Prostate cancer is the most common cancer in men in the UK, with over 40,000 new cases diagnosed every year.
Common symptoms of prostate cancer
Prostate cancer often does not present any symptoms in its early stages. When symptoms do appear, they are usually due to the enlarged prostate affecting the urethra, the tube that carries urine from the bladder out of the body. Common symptoms include:
- An increased need to urinate, especially at night: This can disrupt sleep and lead to fatigue.
- Difficulty starting or stopping urination: This is often due to the prostate gland pressing on the urethra, causing an obstruction.
- A weak or interrupted urine flow: The flow of urine can become weak or start and stop intermittently.
- Straining while urinating: Men may find themselves needing to push or strain to start urinating.
- A feeling that the bladder has not fully emptied: Even after urinating, there may be a persistent feeling that urine remains in the bladder.
It is important to note that these symptoms can also be caused by non-cancerous conditions such as benign prostatic hyperplasia (BPH), which is an enlargement of the prostate gland.
Severe symptoms or complications
As prostate cancer advances, it can lead to more severe symptoms and complications, such as:
- Blood in the urine or semen: Known as hematuria, this can be a sign of advanced prostate cancer.
- Painful ejaculation: Discomfort during ejaculation can occur as the prostate gland becomes more involved.
- Erectile dysfunction: Difficulty achieving or maintaining an erection can result from prostate cancer or its treatments.
- Pain or stiffness in the lower back, hips, or thighs: This may indicate that the cancer has spread to the bones.
- Unintentional weight loss: Significant weight loss without trying can be a sign of advanced cancer.
- Fatigue: Persistent tiredness that doesn’t improve with rest can be a symptom of prostate cancer.
If you experience any of these severe symptoms, it is crucial to seek medical attention promptly, as early detection and treatment can significantly improve outcomes.
What causes prostate cancer?
The exact causes of prostate cancer remain largely unknown. However, certain factors can increase your risk of developing the disease, including:
- Age: The risk of prostate cancer increases as you get older, with most cases occurring in men over the age of 50. The incidence of prostate cancer rises significantly in men aged 65 and older.
- Ethnicity: Men of African-Caribbean or African descent are more likely to develop prostate cancer than men of Asian descent. The reasons for this increased risk are not fully understood, but it may involve genetic and environmental factors.
- Family History: Having a first-degree male relative (such as a father or brother) with prostate cancer slightly increases your risk. If multiple relatives are affected, the risk can be higher.
- Genetics: Certain genetic mutations may contribute to the development of prostate cancer. Mutations in the BRCA1 and BRCA2 genes, which are also associated with breast and ovarian cancer, can increase the risk of prostate cancer.
- Diet and Lifestyle: A diet high in red meat and high-fat dairy products and low in fruits and vegetables may increase the risk of prostate cancer. Obesity and lack of physical activity are also associated with a higher risk of developing the disease.
How is prostate cancer diagnosed?
Usually, a digital rectal examination (examination of the prostate via the back passage) is performed in the outpatient setting at the first visit. Other diagnostic tests include:
Blood Test (PSA)
PSA is a protein produced by the prostate gland. This is prostate-specific and not cancer-specific. Prostate cancer can increase the production of PSA, so a PSA test looks for raised levels of PSA in the blood, which may be a sign of the condition in its early stages.
Multiparametric MRI of the Prostate
We use highly accurate magnetic resonance imaging of the prostate. These are contrast-enhanced scans and, with recent advances in performance techniques, are fast revolutionising the diagnosis and management of prostate cancer.
Biopsies of the Prostate
TRUS Biopsies (Transrectal and Transperineal Template Biopsies) are performed via the conventional transrectal route (usually under local anaesthetic or sedation). This targeted biopsy is carried out through the skin, not the back-passage as with traditional biopsies, and virtually eliminates infection. The new approach means fewer men are biopsied.
Treatments for prostate cancer
There are multiple treatment options for prostate cancer. These depend on the grade and stage of the tumours. We offer counselling and access to all treatment options.
Active Surveillance
When diagnosed, around half to two-thirds of men with low-risk prostate cancer do not need treatment. Active surveillance aims to avoid unnecessary treatment of harmless cancers, while still providing timely treatment for men who need it.
Surveillance is a safe strategy that provides a period of observation to gather extra information over time to see whether the disease is changing.
Active surveillance involves a regular PSA test. This is complemented by interval MRI scans and further biopsies. About one in three men who undergo surveillance will later have treatment.
Good evidence shows that active surveillance is safe over an average of six years. Men undergoing active surveillance will have delayed any treatment-related side effects, and those who eventually need treatment will be reassured that it was necessary.
This is offered in conjunction with the Wellington Oncology group for appropriate patients.
High-Intensity Focused Ultrasound (HIFU)
HIFU is a targeted therapy for prostate cancer which uses high-frequency ultrasound waves to destroy cancer cells in the prostate. HIFU is 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. These sound waves kill cancer cells in the prostate gland by heating them to a high temperature.
Urocare London are part of the Focal therapy users group and are able to offer this treatment to our patients.
Cryotherapy
Cryotherapy is a method of killing cancer cells by freezing them. It is sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate gland.
Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum. They freeze the prostate gland and kill the cancer cells, but some normal cells also die. The aim is to kill cancer cells while causing as little damage as possible to healthy cells.
Hormone Therapy
Hormone therapy is often used in combination with radiotherapy. Hormone therapy may also be recommended after radiotherapy or surgery to reduce the chances of cancerous cells returning.
Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow. The purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone. It is given as:
- Injections to stop the production of testosterone (luteinising hormone-releasing hormone – LHRH – agonists).
- Tablets to block the effects or reduce the production of testosterone (anti-androgen treatment).
Robot Assisted Laparoscopic Prostatectomy (RALP)
RALP is a minimally invasive surgical technique used to remove the prostate gland in men with localised prostate cancer. Utilising advanced robotic technology, the surgeon operates through several small incisions in the abdomen. The robotic system provides enhanced precision, flexibility, and control compared to traditional open surgery.
During the procedure, a camera and instruments are inserted through these incisions, allowing the surgeon to view a magnified, high-definition 3D image of the prostate and surrounding tissues. The robotic arms mimic the surgeon’s hand movements, providing a greater range of motion and precision. This technique aims to reduce recovery time, minimise blood loss, and lower the risk of complications.
External Beam Radiation Therapy (EBRT)
External Beam Radiation Therapy (EBRT) is a common treatment for prostate cancer that involves targeting the prostate gland with high-energy radiation beams.
During EBRT, a machine called a linear accelerator directs radiation beams precisely at the prostate from outside the body. The goal is to destroy cancer cells while sparing as much healthy tissue as possible. The treatment is typically administered five days a week over several weeks.
Advanced imaging techniques are used to plan and guide the therapy, ensuring accurate delivery of radiation.
Is it possible to prevent prostate cancer?
While there is no sure way to prevent prostate cancer, you can take steps to reduce your risk:
- Healthy Diet: Eating a diet rich in fruits, vegetables, and whole grains may help lower your risk. Foods high in antioxidants, such as tomatoes (which contain lycopene), broccoli, and green tea, may have protective effects.
- Regular Exercise: Staying physically active can improve your overall health and help maintain a healthy weight. Regular exercise has been shown to lower the risk of developing many types of cancer, including prostate cancer.
- Regular Screenings: Discuss prostate cancer screenings with your doctor, especially if you have risk factors. Early detection can lead to more effective treatment.
- Limit Alcohol and Avoid Smoking: Reducing alcohol consumption and avoiding smoking can improve your overall health and lower your cancer risk. Smoking is linked to an increased risk of many cancers, including aggressive forms of prostate cancer.
- Maintain a Healthy Weight: Obesity is linked to a higher risk of developing prostate cancer. A balanced diet and regular exercise can help you maintain a healthy weight.
Frequently asked questions
What is the survival rate for prostate cancer?
The survival rate for prostate cancer is high, particularly if the cancer is detected early. The 5-year survival rate for men diagnosed with prostate cancer in the UK is over 90%. Many men with prostate cancer live for many years after diagnosis, particularly if the cancer is caught early and treated effectively.
How does prostate cancer affect sexual health?
Prostate cancer and its treatments can affect sexual health, including reduced libido, erectile dysfunction, and changes in ejaculation. It’s important to discuss these potential side effects with your doctor, as there are treatments and support available to help manage these issues.
What is the role of PSA testing in prostate cancer?
Prostate-specific antigen (PSA) testing measures the level of PSA in the blood, which can be elevated in men with prostate cancer. While PSA testing can help detect prostate cancer early, it is not definitive and can sometimes lead to false positives or overdiagnosis. Discuss the benefits and risks of PSA testing with your healthcare provider.
What are the options if prostate cancer returns after treatment?
If prostate cancer returns after initial treatment, there are several options available, including additional surgery, radiation therapy, hormone therapy, chemotherapy, or participation in clinical trials. The choice of treatment depends on various factors, including the location and extent of the recurrence, previous treatments, and overall health.
How can I support a loved one with prostate cancer?
Supporting a loved one with prostate cancer involves being there for them emotionally and practically. This can include accompanying them to medical appointments, helping with daily tasks, providing emotional support, encouraging healthy lifestyle choices, and being an advocate for their healthcare needs.
