Prostate Cancer2023-02-20T16:28:59+00:00

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What You Should Know About Prostate Cancer

  • Prostate cancer has become the biggest cancer killer of men in the UK. It kills one man every hour

  • Each year nearly 47,000 men in the UK are told they have prostate cancer and more than 11,000 die of the disease

  • Worldwide numbers are staggering. Each year over a million men are diagnosed with prostate cancer and more than 300,000 die from it

  • Cancer of the prostate can be treated effectively even if it has spread beyond the gland but the disease must be caught early to achieve excellent cure rates

  • Every man over 50 has the legal right, by Act of Parliament, to a PSA test​

What You Should Know About Your Risks

There are some things that may mean men are more likely to get prostate cancer – these are called risk factors. There are three main risk factors :

  • Age – it mainly affects men aged 50 or over, and the risk increases as you get older.  It is vital that men over 50 are aware of the potential problem and consult their GP routinely ​

  • Family history – Men are two and a half times more likely to get prostate cancer with a family history (father or brother) of the disease, compared to a man who has no relatives with prostate cancer.

  • Black men are more likely to get prostate cancer than other men. No-one knows why exactly, but it might be linked to genes. In the UK, about 1 in 4 black men will get prostate cancer in their lifetime.  If you’re a black and you’re over 45, speak to your GP about your risk of prostate cancer, even if you don’t have any symptoms.

It is vital that prostate cancer is caught early and before it has spread beyond the prostate, as the cure rate is high – up to 90%.  But in about 10 per cent of cases it has already spread to other organs by the time it is picked up, after which a cure is normally not possible

Treatment for these men simply aims to slow tumour growth with chemotherapy, or by reducing levels of testosterone, a hormone that helps prostate cancer cells to grow.

Because early prostate cancer is usually symptomless, all men who have these risk factors should talk to their GP about having a simple PSA blood test,

dowload the 6th edition of our popular prostate aware booklet

Symptoms Requiring Action

Prostate cancer is diagnosed by using the prostate specific antigen (PSA) test, biopsies and physical examinations.  There can be few symptoms of prostate cancer in the early stages, and because of its location most symptoms are linked to urination. However, such symptoms are often associated with non-cancerous conditions such as an enlarged prostate, prostatitis (inflammation of the prostate) and urinary infection. Men with prostate cancer can also live for decades without symptoms or needing treatment because the disease often progresses very slowly.

  • Frequent need to pass urine, particularly at night

  • Delay before urinating and/or interrupted flow

  • Needing to run to the toilet

  • Feeling your bladder has not emptied fully

  • Pain in passing urine or when ejaculating

  • Blood in semen or urine

  • Difficulty in getting or keeping an erection

  • Nagging pain in the lower back or hip area

Early Prostate cancer often doesn’t have any symptoms, so be aware of the risks and get a PSA Test. If caught early, it is usually curable.

With thanks to our friends at K2 Consultancy, this 90 second animation shouts the Get Tested

Management and Treatment

Treatment options

A number of factors will determine treatment options available to you including your age and the stage and grade of your cancer. In 2014, NICE recommended three curative treatment options, (radical surgery, brachytherapy and external beam radiotherapy). These seem to offer patients the same chance of cure but individuals may be better suited to one treatment over another. For those patients with advanced cancer, where complete cure is not an option, the treatment and support regime will be designed to keep the disease in check, alleviate symptoms, maintain quality of life and maximise the period over which you can lead a normal and productive life.

New treatments and enhancements of existing treatments are coming on stream on a regular basis. Often these are designed to target the cancer more accurately while minimising damage to healthy tissue, so reducing side effects. Inevitably new developments will continue to take place and it is important that you are made aware of all the options by your consultant.

Management and treatment of early prostate cancer

Active surveillance

Do not be surprised if your consultant recommends having no immediate treatment and embarking on a regime of active surveillance. This is suitable for men with small localised and less aggressive cancers that are unlikely to spread. In such cases a slow growing cancer may not cause any problems during your lifetime and active surveillance can mean avoiding or at least delaying treatment with its possible associated side effects. It is important that the prostate has been accurately and extensively assessed before you undertake this option. Patients under active surveillance are closely monitored with PSA tests, digital rectal examinations and MRI scans at appropriate intervals. If the cancer shows signs of progressing your consultant will discuss with you the options for curative treatment.

Watchful waiting

This option is usually offered to older men in cases where the disease may grow so slowly that it will not cause significant symptoms or to men whose health does not allow them to undergo invasive treatment. The aim is to keep an eye on the cancer over the long term and offer palliative (as opposed to curative) treatment if problems do develop. Monitoring activity through PSA tests and digital rectal examinations may not be as frequent as in the case of active surveillance. Should symptoms start to occur or if the disease starts to spread more quickly than expected, then hormone treatment (see page 13) is a likely option.

Radical surgery

This involves the total removal of the prostate gland under general anaesthetic in an operation called a Radical Prostatectomy. It is done where diagnostic tests suggest that all of the cancer can be completely removed along with the prostate gland. This may involve conventional open surgery but most surgeons are now using laparascopic (keyhole) or robotic surgery (both of which involve cutting and manipulating tissue through tiny incisions). Recovery from keyhole surgery is much faster than is the case when the area being operated on is completely opened up and less time is therefore spent in hospital and convalescence.

During surgery you will be fitted with a temporary catheter through which your urine will drain. This will normally be removed 10-14 days after the operation. Tissue that has been removed will be sent to pathology for analysis to check whether the cancer has been completely removed. If any cancer is found outside the prostate or a significant risk of recurrence is identified, then you may be offered further treatment such as radiotherapy or hormone treatment.

Radiotherapy: 2 options

1. Brachytherapy

This is a one-stage treatment for early prostate cancer in which tiny radioactive seeds are implanted directly into the cancerous prostate gland through delivery needles under ultrasound control. The needles are passed through the skin behind the scrotum. A real time planning computer monitors the procedure to ensure that the desired radiation dose is given to the cancerous parts of the gland while the surrounding structures are spared. By delivering radiation directly into the prostate, the side effects can be minimised and patients rapidly return to their normal activities. The procedure is performed under general anaesthetic and may be a day case or involve an overnight stay in hospital.

This short film by Prof Stephen Langley explains brachytherapy for localised prostate cancer; inserting tiny radioactive seeds directly into the prostate. The radiation damages the cancer cells, causing them to die, with minimal side effects.

2. External beam therapy

This involves directing high-energy radiation at the tumour from outside the body. Modern technology (Conformal 3D or Intensity Modulated Radiotherapy) uses a computer to ‘shape’ the radiotherapy beams to a more exact shape of the prostate, minimising the amount of healthy tissue that receives radiation. Fiduciary markers (tiny pieces of metal) may be inserted into the prostate under local anaesthetic. These markers, along with the planning (CT) scan that takes place before treatment, help ensure that the radiotherapy beams are precisely focused on the area needing treatment. External beam radiotherapy may also be used if the cancer has spread outside the gland. Hormone therapy (see page 13) is usually given to men undergoing this treatment.

Treatment is usually daily (Monday-Friday) for 4-8 weeks. To maximise effectiveness and reduce side effects, you are likely to be asked to ensure that your bowels have moved and that your bladder is full before each treatment. This will be explained to you by a radiographer at the planning stage. If anything about the process is unclear, do not hesitate to ask for further explanation and advice at any stage in the process.

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