The prostate, found only in men, is a small gland about the size of a chestnut situated in the lower abdomen, at the base of the bladder. It contributes enzymes, proteins, sugars and fats to the seminal fluid to nourish sperm. As men get older, due to hormone related changes, the gland may become enlarged. This causes pressure on the bladder and on the urethra (the tube within the penis which allows urine to flow freely from the bladder). The pressure on the tube leads to reduced flow and eventually to back pressure within the bladder. The majority of men who develop prostate problems have benign prostate hyperplasia (BHP) - a non-cancerous condition. BPH (benign enlargement of the prostate) is ten times more common than prostate cancer with prostate cancer being present in up to 10% of men over the age of 60.

Symptoms

The most common symptoms of BPH are:

Urinary irregularities e.g. Getting up several times during the night; not being able to visit town or the cinema without going to the toilet; having to interrupt business meetings;

Hesitancy when passing urine i.e. The time between when you are prepared to go and when the urine starts to flow;

A feeling of not quite emptying the bladder;

‘Dribbling’ after passing urine. In a healthy man, the stream of urine will cut off sharply but in a man with prostate problems, the normal cut off is interrupted and dribbling occurs;

Although men with an enlarged prostate don’t usually feel pain, they may experience discomfort.

 These symptoms are common to men with BHP but do not necessarily mean that they have prostate cancer. Although the symptoms of both benign and malignant tumours may be similar, sufferers of prostate cancer can also pass blood in the urine, experience pain on urination or ejaculation and in some cases pain in the lower back. If you experience any of these symptoms, you should visit your GP immediately who will carry out some tests or refer you to a Urologist.

What is Prostate Cancer?

Prostate cancer can be separated into three categories: Localised, Locally Advanced and Advanced.

·          Localised - contained within the prostate gland and not causing any apparent symptoms. This cancer is usually found as a result of screening or during the investigation for some other problem. Many of the localised cancers will never grow.

·          Locally Advanced - this has spread adjacent to the prostate

·          Advanced - the cancer has spread out from the prostate into the adjoining bones and tissue.

How can Prostate Cancer be detected?

Early detection is important. If you experience problems when passing urine, your GP may suggest tests to determine the problem. In all cases, a digital rectal examination will be carried out. This involves the doctor feeling the prostate for any signs of enlargement, nodes or stiffness or signs of abnormality. A PSA (Prostate Specific Antigen) blood test will also be carried out. This is a blood test involving a simple needle prick that will help detect the presence of cancer. The test measures how much specific antigen leaks from the prostate into the bloodstream. This can determine whether or not the problem is prostatic and the doctor can gain evidence of malignancy as cancerous cells leak much more of the enzyme into the bloodstream than in the case of benign tumours. A PSA reading of between 1 and 4 indicates a healthy prostate although it may be enlarged i.e. A benign growth is not the start of a cancerous prostate. A PSA reading above 10 or irregularity revealed by the digital rectal examination can indicate a 50% probability of cancer. If this is the case, an ultrasound biopsy is usually performed by a Urologist to take a sample of the cells for examination under a microscope. This biopsy involves a tube being eased up the rectum. The needle, guided by ultrasound pictures, snips off tiny bits for microscopic study and examination.

Risks

Although the cause of prostate cancer is unknown, it has been suggested that changes in the sex hormones of older men may play a part. It is also thought that men who have a diet high in fat may have a slightly increased risk of developing the disease. Some research suggests that a family history of the disease may be an indication of future problems, but this is evident in less than 5% of patients. It is unusual for a young man to develop prostate cancer, and the chance of being diagnosed with the illness increases dramatically from the age of 50.

What treatments are available?

Factors influencing the choice of treatment are:

- age

- natural life expectancy

- patient’s health

- whether the cancer is local, locally advanced, or advanced (metastatic)

Localised prostate cancer can be treated by surveillance (watchful waiting), surgery (radical prostatectomy), or radical radiotherapy (deep X-ray treatment).

Locally advanced prostate cancer can be treated by radiotherapy or hormone treatment.

Advanced prostate cancer can be treated by hormone therapy.

There are also treatments for specific symptoms. It is often necessary to remove the part of the tumour which is blocking the urethra and causing problems when urinating. The most common operation carried out is TUR (trans-urethral resection). It is usually performed under general anaesthetic and involves passing a tube into the urethra, via the penis. An instrument attached to the inside of the tube is used to remove the blockage.  

Prostate Cancer

What is Prostate Cancer?