Prostate cancer is the most common cancer in men in the UK, with over 40,000 new cases diagnosed every year.
Some prostate cancers develop slowly, so there may be no signs you have it for many years, whilst others grow more rapidly and symptoms often only become apparent when your prostate gland is large enough to affect the urethra (the tube that carries urine from the bladder to the penis). When this happens, you may experience the following symptoms:
- an increased need to urinate
- straining while urinating
- feeling that your bladder has not fully emptied.
Although these symptoms shouldn’t be ignored, they do not mean that you definitely have prostate cancer. It is more likely that they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).
The causes of prostate cancer are largely unknown. However, certain things can increase your risk of developing the condition. The chances of developing prostate cancer increase as you get older. Most cases of prostate cancer develop in men aged 50+.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent. Men who have first-degree male relatives (such as a father or brother) affected by prostate cancer are also at slightly increased risk.
The chance of a man in the UK dying of prostate cancer is now at around three per cent.
A digital rectal examination (examination of the prostate via the back passage) is performed in the outpatient setting at the first visit.
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, and so a PSA test looks for raised levels of PSA in the blood that 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 – Transrectal and Teransperineal template Biopsies
TRUS Biopsies – these are performed via conventional transrectal route (usually under local anaesthetic or sedation)
Transperineal Template Biopsies
To identify and biopsy more accurately fast-growing prostate cancers that need treatment, whilst allowing men without suspicion of lethal cancers to avoid biopsy. This targeted biopsy is carried out through the skin, not through the back-passage as with traditional biopsies, and virtually eliminates infection.
The new approach means fewer men are biopsied.
There are multiple treatment options in prostate cancer. These depend on the grade and stage of the tumours. We offer counselling and access to all treatment options.
Active surveillance aims to avoid unnecessary treatment of harmless cancers, while still providing timely treatment for men who need it.
When they are diagnosed, we know that around half to two-thirds of men with low-risk prostate cancer do not need treatment.
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 complimented with Interval MRI scans and further biopsies. About one in three men who undergo surveillance will later have treatment. This does not mean they made the wrong initial decision. 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) therapy
Urocare London are a part of the Focal therapy users group and are able to offer this treatment to our patients. This 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.
The risk of side effects from HIFU is usually lower than other treatments. However, possible effects can include impotence (in five to 10 in every 100 men) or urinary incontinence (in less than one in every 100 men). Back passage problems are rare. Fistulas (an abnormal channel between the urinary system and rectum) are also rare, affecting less than one in every 500 men. This is because the treatment targets the cancer area only and not the whole prostate.
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. The side effects of cryotherapy can include erectile dysfunction and incontinence. It is rare for cryotherapy to cause rectal problems or fistulas.
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 oftestosterone, called luteinising hormone-releasing hormone (LHRH) agonists
- Tablets to block the effects or reduce the production of testosterone, called anti-androgen treatment
Combined LHRH and anti-androgen treatment
The main side effects of hormone treatment are caused by their effects on testosterone. They usually go away when treatment stops. They include loss of sex drive and erectile dysfunction (this is more common with LHRH agonists than anti-androgens).