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.

Animation - How cancer develops

About prostate cancer

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.

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)

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

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 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.

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

Produced by Dylan Merkett, Bupa Health Information Team, November 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.