Prostate Cancer – Information, Treatment & Support

About the prostate

The prostate is a small gland found only in men. It is the size of the top of your thumb and surrounds the first part of the tube (urethra) which carries urine from the bladder to the penis. Its function is to produce a thick white fluid called semen which mixes with the sperm produced by the testicles. Its activity and function is dictated by male sex hormone, testosterone, which is produced in the testicles. Prostate cancer usually affects men over 50 and most of these cancers grow extremely slowly.

Although the causes of prostate cancer are unknown, there are some factors that are known to increase a man’s chance of developing the disease. These include:

  • Ethnic Groups: Some ethnic groups have a higher chance of developing prostate cancer than others. E.g. African-Caribbean men are more likely to develop prostate cancer, Asian men have a lower risk of developing it.
  • Family History: Studies have shown, men who have close male relatives (a father, brother, grandfather, uncle) who have had prostate cancer are slightly more likely to develop it themselves. It may indicate that a faulty gene is present, however a specific gene linked to prostate cancer has not yet been identified.
  • Diet: A diet, high in animal fat (including dairy products) and low in fresh fruit and vegetables may increase your risk of prostate cancer. A high intake of calcium (such as from dairy foods) may increase the risk. Tomatoes and tomato products (such as ketchup) may help to protect against prostate cancer, as it contains high levels of lycopene.

The symptoms of both benign enlargement of the prostate gland and malignant tumours (cancer) are similar and can include any of the following:

  • difficulty in passing urine
  • passing urine more frequently than usual, especially at night
  • pain when passing urine
  • blood in the urine (this is not common).

TIP: If you have any of these symptoms they should be checked by a doctor – but remember, they are common to many illnesses other than prostate cancer.

After visiting a GP a referral will probably be made to a hospital for some tests.

These may include:

  • Digital rectal examination (DRE): The doctor will feel for any abnormalities in the prostate by inserting a gloved finger into the rectum (back passage) as it is near the prostate. This may be uncomfortable but not painful.
  • PSA Test: A sample of blood is taken to check for PSA (prostate-specific antigen). PSA is a protein produced by the prostate and a small amount is normally found in the blood. Men with cancer of the prostate tend to have more PSA in their blood.
  • Trans-rectal ultrasound scan (TRUS): Ultrasound scans use sound waves to build up a picture of part of the inside of the body. To scan the prostate gland, a small probe is passed into the rectum (back passage) and an image of the prostate appears on a screen. A sample of cells (biopsy) can be taken at the same time for examination under the microscope. The scan may be uncomfortable but it only takes a few minutes.

If the results of the test show prostate cancer, a referral will probably be given to a doctor who specialises in the treatment of prostates (called an urologist).

Staging:

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original area of the body. There are a few different staging systems for prostate cancer, and one is described below:

  • T1 – the tumour is within the prostate gland, too small to be detected during a rectal examination but may be detected through tests such as a PSA test, a biopsy or a transurethral resection of the prostate gland.
  • T2 – the tumour is still within the prostate gland but is large enough to be felt during a digital rectal examination or show up on ultrasound. T1 and T2 tumours are known as localised prostate cancer (early prostate cancer).
  • T3/T4 – the cancer has spread beyond the prostate gland into the surrounding tissues. T3 and T4 are known as locally-advanced prostate cancer.

A team of doctors and other staff at the hospital will plan the treatment. It will depend on the size of the tumour and where it is. Treatment may be coordinated by an oncologist (a doctor who specialises in treating cancer with chemotherapy) a urologist (a surgeon who specialises in the prostate) and a radiologist (a doctor who specialises in treating cancer with radiation).

Treatment may involve:

Hormonal therapy for prostate cancer:

Hormones control the growth and activity of cells. In order to grow, prostate cancer depends on the hormone testosterone produced by the testicles. Hormonal therapies reduce the amount of testosterone in the body. It may be given before radiotherapy, and sometimes before surgery (neo-adjuvant therapy) for locally advanced prostate cancer. The aim is to reduce the chance of the cancer coming back. Hormonal therapy can also be given as a treatment on its own, improving survival rates in many cases. For more information about hormonal therapy, go to our hormonal therapy page.

Chemotherapy for prostate cancer:

Chemotherapy is mainly used to treat advanced prostate cancer that is no longer being controlled by hormonal therapy. It is used to try to shrink and control the cancer and relieve symptoms. For more information about chemotherapy, see our chemotherapy page.

Surgery for prostate cancer:

There are three types of surgery used to treat locally-advanced prostate cancer:

  • Radical prostatectomy: (This operation is only suitable for a small number of men with locally-advanced prostate cancer). The prostate gland is surgically removed either through a cut made in the tummy area (abdomen) or a cut made between the scrotum and the back passage. This aims to get rid of all of the cancer cells. The operation often causes impotence- the inability to have and maintain an erection.
  • Laparoscopic prostatectomy: The surgeon doesn’t need to make a large opening but can take out the prostate gland using only four or five small cuts (1cm each) in the tummy area (abdomen). The surgeon uses specially designed instruments that can be put through these small cuts.
  • Orchidectomy (removal of testicles): The aim of removing the testicles is to reduce the levels of testosterone (male hormone) in the body. Because hormonal therapy drugs are available and effective now, orchidectomy is not used very often.

Another type of surgery specifically for advanced prostate cancer is:

  • Trans-urethral resection of the prostate (TURP): Carried out if it is necessary to remove the part of the tumour that is blocking the urethra (the tube that drains urine from the bladder). A tube containing a miniature microscope is passed through the urethra. A cutting instrument attached to the tube is then used to shave the inner area of the prostate to remove the blockage.

This is done under a general anaesthetic or an epidural. For more information about surgery, go to our surgery page.

Radiotherapy for prostate cancer:

Radiotherapy is often given to people with prostate cancer before and/or after surgery. This is to shrink and destroy the tumour.

For more information about radiotherapy, go to our radiotherapy page.

Side effects:

There are some side effects of the treatments for prostate cancer which can be found in our side effects page.

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