Prostate Cancer

Prostate cancer occurs when abnormal cells develop in the prostate and start to grow in an uncontrolled way.

There are different types of prostate cancer. In some men prostate cancer grows too slowly to cause any problems and does not require treatment but, in other men, prostate cancer grows quickly and spreads aggressively and treatment is needed to stop it spreading and prevent serious illness.

The different types of prostate cancer include:

• Early prostate cancer – often called localised prostate cancer. Only the prostate gland is affected and cancer has not spread.
• Locally advanced prostate cancer - cancer has spread to tissues around the gland.
• Advanced prostate cancer - cancer has spread beyond the gland to other parts of your body.

The cause of prostate cancer is unknown, but some factors can increase your risk of developing prostate cancer. These include age with men aged 50 or older more likely to develop prostate cancer, African-Caribbean or African descent, family history if your father or brother has been affected by prostate cancer, and obesity.

Usually, men have no prostate cancer symptoms for many years until the cancer is large enough to put pressure on their urethra tube that they urinate through. You should bear in mind that a man’s prostate gland can get bigger with age due to a non-cancerous condition called prostate enlargement and so the symptoms may not only signify prostate cancer.

Symptoms of prostate cancer include:

• needing to urinate more frequently, often during the night
• a sudden need to urinate
• difficulty starting to urinate
• straining or taking longer to urinate
• a weak flow
• feeling that your bladder has not fully emptied
• blood in urine or semen

If you have these symptoms it is important to get them checked out by a doctor.

If prostate cancer has spread it may present other symptoms such as back pain, hip pain or pelvis pain, erectile dysfunction, testicle pain, and unexplained weight loss.

Prostate cancer is highly treatable in the early stages. Screening for prostate cancer is controversial and there is no screening programme for prostate cancer on the NHS. There is no single prostate cancer test and all tests have benefits and risks. Prostate cancer diagnosis has advanced rapidly over the last decade. Your consultant will discuss these in detail with you.

Prostate cancer screening tests might include:

• Prostate-specific antigen (PSA) test - measures the level of prostate-specific antigen (PSA) in your blood. A high PSA might be a sign of prostate cancer or another condition.
• Digital rectal examination (DRE) – a physical examination of your prostate gland to check its size and for anything unusual.
• An MRI scan - detailed scan of your prostate to help identify signs of cancer.
• A biopsy – prostate cells are removed and examined under a microscope.

The stage of prostate cancer describes the size of the cancer tumour and how far it has spread from the prostate. Prostate cancer is also graded based on the appearance of the cancerous cells. Together staging and grading prostate cancer will help doctors determine the best treatment.

Cancer grades
The Gleason score is the most common system doctors use to grade prostate cancer. A pathologist looks at several biopsy samples of your prostate cells and grades each sample based on how quickly they are likely to grow or how aggressive the cells look. There are five Grade Groups. Grade Group 1 is the least aggressive and Grade Group 5 is the most aggressive.

Prostate cancer treatment options are based on several factors including how fast the cancer is growing, how much it has spread, your general health and also the benefits and side effects of the treatment. Our expert consultants will discuss these with you in detail.

Possible treatments include:

• Watchful waiting or active surveillance – watchful waiting is keeping an eye on your prostate cancer if it isn’t causing symptoms or problems. Active surveillance is having regular PSA tests, MRI scans, and sometimes biopsies to monitor slow-growing prostate cancer rather than treat it immediately. Both avoid unnecessary treatment.
• Radical prostatectomy – surgery that removes the prostate gland and some surrounding tissue to treat prostate cancer that has not spread out of the prostate. It is performed through open surgery known as open prostatectomy or keyhole surgery known as laparoscopic prostatectomy. Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction.
• Radiotherapy – radiation kills the cancerous cells and stops their growth. It is a treatment option for prostate cancer that has not spread beyond the prostate or to slow the progression of prostate cancer that has spread and relieve its symptoms. An outpatient procedure delivered in short sessions, over five days for four weeks. There are short- and long-term side effects. It may be combined with hormone therapy.
• Brachytherapy – a form of radiotherapy where the radiation is delivered inside the prostate gland. The radiation can be delivered using tiny radioactive seeds that are implanted into your prostate cancer to destroy the cancer cells. This low dose rate brachytherapy delivers radiation to the prostate while minimising damage to other tissues.
• Hormone therapy – helps manage and control prostate cancer by reducing the level of testosterone, which encourages cancer growth. It does not cure prostate cancer. Hormone therapy can be given on its own or combined with other treatments such as radiotherapy or brachytherapy.
• High-intensity focused ultrasound (HIFU) – kills prostate cancer cells by heating them to a high temperature using high-frequency sound waves. It treats localised prostate cancer that has not spread beyond the prostate.
• Cryotherapy – kills the cancer cells by freezing them. It treats localised prostate cancer that has not spread beyond the prostate gland.
• Bisphosphonates – medicines help reduce bone pain and bone loss if cancer has spread to your bones.
• TURP (Transurethral resection of the prostate) - is the prostate cancer is blocking the urethra, this surgery would be advised prostate surgery to remove the blockage

Cancer that reaches an advanced stage cannot be cured but its progression can be slowed down to prolong life and relieve symptoms. Radiotherapy, hormone treatment, and chemotherapy are treatment options for prostate cancer at this stage.