Prostate Cancer

Prostate Cancer is the most commonly diagnosed cancer in men in the UK with over 41,000 men diagnosed per year. Globally, more than 1.3 million men are diagnosed with prostate cancer every year. 

What is Prostate Cancer?

Prostate cancer develops in a man’s prostate, the walnut-sized gland just below the bladder that produces some of the fluid in semen. It’s the most common cancer in men after skin cancer. Prostate cancer often grows very slowly and may not cause significant harm. But some types are more aggressive and can spread quickly without treatment.

The prostate can grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms similar to prostate cancer. This is called benign prostatic hyperplasia (BPH). It’s not cancer and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis. This inflammation or infection may also cause a fever and in many cases is treated with medication.

Signs and symptoms

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs

Advanced cancer can cause deep pain in the lower back, hips, or upper thighs.

Myths

Here are some things that will not cause prostate cancer: Too much sex, a vasectomy or masturbation. If you have an enlarged prostate (BPH), that does not mean you are at greater risk of developing prostate cancer. 

Risk Factors

Your risk of developing prostate cancer increases with age, but that doesn’t mean it’s a disease that only affects old men. Prostate cancer is the second most common cancer in men worldwide. Men who are black, and men who have a family history (a brother or father with prostate cancer), are 2.5x more likely to get prostate cancer.

Screening: Digital Rectal Examination & PSA Test

Your doctor may initially ask to do a digital rectal exam (DRE) to feel for bumps or hard spots on the prostate. After a discussion with your doctor, a blood test can be used to measure prostate-specific antigen (PSA), a protein produced by prostate cells. 

An elevated level may indicate a higher chance that you have cancer, but you can have a high level and still be cancer-free. 

It is also possible to have a normal PSA and have prostate cancer.

When should you get tested?

If you have any of the signs or symptoms as listed above you should have a discussion with your Doctor.

Routine asymptomatic surveillance of PSA is generally not advocated by Doctors in the UK.

Have a discussion with your doctor about when routine testing is right for you. The following recommendations usually apply.

  • Age 55 for average-risk men who expect to live at least 10 more years
  • Age 45 for men at high risk; this includes African-Americans and those with a father, brother, or son diagnosed before age 65
  • Age 40 for men with more than one first-degree relative diagnosed at an early age
Blood sample for PSA (prostate-specific antigen) test, prostate cancer diagnosis

PSA levels – What do they mean?

A normal PSA level is considered to be under 4 nanograms per milliliter (ng/mL) of blood, while a PSA above 10 suggests a high risk of cancer. But there are many exceptions:

  • Men can have prostate cancer with a PSA less than 4.
  • A prostate that is inflamed (prostatitis) or enlarged (BPH) can boost PSA levels, yet further testing may show no evidence of cancer.
  • Some BPH drugs can lower PSA levels, despite the presence of prostate cancer, called a false negative.

If either a PSA or a digital rectal examination test are abnormal, your doctor will likely recommend other tests. These may include a scan, a biopsy or a direct referral to a urology specialist.

2 Week Cancer Wait Referral

NICE guidelines in the UK advise GPs to urgent refer all men with abnormal digital rectal examinations or raised PSA levels above the normal reference range dependent on their age group.

This referral route will enable patients to be assessed as quickly as possible.

Treating prostate cancer

Treatment options are many and varied. Testing still can’t answer lots of key questions about disease aggression, prognosis and progression.

If you have been diagnosed with prostate cancer, it’s important to keep in mind that many prostate cancers are slow growing and may not need surgery or other radical treatment.

Treatment options may include:

  • Active Surveillance
  • Prostatectomy
  • Radiotherapy
  • Hormone Therapy
  • Chemotherapy

The actual risk of dying from prostate cancer is around 3% – and many cases do not warrant treatment.

If you need a referral to a specialist or further advice on prostate cancer, get in touch with our team of Doctors.