Prostate Cancer

Prostate cancer is a common disease and develops in the prostate gland affecting millions of men worldwide. Find out the common symptoms, diagnosis and treatment of this disease.

What is Prostate Cancer?

Prostate cancer is a malignant tumour that develops in the prostate gland, a walnut-sized gland located below the bladder and in front of the rectum in men.

Prostate cancer is one of the most common types of cancer in men and typically grows slowly, often without causing symptoms in its early stages. However, if left untreated, prostate cancer can spread beyond the prostate gland to other parts of the body, leading to serious complications.

Causes

The exact cause of prostate cancer is not fully understood, but it is believed to involve a combination of genetic, hormonal, environmental, and lifestyle factors. Possible risk factors and causes include:

• Age: Advancing age is the most significant risk factor for prostate cancer, with the majority of cases occurring in men over the age of 50. Prostate cancer is rare in younger men but becomes more common with increasing age.
• Family History: Men with a family history of prostate cancer, particularly in first-degree relatives such as fathers or brothers, have an increased risk of developing the disease. Certain genetic mutations or inherited predispositions may contribute to familial clustering of prostate cancer.
• Race and Ethnicity: Black men have a higher risk of developing prostate cancer compared to men of other racial or ethnic groups. Additionally, black men are more likely to be diagnosed with aggressive forms of prostate cancer and have higher mortality rates.
• Hormonal Factors: Hormonal imbalances, particularly changes in androgen levels such as testosterone, may influence the development and progression of prostate cancer. Androgens play a key role in prostate cell growth and function, and alterations in androgen signalling pathways may promote cancerous changes.
• Dietary Factors: Diet may play a role in prostate cancer risk, with high consumption of red meat, processed meats, dairy products, and saturated fats being associated with an increased risk. Conversely, diets rich in fruits, vegetables, whole grains, fish, and healthy fats may help reduce the risk of prostate cancer.
• Obesity: Obesity and excess body weight have been linked to an increased risk of aggressive prostate cancer and disease progression. Adipose tissue produces hormones and cytokines that may promote inflammation, insulin resistance, and tumour growth in the prostate gland.
• Environmental Exposures: Exposure to certain environmental toxins, chemicals, pollutants, or carcinogens may increase the risk of prostate cancer. Occupational exposures, such as to cadmium, pesticides, or polycyclic aromatic hydrocarbons (PAHs), have been implicated in prostate cancer risk.

Symptoms

Prostate cancer may not cause any symptoms in its early stages, and symptoms may vary depending on the size, location, and extent of the tumour. Common symptoms of prostate cancer may include:

• Urinary Symptoms: Changes in urinary habits, such as increased frequency of urination, especially at night (nocturia), difficulty starting or stopping urination, weak or interrupted urine flow, or pain or burning during urination.
• Blood in the Urine or Semen: Haematuria (blood in the urine) or haematospermia (blood in the semen) may occur in some cases of prostate cancer. Blood in the urine or semen may present as visible blood or may be detected on laboratory testing.
• Pelvic Pain or Discomfort: Pain, discomfort, or pressure in the pelvic area, lower abdomen, perineum (the area between the scrotum and anus), or lower back may occur with advanced prostate cancer or if the tumour has spread to surrounding tissues.
• Erectile Dysfunction: Difficulty achieving or maintaining an erection (erectile dysfunction) may occur in some men with prostate cancer, particularly if the cancer has spread to the nerves or blood vessels involved in erections.
• Bone Pain: Advanced prostate cancer may spread to the bones, particularly the spine, pelvis, ribs, or long bones, leading to bone pain, fractures, or weakness. Bone metastases can cause severe pain, immobility, and other complications.

Diagnosis

If you experience symptoms suggestive of prostate cancer or if you have risk factors for the disease, your doctor may recommend diagnostic tests and evaluations, which may include:

• Digital Rectal Examination (DRE): During a DRE, your doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland for abnormalities such as nodules, lumps, or enlargement.
• Prostate-Specific Antigen (PSA) Test: The PSA test measures the level of prostate-specific antigen, a protein produced by the prostate gland, in the blood. Elevated PSA levels may indicate the presence of prostate cancer or other prostate conditions, although PSA levels can also be elevated due to benign causes such as benign prostatic hyperplasia (BPH) or prostatitis.
• Imaging Studies: Imaging studies such as ultrasound, MRI, CT scan, or bone scan may be performed to visualize the prostate gland, assess the size and extent of the tumour, detect metastases, and guide treatment planning.
• Prostate Biopsy: If abnormalities are detected on DRE or if PSA levels are elevated, a prostate biopsy may be recommended to obtain tissue samples from the prostate gland for microscopic examination. A biopsy is the definitive diagnostic test for prostate cancer and helps determine the Gleason score, which indicates the aggressiveness of the cancer.
• Genetic Testing: Genetic testing may be recommended for individuals with a family history of prostate cancer or certain genetic risk factors to assess their risk of developing the disease.

Treatment and Management

Treatment for prostate cancer depends on various factors, including the stage, grade, aggressiveness, and extent of the tumour, as well as the patient’s age, overall health, and personal preferences. Treatment options may include:

• Active Surveillance: For low-risk, early-stage prostate cancer with a low Gleason score and slow growth rate, active surveillance or watchful waiting may be recommended. Regular monitoring with PSA tests, DRE, imaging studies, and periodic biopsies may be performed to assess disease progression and determine the need for treatment.
• Surgery: Surgical removal of the prostate gland (radical prostatectomy) may be recommended for localized prostate cancer, particularly in younger, healthier men with longer life expectancy. Robot-assisted laparoscopic surgery or open surgery may be performed to remove the prostate gland and surrounding tissues.
• Radiation Therapy: External beam radiation therapy (EBRT) or brachytherapy (internal radiation therapy) may be used to deliver targeted radiation to the prostate gland, killing cancer cells and shrinking tumours. Radiation therapy may be used as primary treatment or as adjuvant therapy following surgery.
• Hormone Therapy: Hormone therapy, also known as androgen deprivation therapy (ADT), may be used to reduce levels of male hormones (androgens) such as testosterone, which fuel the growth of prostate cancer cells. Hormone therapy may be used alone or in combination with other treatments to shrink tumours, control disease progression, or alleviate symptoms in advanced or metastatic prostate cancer.
• Chemotherapy: Chemotherapy may be recommended for advanced or metastatic prostate cancer that has spread beyond the prostate gland and is no longer responsive to hormone therapy. Chemotherapy drugs are administered intravenously or orally to kill cancer cells and slow disease progression.
• Immunotherapy: Immunotherapy drugs such as checkpoint inhibitors or targeted therapies may be used to stimulate the immune system to recognize and attack cancer cells. Immunotherapy may be used in combination with other treatments to enhance their effectiveness or as a standalone therapy in certain cases.
• Targeted Therapy: Targeted therapy drugs that target specific molecular pathways or genetic mutations involved in prostate cancer growth and progression may be used to block tumour growth, reduce metastases, or improve treatment outcomes.
• Clinical Trials: Participation in clinical trials may offer access to novel treatments, experimental therapies, or investigational drugs that are being evaluated for safety and efficacy in the treatment of prostate cancer. Clinical trials help advance scientific knowledge and may provide potential benefits to participants.

Follow-Up and Monitoring

After treatment for prostate cancer, regular follow-up visits with your doctor, urologist, or oncologist are essential to monitor treatment response, assess disease recurrence, and address any complications or side effects. Monitoring may include:

• PSA Testing: Periodic PSA tests may be performed to monitor PSA levels and detect signs of disease recurrence or progression. Rising PSA levels may indicate the presence of residual cancer cells or recurrent disease.
• Imaging Studies: Follow-up imaging studies such as MRI, CT scan, or bone scan may be ordered to evaluate the prostate gland, detect metastases, or assess treatment response.
• Physical Examination: Regular physical examinations, including DRE, may be performed to assess the prostate gland, detect abnormalities, or evaluate for signs of recurrence.
• Symptom Assessment: Your doctor will ask about any changes in symptoms, such as urinary habits, erectile function, pain, or discomfort, during follow-up visits.

Supportive Care and Survivorship

In addition to medical treatments, supportive care and survivorship programs play an important role in managing prostate cancer and improving quality of life for patients and their families. Supportive care services may include:

• Palliative Care: Palliative care focuses on providing relief from symptoms, pain, and stress associated with cancer and its treatment. Palliative care services may include pain management, symptom control, psychosocial support, and spiritual care to improve quality of life and support patient and family needs.
• Cancer Rehabilitation: Cancer rehabilitation programs help address physical, emotional, and functional impairments related to cancer and its treatment. Rehabilitation services may include physical therapy, occupational therapy, speech therapy, lymphedema management, or nutritional counselling to optimise recovery and restore function.
• Psychosocial Support: Psychosocial support services such as counselling, support groups, educational resources, or individual therapy may be available to help patients cope with the emotional, psychological, and social challenges of prostate cancer diagnosis and treatment. Support groups provide opportunities for patients and families to connect with others facing similar experiences, share information, and offer mutual support.
• Nutritional Support: Nutritional counselling and dietary support may be provided to help patients maintain a healthy diet, manage side effects of treatment, prevent malnutrition, and optimize nutritional status during and after cancer treatment.
• Exercise and Physical Activity: Regular exercise and physical activity are important for maintaining overall health, reducing treatment-related side effects, improving quality of life, and enhancing physical function and well-being in prostate cancer survivors. Exercise programs tailored to individual needs and abilities may include aerobic exercise, strength training, flexibility exercises, or relaxation techniques.

Conclusion

Prostate cancer is a common malignancy that develops in the prostate gland and affects millions of men worldwide.

While the exact cause of prostate cancer is not fully understood, it is believed to involve a complex interplay of genetic, hormonal, environmental, and lifestyle factors.

Prostate cancer typically grows slowly and may not cause symptoms in its early stages, highlighting the importance of regular screening and early detection.

If diagnosed with prostate cancer, treatment options may include surgery, radiation therapy, hormone therapy, chemotherapy, immunotherapy, targeted therapy, or participation in clinical trials.

Supportive care services, survivorship programs, and lifestyle interventions play a crucial role in managing prostate cancer, optimizing treatment outcomes, and improving quality of life for patients and their families.

By working closely with healthcare providers, staying informed about treatment options, and accessing support services, individuals with prostate cancer can navigate their journey with confidence and resilience.

Arranging To Visit A Private GP

To discuss any worrying symptoms that could be an indication of prostate cancer make an appointment with one of our private GPs. Appointments are available to everyone and can often be booked for the same day. There is no need to be registered with our Buckinghamshire hospital, or live locally.

If you have insurance which covers a GP visit, we can in most cases invoice the insurer directly. Where you are paying directly, the cost for a 30 minute consultation is £125.

Any additional costs will always be discussed. They could apply if you are referred for an MRI scan, or to a consultant, or for other agreed decisions to support your health.

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