Prostate Cancer is one of the most common cancers in men. Around 47,000 new prostate cancer cases a year are diagnosed in the UK with around 12,000 deaths from the disease.
At any one point around 400,000 men in the UK are living with the disease. Around 1 in 8 men will be diagnosed with prostate cancer but only a small amount of men will die from the disease around 3% or 1 in 30. So a lot of men that are diagnosed with the disease can live with it for many years and die from other causes. It is the job of your Urologist and Oncology team to establish if your prostate cancer is one of the more aggressive ones that requires treatment or one of the less aggressive forms that can just be monitored.
What are the symptoms of Prostate Cancer?
The majority of men that are diagnosed do not have any symptoms, it is just picked up with an abnormal PSA blood test or a lump felt on the prostate during a rectal examination. If a patient has symptoms, it can cause problems with the urinary system, or lower urinary tract symptoms (LUTS), typical symptoms include:
- slowing of the urinary flow
- pause before you pee or stop/start urination
- frequency of urination
- rushing to the toilet
- not emptying your bladder properly
- getting up at night to pee
However it must also be stressed that these symptoms can be just because of an enlarged prostate (benign or non-cancerous growth) and not prostate cancer. Prostate cancer can also cause retention (where a man is unable to pee at all), or blood in the urine or urine infections. Rarely patients can present with more advanced disease where prostate cancer has spread from the prostate gland. This can cause back, pelvic or bony pain, rectal problems, swelling of the legs or lymphoedema.
Am I at risk of prostate cancer?
All men are at risk of prostate cancer, the risk increases with age, i.e. the older you get the more likely you are to develop the disease. Other risk groups are family history and the black population.
If you have prostate cancer in the family then you are more at risk of developing prostate cancer yourself. The risk is higher if it’s your father or brother rather than a cousin or grandfather and higher if they are diagnosed young, under 55. If you have 2 or more family members then the risk is the highest. If you have a family history you should think about PSA testing from 45 or discuss this with your GP. In some rare genetic forms of prostate cancer it can be associated with Breast and Pancreatic cancer, this occurs in around 1.5% of prostate cancers. The genetics of prostate cancer are not fully understood but it is recommended that GP’s should consider PSA testing from 45 onwards. In some families with multiple cases we may consider specific genetic testing as this can have an impact on future generations.
The black population is also at increased risk of prostate cancer with a higher proportion of men being diagnosed with the disease. The disease can be more aggressive and diagnosed at a young age. Again recommendations for PSA testing should be from 45 onwards. Black men with a family history of prostate cancer with a fathers or brothers diagnosed young would be at the highest risk of all.
Obesity may also be linked not only to prostate cancer but other forms of cancer. Smoking doesn’t seem to be a risk factor for prostate cancer.
What can I do to prevent Prostate Cancer?
It’s important to maintain a healthy lifestyle. Keeping your weight under control and exercising regularly can be protective against cancer. For men a western lifestyle seems to put you at increased risk. A diet high in red meat, high fat diet or high in cholesterol or dairy products can increase risk. Protective foods include green tea, cruciferous vegetables such as broccoli and cauliflower, pomegranate and lycopene’s which are the denatured proteins found in cooked tomatoes.
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How do we diagnose prostate cancer?
To diagnose prostate cancer men go through a number of steps or investigations. It starts with a PSA blood test and/or a rectal or prostate examination. Men should not be fearful of this examination, it is quick, simple and pain free. Following that an MRI scan of the prostate would be organised and then prostate biopsies. Other investigations and scans are used to see if the prostate cancer has spread these include a specific type of CT scan called a PSMA PET CT or a bone scan.
Can prostate cancer spread?
Yes. Prostate cancer can spread, this is what really defines a cancer. It can grow locally and grow up into the bladder or out into the rectum or down into the penis, this would be regarded as advanced disease and would very commonly be causing symptoms. Prostate cancer can also spread in the blood stream or in the lymphatic system. Sites it can spread to commonly are the bones, commonly the pelvis, spine or ribs but can go to any part of the skeleton. It can also spread to other organs such as the liver, lungs or brain but this is much rarer and only tends to happen in very advanced disease. Through the lymphatic system it spreads to the local lymph nodes near the prostate in the pelvis or to lymph nodes higher up in the abdomen. The lymphatic system is an important part of your immunity, the lymphnodes are about the size of a baked bean. These little lumps can commonly be felt in your neck if you have a cold or flu and you have them all around your body. Scans are used after the biopsies in selected cancers to see if it has spread. The spreading of the cancer is known as Metastases.
How can we determine if my prostate cancer is life threatening?
As Urologists we do a number of things to determine if the prostate cancer is one of the more life threatening forms and therefore needs treatment. This can be summarised as “Staging” and “Grading” the disease.
Staging of the disease determines how big the cancer is and whether it is growing out of the prostate. If its not seen on an MRI or not felt and just picked up on a biopsy it would be a T1, if it is felt but still in the prostate gland it would be T2 and if its growing out of the prostate its T3 and if its growing into other organs its T4. We also add in a number if any lymphnodes are seen or any further spread around the body. This is known as the TNM (Tumour Nodes Metastasis) classification and all patients diagnosed will have a TNM allocated to them. TNM tends to be determined by the examination and scans.
Grading of the tumour is performed by our pathologists when they look at the biopsies under the microscope. This determines how aggressive the prostate cancer is. The grading system used is known as the Gleason Grading system. The pathologist looks at all the biopsies and adds up the most dominant grade seen and the worst grade so we get a combined score. The lowest score is 3+3=6 and the highest score is 5+5=10. So the grading system runs from 6 to 10. Grade 6 tumours are low grade and usually don’t need to be treated and grade 10 are the most aggressive cancers. A more modern grading system known as the ISUP grading system is also used and that’s on a scale of 1-5. The grading is all determined on the pathology whether that is prostate biopsies or tissue from prostate surgery.
Gleason Grading System
ISUP Grading System
4 + 3 = 7
The Grading and Staging of a Cancer will determine whether a prostate cancer needs treatment, but another very important point to consider is the age of the man diagnosed and what other health issues that patient has. To put it simply a very old patient diagnosed with prostate cancer is less likely to die from the disease than a younger man who has a much longer life expectancy. On the whole we look for a 10 year life expectancy with some flexibility if we are going to consider major curative treatments.
Other terms such as localised, early or organ confined, locally advanced, and advanced can also commonly be used.
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