The prostate gland is located below the bladder and in front of the rectum. It’s about the size of a walnut, producing the liquid that nourishes, protects and carries sperm on ejaculation. It tends to increase in size with age – this is called benign prostatic hyperplasia and it is not cancerous. Benign prostatic hyperplasia is very common in older men and causes symptoms such as urinary frequency
Most cancers develop in the peripheral or outer zone of the prostate gland. They are usually a type known as adenocarcinoma, and tend to be slow growing tumours (although some are more aggressive). If prostate cancer is found early, while still confined to the gland itself, chances of survival are excellent – more than 80 per cent of men survive for five years or more.
Prostate cancer symptoms
Often prostate cancer doesn’t have any symptoms, but when they do occur they may include:
- Urinating frequently
- Difficult or painful urination or ejaculation
- Delay or hesitancy before urinating
- A feeling that the bladder has not completely emptied
- Blood in urine or semen
- Disturbed sleep because of the need to urinate
- Sometimes the first sign of prostate cancer is from secondary deposits (also known as metastases) once the cancer has spread through the body.
Prostate cancer typically spreads to the bones, so in advanced prostate cancer, the following symptoms may occur:
- Weight loss
- Bone pain
- Pain in the loins, pelvis or lower back
- It’s important to be aware that there are a number of non-cancerous medical conditions that may also cause these symptoms, for example infection or benign prostate enlargement. Diagnostic tests will help clarify the problem
Prostate Cancer Causes
The causes of prostate cancer aren’t yet understood. Cases are rare in men aged under 50, but there are certain things that place some men at higher risk of developing the disease than others:
- Being overweight or obese
- Genetic factors: having a father or brother with prostate cancer (this increases the risk by 3-fold or more, especially if they were diagnosed before the age of 60)
- Men who have relatives with breast cancer, especially when a faulty gene called BRCA2 has been found, may have a risk of prostate cancer several times the average. Other cancers in the family, such as bowel cancer, may also indicate higher risk.
- Being of African-Caribbean or African-American descent and living in western countries
- Several dietary factors have been investigated but no definite links have yet been shown. However foods rich in lycopene (tomato based foods, especially processed products such as tomato sauce) and selenium (found in vegetables, fish grains and eggs) may reduce the risk while a diet rich in dairy protein and calcium may increase it.
A small dose of aspirin every day may reduce the risk of prostate cancer as well as other cancers. However as there is a risk of gastrointestinal bleeding, check with your doctor first. Studies linking the cancer to vasectomy, an operation to remove a man’s fertility, are contradictory but there may be a slight increase in risk.
Prostate Cancer Diagnosis
There are several methods to check for the presence of prostate cancer. The simplest is the digital rectal examination, in which a gloved finger is inserted into the rectum, through which an enlarged prostate can be felt.
Blood tests are the next step, in particular to measure levels of a protein called Prostate Specific Antigen (PSA). PSA may be raised in prostate cancer although other conditions can also cause a high level of PSA. PSA is also used to monitor a man’s response to treatment (levels fall with successful treatment).
If cancer is suspected then a sample of cells, or a biopsy, may be taken from the prostate and examined in the laboratory. More sophisticated tests including a bone scan, ultrasound, CT or MRI may be done to check whether the cancer has spread and to see how well the urinary system is working.
Prostate Cancer Treatment
As with most cancers, once prostate cancer is diagnosed, tests will be done to work out the grade of the tumour (high grade cancer cells are aggressive and tend to spread faster, while low grade cancer cells may spread very slowly) and how far it has spread. This is called staging, and it helps to predict how the cancer is likely to progress and which treatments are most appropriate. A team of specialists including doctors, nurses, radiologists, oncologists, radiotherapists and others then get together to review all the test results and recommend a schedule of suitable treatment.
If diagnosed early, success rates are high. Therefore, it’s important to be aware of the symptoms and to see a doctor as early as possible.
The key decision in prostate cancer is whether or not to treat at all. In many older men, especially if they have a low grade tumour, the cancer progresses so slowly that surgery and other treatments may cause more harm than good (particularly if they are frail and have other health issues).
In these cases it may be suggested that regular check-ups and PSA monitoring are the best way to keep an eye on the situation – this is sometimes called a “wait and see” policy, or active monitoring.
However, in younger men the risk of the cancer growing within their lifetime is higher. So for them, or those men whose cancer is more aggressive, either already spreading or liable to spread beyond the prostate, treatment is usually recommended earlier rather than later.
For a cancer that hasn’t spread beyond the prostate (localised disease) the choice is usually between surgery to remove the prostate gland (a prostatectomy), radiotherapy, cryotherapy or high-frequency ultrasound therapy.
It’s important to try to weigh up the benefits and possible risks of each of these treatments. For example, during a prostatectomy the prostate gland is removed, normally along with small parts of the lymphatic system near the gland. Unfortunately, the operation may cause nerve damage which can make it sometimes impossible for men to achieve an erection afterwards, or maintain complete control over urination.
However, with modern ‘nerve-sparing’ surgical techniques – combined with drugs such as Viagra – the effects on both sexual function and quality of life can be minimised. Surgeons are learning how to remove the prostate without causing the problematic nerve damage which was inevitable in the past. And radiotherapy technology advances mean that far higher doses can be targeted more precisely on the prostate, killing more cancer cells with fewer treatments.
Recent advances include the use of an internal radiotherapy technique called brachytherapy. There are two major methods of prostate brachytherapy, permanent seed implantation and high dose rate (HDR) temporary brachytherapy. Permanent seed implants involve injecting approximately 100 radioactive seeds into the prostate gland. They give off their cancer-killing radiation at a low dose rate over several weeks or months, and the seeds remain in the prostate gland permanently.
HDR temporary brachytherapy instead involves placing very tiny plastic catheters into the prostate gland, and then giving a series of radiation treatments through these catheters.
In 2011 a review of the research looking at different treatments concluded that after five years brachytherapy worked just as well as surgery to remove the prostate gland. But there were differences in side effects. The men who had surgery were more likely to be incontinent and the men who had brachytherapy were more likely to have chronic pain and a need to pass urine often. More research in underway to compare treatments. There are a number of clinical trials available for people with prostate cancer which you should discuss with your specialist for suitability.
Other treatment options include High Intensity Focussed Ultrasound (HIFU), which uses sound waves to ‘melt’ away the cancer, hormone therapy and chemotherapy.
Cancer of the prostate depends on the male hormone testosterone for growth. By reducing the amount of testosterone in a man’s body, growth of the tumour can be slowed and the chance of spread or recurrence can be reduced. Whether it is recommended depends on factors such as the grade and stage of the cancer but it tends to be used in more advanced cancer that has spread beyond the prostate. Several different types of drugs may be used to reduce testosterone levels and they may be used in combination with other treatments such as radiotherapy. One problem with hormone therapy is that although it can work very well at first, the cancer often stops responding to treatment after a few years and starts to grow again.
Chemotherapy, or anti-cancer drugs, may be used when the cancer has spread through the body or is not responding to hormone therapy. HIFU is currently only used as part of research trials as it is not yet clear how its efficacy compares to standard treatment.
Prostate Cancer Survival Rate and Life Expectancy
Prostate cancer survival rate are generally good – men diagnosed between the ages of 50 and 70 have five-year survival rates of over 90 per cent This rate falls among older men, especially after the age of 80 but of course they often have other serious health problems, which may be the cause of their demise. Many more men die with prostate cancer than from it. Even so, the cancer and its treatment can cause challenging physical and emotional problems, and many men find support from prostate cancer organisations and other patient groups.