An overview of prostate cancer; the symptoms, diagnostic tests and treatment
In the UK, approximately 1 in 8 men will be diagnosed with prostate cancer in their lifetime and it’s currently the most diagnosed cancer in Great Britain.1 Located underneath the bladder and surrounding the urethra, the main function of the prostate gland is to help produce semen, and as men get older, the prostate gland grows larger.
Prostate cancer occurs when cells in the prostate reproduce more quickly than normal, creating a tumour. If left untreated, these cancerous cells can spread throughout the body resulting in secondary tumours. If prostate cancer is detected early, then a man has nearly 100% chance of surviving beyond 5 years.2
Symptoms of Prostate Cancer
Often prostate cancer does not have any symptoms. Early warning signs the NHS advise to look out for, are:
- A need to urinate frequently, particularly at night
- Difficulty starting to urinate
- Pain or burning when urinating
- Erectile dysfunction
- Painful ejaculation
- Blood in urine or semen
- A feeling that the bladder has not fully emptied
Men displaying these symptoms are encouraged to visit their GP for urgent testing. Although these symptoms may not mean they have prostate cancer, they shouldn’t be ignored.
How is Prostate Cancer Diagnosed?
There are several ways in which a man can be tested for prostate cancer. Initially, a Digital Rectal Exam (DRE) may be performed by a GP. This involves a lubricated and gloved finger inserted into the rectum. By doing this, the GP will be able to feel for any changes to the surface of the prostate. While this can be uncomfortable, it shouldn’t cause any pain.
In addition, a Prostate-specific antigen (PSA) blood test will be carried out. A PSA test is a routine blood test. The blood will be analysed to detect the amount of PSA present and the results from this will determine the likelihood of cancer.
If test results come back with a level of PSA present or a GP has noticed a change to the prostate itself, it’s likely a man will be referred to hospital for further diagnostic and investigative testing. Further testing may include a biopsy, which involves taking small pieces of prostate tissue to be looked at under a microscope to check for cancer cells. Some patients may also be offered an MRI scan of the prostate. This scan can help to see if there is any cancer inside the prostate and assist in determining the rate of growth.
NICE (National Institute of Health and Care Excellence) now recommends an MRI scan as the first-line investigation for people with suspected clinically localised prostate cancer. An MRI is non-invasive, easy, simple, discreet and highly accurate. An MRI scan can also reduce the need for a biopsy.
Who Is at Risk of Prostate Cancer?
Prostate cancer is one of the most common cancers found in men, not just in the UK but worldwide. Although a man’s risk of developing prostate cancer increases with age, it’s not a disease that only affects older males.
Black males are more at risk, as well as men with a family history of prostate cancer. Therefore, it’s vital that men speak to their GP if they are experiencing concerning symptoms or about a PSA test if aged 45 or over. Men not in these categories are recommended to request a PSA test when they reach 50.
Understanding Treatment for Prostate Cancer
Treatment for prostate cancer will depend on individual circumstances. For many men with prostate cancer, no treatment will be necessary. But when treatment is necessary, the aim is to cure or control the disease, so it affects everyday life as little as possible and doesn’t shorten life expectancy. In some cases, if cancer has already spread, the aim is not to cure it but to prolong life and delay symptoms.
When deciding what treatment is best, healthcare professionals will consider:
- The type and size of the cancer
- What grade it is
- The man’s general health
- Whether cancer has spread to other parts of the body
Staging of Prostate Cancer
Doctors will use the results of a prostate examination, biopsy and scans to identify the “stage” of the prostate cancer which means how far cancer has spread. The stage of cancer will determine which types of treatments will be required.
Treatment Options For Prostate Cancer
Active surveillance
If caught in the early stages, men with localised (early) prostate cancer may be put on ‘active surveillance’. This requires monitoring with regular tests to check on cancer, rather than starting treatment straight away. Regular tests may include PSA Testing, MRI scans, digital rectal examinations and biopsies. If testing identifies cancer may be growing, further testing will be offered and if changes are found treatment may be offered.
Watchful waiting
Often confused with active surveillance, watchful waiting is a way of monitoring prostate cancer that is not causing any symptoms or problems. Men will be monitored over the long term, and offered treatment only if symptoms develop.
Side effects of treatment for prostate cancer can cause side effects which affect the quality of the life for some men. The most common side effects include problems getting and keeping an erection (erectile dysfunction) and problems controlling or passing urine (incontinence). Active surveillance and watchful waiting can avoid or delay any potential side effects prostate cancer treatment may cause.
The most common treatment for Prostate Cancer is prostatectomy or radiotherapy:
Surgically Removing the Prostate Gland (Radical Prostatectomy)
A radical prostatectomy is the surgical removal of the prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread far. Like any operation, this surgery carries some risks.
After a radical prostatectomy, a man will no longer ejaculate during sex, meaning they will no longer be able to have children through sex.
Radiotherapy
Radiotherapy involves using radiation to target cancerous cells. This treatment is an option for treating prostate cancer that has not spread beyond the prostate or has not spread very far.
Radiotherapy can also be used to slow the progression of prostate cancer that’s spread and relieve symptoms. Radiotherapy is usually undergone as an outpatient in a hospital and is done in short sessions for 5 days a week, usually for 4 weeks.
Short-term effects of radiotherapy can include:
- Discomfort around the bottom
- Diarrhoea
- Loss of pubic hair
- Tiredness
- Inflammation of the bladder lining, which can cause painful peeing and needing to go more often (cystitis)
Potential side effects of radiotherapy treatment for prostate cancer can include problems such as diarrhoea, bleeding, and discomfort.
Brachytherapy
Brachytherapy is a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It’s also known as internal or interstitial radiotherapy. The radiation can be delivered using several tiny radioactive seeds surgically implanted into the tumour. This is called low dose rate brachytherapy. The radiation can also be delivered through thin, hollow needles placed inside the prostate. This is called high dose rate brachytherapy. The intention of this method of treatment is to deliver a high dose of radiation to the prostate while minimising damage to other tissues.
Hormone Therapy
Hormone therapy is often used in combination with radiotherapy. For example, a patient may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment. It may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.
Hormone therapy alone does not cure prostate cancer. It can be used to slow the progression of advanced prostate cancer and relieve symptoms. Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow.
Hormone therapy can be given as:
- Injections to stop the body making testosterone
- Tablets to block the effects or reduce the production of testosterone
- A combination of the two
Trans-Urethral Resection of The Prostate (TURP)
TURP is a procedure that can help relieve pressure from the tube that carries urine from the bladder out of the penis (urethra) to treat any problematic symptoms associated with urination. It does not cure cancer.
A thin metal wire with a loop at the end is inserted into the urethra and pieces of the prostate are removed. This is carried out under general anaesthetic or a spinal anaesthetic (epidural).
High-Intensity Focused Ultrasound (HIFU)
HIFU is sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate. An ultrasound probe inserted into the rectum releases high-frequency sound waves through the wall of the rectum.
The sound waves kill cancer cells in the prostate gland by heating them to a high temperature. The risk of side effects of HIFU is usually lower than other treatments.
HIFU treatment is still going through clinical trials for prostate cancer.
Chemotherapy
Chemotherapy is often used to treat prostate cancer that’s spread to other parts of the body (metastatic prostate cancer). It destroys cancer cells by interfering with the way they multiply. It does not cure prostate cancer but can keep it under control. It also aims to reduce symptoms, such as pain, so everyday life is less affected.
Support for Those Suffering from Prostate Cancer
If you or someone you know would like any support or additional information on prostate cancer, there are several reputable sources. Please see below:
If prostate cancer is caught in the early stages, it is more likely for treatment to be successful. If you are experiencing symptoms such as an increased need to pee, the feeling you’ve not finished after going or straining whilst peeing, you should visit your GP as soon as you can.
Don’t put it on hold, as although these symptoms do not mean you definitely have prostate cancer, but they shouldn’t be ignored.
At Medical Imaging Partnership centres across the UK, we specialise in expert-led, painless, Fast-Track Prostate Assessments using state of the art MRI scans. We aim to get you seen and be scanned within 1-2 days and your results will be available very quickly, often on the same day.
If you would like to find out more, our specialist team are available to discuss any concerns you might have. Please send submit your enquiry via our contact form or call our team on 01293 534 043.
Please note Medical Imaging Partnership do not provide treatment for prostate cancer.
