Introduction
Prostate cancer is the second most common cancer affecting males (skin cancer is the most common). The prostate is a gland that is only present in men and is located below the bladder. Shaped like a walnut it wraps around the urethra (the tube which carries urine/semen to the penis) and its function is producing components of semen.
Most types of cancer that form in the prostate gland are slow growing, although there are some more aggressive and faster growing variants.
Causes
The precise cause or causes of prostate cancer is not completely understood. However, there are a number of known risk factors for the condition. These are:
Age
The vast majority of diagnoses of prostate cancer are in men aged over 50 (99%). 60% of cases are diagnosed in men aged over 65.
Hereditary factors
Despite the fact that most men diagnosed with prostate cancer do not have a family history of the condition, there is nonetheless an elevated risk of developing the condition where there is a close blood relative (e.g. brother or father) with prostate cancer. Some gene mutations (including BRCA1, BRCA2) may also be risk factors.
Ethnicity
Prostate cancer is more common in North America, Europe and Australia than in South/Central America, Africa and Asia. This may be more to do with differences in diet and lifestyle than any other factors.
Symptoms
Most cases of prostate cancer do not cause any symptoms at all at an early stage. Those symptoms that do occur may include:
- Difficulty urinating. This can include needing to urinate more frequently than before, not being able to go when feeling the need to, discomfort when urinating, reduced or weaker urine stream.
- Presence of blood in urine or semen.
- Pain in lower back.
- Difficulty getting an erection (also known as 'erectile dysfunction' or 'ED').
In some cases, prostate cancer may put pressure on the spinal cord causing weakness or numbing in the feet or legs and in some cases loss of bladder or bowel control.
Tests / Diagnosis
The first step in diagnosing prostate conditions is a review of medical history and a physical examination, which involves a 'digital rectal examination' where the doctor inserts a gloved finger into the rectum. Further tests may include:
Prostate-specific antigen (PSA) blood test
PSA is present at higher levels in those with prostate cancer. The test is also used after a diagnosis of prostate cancer to monitor the treatment and guide ongoing management of prostate cancer.
Biopsy
This procedure involves the patient undergoing a general anaesthetic and the surgeon taking a number of core biopsies from the prosate. The biopsies are taken through the skin between the scrotum and anus under the guidance of an ultrasound.
Bone scan / CT (Chest / Abdomen / Pelvis) / PET PSMA
These tests are used to determine if there is any spread of prostate cancer out of the prostate gland
Treatment
Your surgeon will discuss with you the various treatment options available and which one may be the most suitable for you.
The treatment options include:
- Radical prostatectomy – surgical removal of the prostate.
- Radiotherapy.
- Active surveillance – deferring active treatment of very low-grade cancers but continuing to monitor the patient and commencing treatment when there is evidence of disease progression.
- Watchful waiting – treatment not designed to cure prostate cancer, but to prevent the complications that come from metastatic disease.