason score acts as a guide for your doctor to help him or her plan the best course of treatment for you. It's not a fail-safe approach – most tumours grow as expected, but not all of them do.

    If you have any questions about prostate cancer or the Gleason system, talk to your doctor.

    Why isn't there a national screening programme for prostate cancer?

    Answer

    In the UK there isn't currently a screening programme for prostate cancer because of concerns about how reliable the prostate-specific antigen (PSA) test is and whether early diagnosis affects outcome. However, if you're concerned about prostate cancer, you can ask your GP for a PSA test.

    Explanation

    The most commonly used test to check for prostate cancer is called a PSA test. It involves a blood test to measure the levels of a protein called PSA, which is produced by both normal and cancerous cells in your prostate.

    There has been much debate over whether the PSA test should be used in a nationwide screening programme but so far doctors have decided it may actually cause more harm than good.

    This is because the PSA test isn’t a precise test. There can be many reasons why you may have a high PSA level, and these aren't always related to having prostate cancer. Different factors such as old age or a urinary infection can raise your PSA level. In addition a screening programme that uses PSA levels to test for prostate cancer could mean that men who have a slow growing cancer may have unnecessary treatment. You can also have a normal PSA level even if you do have prostate cancer, although this is unusual.

    Although there isn’t a screening programme, the NHS runs an informed choice programme, called Prostate Cancer Risk Management. This is where your GP can provide you with information about the PSA test and prostate cancer, which will help you to decide whether to get the test.

    Will treatment for prostate cancer affect my sex life?

    Answer

    Treatment for prostate cancer can affect your sex life. How it's affected will depend on the type of treatment you have.

    Explanation

    Treatment for prostate cancer can affect your sex life in different ways. However, it's important to remember that not everybody will be affected or affected in the same way. Some of the sexual problems caused by treatment are temporary and many can also be treated. Being diagnosed with cancer can affect how you feel about having sex and your relationship with your partner. This can affect your desire to have sex and your ability to have an erection.

    A side-effect of treatment for prostate cancer is impotence (erectile dysfunction). This is when you can't achieve or sustain an erection. Erectile dysfunction can be caused by:

    • radiotherapy to your prostate
    • surgery, such as a radical prostatectomy or orchidectomy (an operation to remove your testicles)
    • hormone therapy

    Erectile dysfunction is often temporary, but it can be permanent, especially if you've had a radical prostatectomy. Sometimes it improves once you have finished your treatment – for example, if you have hormone therapy. With other treatments, such as radiotherapy, erectile problems may not occur until several years after treatment.

    If you do have problems getting an erection there are a number of different options that might help, such as medicines, a vacuum pump or injections. Talk to your doctor to find out what options are available to you.

    Some men find that they have a lower sex-drive after treatment. This is usually caused by an orchidectomy or hormone therapy, which leads to a lower level of testosterone in your blood. Sometimes changing to a different type of hormone therapy can help. Talk to your doctor about the options available to you.

    Treatment can also affect the type of orgasm you have. After a radical prostatectomy, you will always have a dry orgasm. This means that when you ejaculate, no semen will come out. The strength of your orgasm and the ability to have an orgasm may be affected. Cancer treatments can also affect your fertility. If you plan to have a family, your sperm can usually be collected and used for artificial insemination or in vitro fertilisation (IVF) treatments.

    If you're worried about how treatment for prostate cancer will affect your sex life, talk to your doctor.

  • Resources Resources

    Further information

    Sources

    • Prostate cancer. Prostate Cancer UK. www.prostatecanceruk.org, published January 2011
    • Prostate cancer. Macmillan Cancer Support. www.macmillan.org.uk, published February 2010
    • Prostate cancer. CancerHelp UK. http://cancerhelp.cancerresearchuk.org, published July 2012
    • Prostate cancer diagnosis and treatment. National Institute for Health and Clinical Excellence (NICE), February 2008. www.nice.org.uk
    • PSA test. Prostate Cancer UK. www.prostatecanceruk.org, accessed 23 July 2012
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    Produced by Dylan Merkett, Bupa Health Information Team, November 2012.

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