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Health Centres - Prostate cancer
Written by Dr Russ Hargreaves, PhD, Director of Support and Information, The Prostate Cancer Charity, London UK
What is prostate cancer?Prostate cancer is a disease that affects men from around the age of 45 years. It involves the prostate gland, which is a small gland about the size of a walnut, positioned just beneath the bladder, and is responsible for producing fluids that nourish and protect sperm (see Figure 1).
Since the urethra (the tube that carries urine from the bladder) passes through the centre of the prostate gland, any growth within the gland will cause pressure on the urethra, causing difficulties in passing urine.
The disease is the commonest male cancer in the UK. Around 20,000 men in this country are diagnosed each year. Sadly, approximately 10,000 British men die of prostate cancer every year, so it is a disease that needs to be taken very seriously. Because we do not routinely screen for prostate cancer in the UK, the disease is very often detected only when it has spread away from the prostate gland to other parts of the body.
Why or how do I get prostate cancer and how can it progress?
It is still not entirely clear why some men develop prostate cancer and others do not. However, we do know that there are both genetic and environmental factors that can influence it.
In terms of genetic factors, you have a higher risk of developing prostate cancer if your father or brother had prostate cancer, although the increased risk is relatively small.
Perhaps more important are environmental factors such as diet and lifestyle. Vegetarians are half as likely to develop cancer as meat eaters. When we look at geographical differences, people living in the Far East such as the Chinese and Japanese have an extremely low risk of developing prostate cancer compared with those who live in Western countries such as America and Britain.
Scientists are currently investigating whether certain dietary factors may help to prevent prostate cancer. Much of this work is focussing on the mineral selenium and a substance from processed tomatoes called lycopene. Several very large studies have shown that both these agents lower the risk of developing prostate cancer.
- You cannot catch prostate cancer through sex, nor can you infect your partner with prostate cancer.
- Smoking is not linked to the occurrence of prostate cancer.
- Vasectomy was once thought to predispose men to prostate cancer but this is no longer considered to be the case.
Prostate cancer generally takes a long time to progress and it can take 10 years before it is detected. However, some men have a particularly aggressive form of the disease, and the disease can grow and spread more quickly. The cancer has a great tendency to grow on the outside edge of the prostate gland and can therefore easily break away from the gland itself.
Once it does this, it tends to travel almost exclusively to the bones including the hip bones, lower spine and ribs.
What are the symptoms?
. If the prostate gland grows significantly for any reason, it can put pressure on the urethra, and this may cause various problems. Common symptoms include:
- frequent visits to the bathroom to pass urine (frequency)
- having to wake up regularly throughout the night to pass urine (nocturia)
- a sense of urgency in getting to the bathroom in time (urgency)
- hesitation before the urine begins to flow (hesitancy).
Less common symptoms include:
- pain while passing urine
- blood in the urine
-
impotence (inability to sustain an erection)
- hip or lower back pain.
It is very important to emphasise that the presence of such symptoms does not necessarily mean you have prostate cancer. Indeed, any problem with the prostate will generally lead to some of these symptoms, which can include prostatitis - a prostate infection - or benign prostatic hyperplasia - a non-cancerous enlargement of the prostate gland. However, if you do have any of these symptoms, please consult your doctor since the earlier they are treated the better.
Equally important to emphasise is that many men, especially those in the early stages of the disease, do not develop symptoms at all. Therefore, a lack of symptoms does not always mean that you are free from the disease, and further tests will be needed to confirm this.
How is prostate cancer diagnosed?
There are two very simple and painless tests that can help to diagnose prostate cancer. Firstly, a test will be carried out to measure levels of prostate specific antigen (PSA) in the blood. The other test that can be carried out is a digital rectal examination (DRE).
- PSA is a protein produced exclusively by the prostate gland. All men have a small amount of PSA in their bloodstream (around 4ng/ml). If this level rises, and it can reach 3000ng/ml or more in some men, your GP may wish to refer you to a specialist for further tests.
- A DRE involves the doctor placing a finger inside your back passage and feeling the prostate gland to check its size and shape and whether any lumps can be detected. Although not very pleasant, this should not hurt in any way.
Although neither test is 100 per cent accurate, taken together they can alert the doctor to any possible concerns. Your doctor may also take into account your age, since prostate cancer generally affects men over the age of 50 years, and he may also ask about any family history of prostate cancer.
What else could it be?
A raised PSA does not necessarily mean that you have prostate cancer. Almost any condition that causes the prostate gland to grow or swell will result in a raised PSA test result.
PSA also rises slightly as you get older. Similarly, a DRE can be very difficult to interpret and may require the expertise of a doctor with specialised knowledge.
What can your doctor do?
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