PROSTATE CANCER
Prostate cancer is the most commonly diagnosed cancer in the UK. Increased awareness and testing has led to improved opportunities to reduce the numbers of men dying from the disease, but at the same time minimising where possible the side effects of treatment, or often monitoring the condition without the need for treatment at all. It is important if you are concerned regarding your prostate cancer risk to speak to a specialist for expert advice and assessment if required.
For more detail on specific topics, please visit the Prostate Cancer Resources page via the main menu.
SOME FACTS ABOUT PROSTATE CANCER
HOW COMMON IS PROSTATE CANCER?
Around 50,000 men are newly diagnosed with prostate cancer every year in the UK. Over 12,000 men die from the disease every year, second only to lung cancer. Though it often affects older men, post mortem studies have demonstrated a man's chance of having prostate cancer in percentage terms is roughly the same as his age. Therefore it is not only extremely common, but also importantly often does not affect a man's life at all. Approximately 4% of men die from prostate cancer in the UK. Your chance of being significantly affected is higher if you have close relatives who have had the condition, or if you are Black. Being significantly overweight (obese) may also increase your risk of high grade (more aggressive) disease.
WHAT SYMPTOMS DOES IT CAUSE?
In the early stages, prostate cancer usually has no symptoms. The majority of problems men have passing urine as they get older are due to benign (non-cancerous) prostatic enlargement. However, if you have new symptoms of this nature, it's wise to discuss with your GP or Specialist. Prostate cancer can also present with blood in the urine, erection problems, and occasionally pain. In more advanced cases, if the disease has spread elsewhere in the body, men can lose weight, develop bone pain, and block the drainage of their kidneys causing them to fail. If you have symptoms such as these, you should see your doctor urgently, be examined and have a prostate blood test (PSA).
HOW IS PROSTATE CANCER DIAGNOSED?
To investigate for the possibility of prostate cancer, the first step is an examination of the prostate with a finger (rectal exam). This gives a lot of information about the size of the prostate and whether any nodules are present. Your will be offered a prostate blood test (PSA), and if there are any concerns, for example if the PSA is too high, or the prostate feels suspicious, you can discuss onward referral to a Specialist for an MRI scan and then possibly a prostate biopsy. Sometimes other scans such as a CT and Bone Scan are necessary to examine the whole body if there is concern the disease may be at risk of spreading.
WILL I NEED TREATMENT?
Your Urologist will talk you through the implications of your results, and offer you detailed insight into how you might be affected long term. Your risk depends on how high your PSA is, the amount and aggressiveness of the disease on biopsy (Gleason grade), and how advanced the disease looks on the scans (the cancer's stage).
Not all cancers need treatment, and we often put men at relatively low risk onto Active Surveillance, meaning close monitoring with the intention of only treating in the future if the condition deteriorates. If a man has more significant disease, he may be offered localised treatments to the prostate, and if it is more advanced, whole body treatment with hormone therapy or chemotherapy can be discussed.
TREATMENT OPTIONS FOR PROSTATE CANCER
ROBOTIC PROSTATECTOMY
Surgical removal of the whole prostate can be achieved through small incisions using the Da Vinci surgical robot controlled by the surgeon. It has the advantage of the lowest risk of cancer recurrence vs other options, but potential for side effects including erection problems and urinary leakage. Your surgeon will discuss the individually tailored approach to your operation, and how to minimise these risks. For more information on robotic surgery please click below.
RADIOTHERAPY OPTIONS
Radiotherapy treats the prostate either from the outside (external beam) or by the implantation of radioactive beads into the prostate (brachytherapy) . Hormone therapy to block the action of testosterone is often required to enhance the action of radiotherapy. External beam therapy is usually delivered over 4-7 weeks, with 20 - 35 treatments over this time period, whereas brachytherapy is delivered as a single procedure under general anaesthetic.
Common early side effects include prostate, bladder and bowel inflammation, and occasionally longterm issues with damage to these organs. Erection problems are also common with radiotherapy techniques, though urinary incontinence is not often seen. Recurrence rates are likely a little higher than surgery, and going on to remove the prostate ofter radiotherapy is extremely difficult due to the scarring it causes. However, for many men it represents an excellent alternative to surgery.
HORMONE THERAPY AND CHEMOTHERAPY
If the disease has spread, or if you don't wish to have localised treatment and the cancer is at risk of advancing, then the aim of these options are to treat the whole body, so called systemic treatment. By blocking the action of testosterone, the male hormone, the prostate usually in effect goes to sleep, as it is a reproductive organ usually dependent on testosterone for function. The cancer is usually slowed down in 90% of cases, but it will not be cured in this way, and after a couple of years may start to regrow as cancers often change (mutate) to develop ways of nullifying drug treatments.
Hormone therapy can be taken as tablets or injections. It often has side effects of hot flushes, tiredness and loss of libido.
Chemotherapy is sometimes used shortly after diagnosis in men with metastatic disease (where it has spread, or metastasised around the body). This can prolong the life expectancy, but again cannot cure the condition. More advanced hormone treatments have been developed which are more effective than traditional hormone therapy, but they are usually reserved for if the disease progresses, and you would be referred to an Oncologist for a discussion of these options if relevant.
FOCAL THERAPY
Increasing evidence is demonstrating a role for only treating the affected part of the prostate in certain cases of prostate cancer. This can avoid many of the side effects associated with more traditional whole gland treatment options such as surgery or radiotherapy. It is not applicable to all cases though, and a detailed consideration of the pros and cons to each option is crucial. Mr Streeter is pioneering Nanoknife, also known as Irreversible Electroporation, at Kent and Canterbury Hospital, which is actually pulsed electric current accurately passed through a tumour to kill it whilst preserving structures nearby.
For more information and a wealth of other resources, please see the links below.