Answering men’s biggest cancer worry
HE PROSTATE is a gland, which in young men i s the size of a walnut, at the exit of the bladder. It surrounds the male urethra, the tube which d r a i ns ur i ne from the bladder during urination. The prostate produces secretions that form part of seminal fluid.
HOW COMMON IS PROSTATE CANCER ?
As men age, the prostate tends to enlarge benignly and may compress the urethra, causing a slow urinary stream. Prostate cancer (PCa) can coexist with benign enlargement and may start as a small lump within the prostate which cannot be detected by a digital rectal examination. Most such cancers grow slowly. PCa is the most common cancer in men over 50 (excluding some skin cancers). Lifetime risk is one in eight and there were about 43,400 new cases and 10,800 deaths from it in the UK in 2012. About 84 per cent of men diagnosed survive for 10 years or longer.
WHAT ARE THE SIGNS OF PCA?
It often starts silently — early PCa is unlikely to affect passing urine or cause other symptoms. Over time, some PCas may grow enough to cause urinary difficulty. Advanced PCa can cause bleeding into the urine or semen and may spread to the bones, causing pain. It can often be detected by a digital rectal examination, as the prostate may feel hard or irregular.
SHOULD I BE CHECKED?
Screening would involve a blood test to detect a substance called prostate specific antigen (PSA) in the blood. PSA may be elevated when no PCa is present, resulting in unnecessary tests and worry, while some men may develop PCa despite a normal PSA.
There is evidence that screening can reduce a man’s chance of dying from PCa. But it also results in many men receiving unnecessary treatment, possibly with side effects, for slowly growing forms of PCa that would not cause harm. Men should understand the pros and cons of a test and make an informed choice.
Risk of PCa is increased in men whose father or brother have had the disease and in carriers of BRCA gene mutations. Although such mutations are more common in Ashkenazim, overall they are relatively rare. Men with known risk factors should be screened from age 40.
Menwithurinarysymptomsshould be investigated to find the cause.
HOW IS PCA DIAGNOSED?
Suspicion is typically based on a raised PSA blood test but other factors should be considered in interpreting this, including benign enlargement, urinary infection and previous PSA results. Suspicion may arise from an abnormal digital rectal examination.
Specialist prostate MRI scanning is effective in identifying PCa and, if negative, can be reassuring. A worrying MRI may lead to prostate biopsy to confirm the diagnosis and to assess the extent of the cancer if present.
HOW IS PCA TREATED ?
Treatment depends on the extent of cancer within the prostate (stage), the grade of PCa (which may predict cancer growth rate) and its spread, if any.
If PCa is contained within the membrane around the gland (capsule), treatments such as surgical removal, radiotherapy and other physical therapies are likely to be successful. Close surveillance alone may be recommended for some slowly growing cancers. When cancer has grown through the capsule but has not spread, radiotherapy is often combined with hormone treatment, while some urologists advocate surgical removal followed by radiotherapy.
If PCa has spread, hormonal treatment is used to control the disease and chemotherapy is held in reserve.
WHERE CAN I FIND OUT MORE?