Prostate cancer

Published by Bupa's Health Information Team, October 2010.

This factsheet is for men who have prostate cancer, or people who would like information about it.

Prostate cancer is a lump in the prostate gland created by an abnormal and uncontrolled growth of cells.

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About prostate cancer

Your prostate is a gland that produces the liquid part of semen. It's 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 your prostate, such as changes that occur if you have prostate cancer, can narrow this tube, making it difficult for you to pass urine.

Each year about 36,000 men in the UK are diagnosed with prostate cancer, making it the most common cancer in men. It mainly affects men aged over 50.

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

Symptoms of prostate cancer

You may have:

• 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
• rarely, blood in your urine or semen and pain when passing urine

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

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

• pain in your bones, such as your back and hips
• weight loss
• impotence

Causes of prostate cancer

The exact reasons why you may develop prostate cancer aren't fully understood at present. But you're more likely to develop prostate cancer 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 faulty gene which may increase your risk of prostate cancer
• you're African-Caribbean or African-American
• your diet is high in fat, meat and dairy products

Diagnosis of prostate cancer

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP 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 examine the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein that is made by both normal and cancerous prostate cells. The test can be inaccurate as a high PSA level doesn't always indicate cancer and 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, where your doctor uses a needle to remove a small piece of tissue from your prostate. The sample will be sent to a laboratory to find out if you have cancer and if so, how fast it's growing.
• 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). Doctors are currently trialling a new urine test to look for a protein made by PCA3 (prostate cancer gene 3). However, it's not available at the moment.

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 treatments on their own or you may have a combination of different treatments.

Active monitoring

Sometimes, particularly for slow-growing tumours, no treatment is the best course of action. This is often called active monitoring or watchful waiting. 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 having treatment.

Surgery

Surgery is a common treatment for prostate cancer. It's most suitable for otherwise healthy men (usually, those under 70) whose cancer hasn't spread beyond their prostate. There are several types of surgery used, including:

• radical prostatectomy - a major operation to remove the whole of your prostate and some surrounding healthy tissue
• keyhole surgery (a laparoscopic prostatectomy) where your prostate is removed through smaller incisions and robot-assisted surgery
• very rarely, an orchidectomy - where your surgeon removes your testicles to get rid of the main source of the male sex hormone testosterone, which can help the cancer grow

Sometimes, if part of the prostate 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

• Radiotherapy, which uses X-rays to destroy cancer cells.
• Hormone therapy, which blocks the action of testosterone. This can slow the growth and spread of prostate tumours but won't kill the cancer cells. Hormone therapies include taking a medicine called bicalutamide or having injections of a medicine called goserelin.
• Chemotherapy, which uses medicines to destroy cancer cells. Your doctor may recommend a medicine called docetaxel combined with a steroid called prednisolone if hormone therapy isn't working (hormone refractory cancer).
• High intensity focused ultrasound (HIFU). This treatment uses heat to target and destroy cancer cells. It may only be available as part of a clinical trial and only if the cancer is in its early stages or if your cancer has come back.
• Cryotherapy, which uses liquid nitrogen to freeze and kill cancer cells. This may only be available as part of a clinical trial and only if your cancer is in its early stages or if your cancer has come back.

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
• consuming less meat and dairy products
• being physically active - you should exercise for 30 minutes at least five times a week

Getting enough vitamin D may reduce your risk of developing a number of cancers, including prostate cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

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

For sources and links to further information, see Resources.