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Prostate Cancer

prostate cancer

The prostate gland (just called prostate from now on) is only found in men. It lies just beneath the bladder. The urethra (the tube which passes urine from the bladder) runs through the middle of the prostate. The prostate's main function is to produce fluid which protects and enriches sperm.

The prostate often gets bigger (enlarges) gradually after the age of about 50. By the age of 70, about 8 in 10 men have an enlarged prostate.

What is prostate cancer?

Prostate cancer is a cancer which develops from cells in the prostate gland. Prostate cancer is different to most other cancers because small areas of cancer within the prostate are actually very common, especially in older men. These may not grow or cause any problems for many years (if at all).

What causes prostate cancer?

A cancerous tumor starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. Although the exact cause is unclear, certain risk factors increase the chance that prostate cancer may develop. These include:

  • Ageing. Most cases occur in older men.
  • Family history and genetic factors. If your father or brother had prostate cancer at a relatively early age (before they were 60) then you have an increased risk.
  • Ethnic group. Prostate cancer is more common in African-Caribbean men and less common in Asian men.
  • A diet high in fats and low in fruit and vegetables may increase the risk.
  • Exposure to the metal cadmium may be a risk.
What are the symptoms of prostate cancer?
  • Poor stream. The flow of urine is weaker, and it takes longer to empty your bladder.
  • Hesitancy. You may have to wait at the toilet for a while before urine starts to flow.
  • Dribbling. A bit more urine may trickle out and stain your underpants soon after you finish at the toilet.
  • Frequency. You may pass urine more often than normal.
  • Urgency. You may have to get to the toilet quickly.
  • Poor emptying. You may have a feeling of not quite emptying your bladder.

Other symptoms such as pain at the base of the penis or passing blood occasionally occur. If the cancer spreads to other parts of the body, various other symptoms can develop. The most common site for the cancer to spread is to one or more bones, especially the pelvis, lower spine and hips. Affected bones can become painful and tender.

How is prostate cancer diagnosed?

Initial assessment

If a doctor suspects that you may have prostate cancer, he or she will usually examine the prostate gland. They do this by inserting a gloved finger through the anus into the rectum to feel the back of the prostate gland. An enlarged-feeling gland, particularly if it is not smooth to feel, may indicate prostate cancer.

Do a blood test to measure the level of prostate specific antigen (PSA). PSA is a chemical which is made by both normal and cancerous prostate cells. Basically, the higher the level of PSA, the more likely that you have cancer of the prostate.

A PCA3 test may be offered. This is a new urine test which provides a more effective means of detecting prostate cancer than the PSA test. PCA3 is a chemical made particularly by prostate cancer cells. Up to 100 times more PCA3 is present in prostate cancer cells than non-cancerous cells. A certain level of PCA3 in the urine is a good indication that prostate cancer is present.

Biopsy - to confirm the diagnosis

A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. A biopsy can usually confirm the presence of prostate cancer.

Having a prostate biopsy can be uncomfortable. Therefore, local anaesthetic is used to reduce the pain as much as possible.

The severity of the disease is mainly based on three factors - the grade of the cancer cells, the stage of the cancer, and the blood PSA level.

Grade of the cancer

By looking at certain features of the cells taken at biopsy, the cancer can be graded. The common grading system used is called the Gleason Score. A Gleason score of between 2 and 6 is a low-grade prostate cancer. It is likely to grow very slowly. A Gleason score of 7 is an intermediate grade that will grow at a moderate rate. A Gleason score of 8 to10 is a high-grade cancer that is likely to grow more quickly.

Staging

The aim of staging is to find out:

  • How much the tumour has grown, and whether it has grown through the wall of the prostate and into nearby structures such as the bladder wall.
  • Whether the cancer has spread to local lymph nodes.
  • Whether the cancer has spread to other areas of the body (metastasised).
What are the treatment options for prostate cancer?

The treatment of prostate cancer is complicated. It varies tremendously between different cases. Treatment options which may be considered include: surgery, radiotherapy, hormone treatment and, less commonly, chemotherapy. Often a combination of two or more of these treatments is used. The treatments used depend on:

The cancer itself - its size and stage (whether it has spread), the grade of the cancer cells, the PSA level;

AND

Your age, your general health and also personal preferences for treatment.

Surgery

Removing the prostate (radical prostatectomy) can be curative if the cancer is in an early stage (confined to the prostate and not spread). It is a major operation and so tends to be advised more often for younger men whose general health is good, especially if the cancer grade means the cancer is likely to spread in the future. Side-effects such as impotence and/or incontinence of urine may occur following a prostatectomy.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.

Radiotherapy is often more suitable for men who are not fit enough to have an operation or choose not to have an operation.

External radiotherapy. This is where radiation is targeted on the prostate cancer from a machine. (This is a common type of radiotherapy used for many types of cancer.)

Internal radiotherapy (brachytherapy). This treatment involves inserting a small radioactive implant into the cancerous tumour, or next to the tumour. Sometimes radioactive seeds are placed into the prostate gland.

Treatment options for locally advanced prostate cancer

You may be offered hormone treatment with radiotherapy. The radiotherapy given is usually similar to that given for men with early prostate cancer although the radiotherapy may include the surrounding structures in addition to the prostate.

Hormone treatment

Prostate cancer cells need the male hormone called testosterone to grow and multiply well. Testosterone is made in the testes and circulates in the bloodstream. Hormone treatments aim to stop you from making testosterone or to block the effect of testosterone on prostate cancer cells.

Two groups of medicines are available:
  • Medicines which work on the pituitary gland. For example: goserelin and leuprorelin. These medicines are given by an injection.
  • Medicines which block the action of testosterone (anti-androgen medicines). For example: flutamide and cyproterone acetate. These medicines are tablets.
Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. Chemotherapy is not commonly used for the treatment of prostate cancer. It may be used for more advanced cancers.

Watchful waiting

In some cases it may be best not to have any active treatment but to see how the cancer develops. This is called watchful waiting. Various factors are taken into account such as the stage of the cancer, your age, general health, the impact and the potential side-effects if treatment were to be used. Watchful waiting may be more appropriate for men where the cancer is not causing much in the way of symptoms, and is slow-growing, especially in older men.

Newer treatments

Cryotherapy (also known as cryosurgery) is an alternative treatment for men with early prostate cancer and recurrent prostate cancer. It involves placing a number of metal probes through the skin and into the affected area of the prostate gland. The probes contain liquid nitrogen, which freezes and destroys the cancer cells.

High-intensity focused ultrasound (HIFU) treatment may be offered to some men, again with early prostate cancer. As this is still a relatively new procedure. HIFU involves inserting a probe into the rectum. It is then pushed through the wall of the bowel into the prostate gland. The probe produces a high-energy beam of ultrasound which then heats and destroys the cancer. The probe is surrounded by a cooling balloon to protect the normal prostate tissue from damage.

What is the prognosis?

The outlook for prostate cancer is very variable. Some prostate cancers are slow-growing and do not affect life expectancy. On the other hand, some have already spread to other parts of the body when they are diagnosed. The response to treatment is also variable.


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