By Dr Ananya Mandal, MD
Prostate cancer is one of the most common cancers in men, with more than 40,000 new cases diagnosed every year in the UK. This is usually a slow growing cancer and most men do not notice the symptoms until the cancer has become large enough to press against the urethra and interfere with urination.
Symptoms of prostate cancer
The most common symptoms of a cancerous growth in the prostate include an increase in the frequency to urinate (particularly at night), a greater sense of urgency to reach a toilet, difficulty in starting and continuing to pass urine, a weak urine flow, and a feeling of incomplete emptying of the bladder. These symptoms are also seen in a non-cancerous form of prostate enlargement called benign prostatic hyperplasia (BPH).
Causes, risk factors and diagnosis of prostate cancer
The exact cause of this cancer is unclear. Factors that influence the risk for the condition, however, include age, ethnicity and genetics. The risk of developing prostate cancer increases with age and the condition usually develops in men aged 50 years or older.
Individuals of Afro-Caribbean or African descent are at a greater risk of developing the cancer, while those of Asian descent are at less risk. In addition, men with a first-degree relative who has had prostate cancer are at a slightly increased risk for developing the condition.
There is no single test to diagnose prostate cancer. Usually, a diagnosis is made based on a physical examination of the prostate, blood tests and a biopsy.
The physical assessment is called a digital rectal examination and involves a doctor or nurse feeling for abnormalities in the prostate gland through the wall of the rectum using their finger. The healthcare professional may be able to detect a hardening or enlargement of the gland, for example. Blood is tested to check the level of a protein called prostate-specific antigen (PSA), as a raised PSA level may be an early indicator of prostate cancer.
If an abnormality is detected through DRE or PSA assessment, a doctor may order an ultrasound scan which uses sound waves to generate an image of the prostate gland that can be evaluated. A biopsy may also be taken, in which a tissue sample is removed from the prostate and sent for laboratory analysis to confirm whether cancer is present or not.
Treatment of prostate cancer
In many men with prostate cancer, immediate treatment may not be necessary. If the cancer is detected at an early stage, "watchful waiting" or "active surveillance" may be recommended. This approach involves careful monitoring of the patient for symptoms of aggressive cancer growth and may be considered in cases where the cancer appears to be slow growing, is not causing symptoms and is confined to one area of the prostate.
In some cases, prostate cancer can be treated and cured if caught early. Treatment includes surgical removal of the gland or prostatectomy, followed by radiotherapy to kill any remaining cancer cells. Prostatectomy and radiotherapy may be followed by hormone therapy, which cuts off the cancer cells' supply of testosterone, which fuels their growth.
Medications used in hormonal therapy can either stop the body producing testosterone or prevent the hormone form reaching the cancer cells. Another form of hormonal therapy is orchiectomy or removal of the testicles, to quickly reduce the level of testosterone produced.
Individuals with advanced prostate cancer that has spread to other organs or who have not been responsive to hormonal therapy may be treated with chemotherapy, which kills rapidly dividing cells such as cancer cells.
Reviewed by Sally Robertson, BSc