Prostate cancer is the most common cancer for men in the UK. The good news is that thanks to the work of organisations such as Prostate Cancer UK and Movember and some high profile individuals including Stephen Fry and Bill Turnbull speaking publically about their own experiences of the disease, awareness is increasing and there has been an unprecedented rise in the number of men coming forward for testing.
Over the years we’ve answered countless questions from people concerned about, or dealing with a diagnosis of prostate cancer – their own or that of someone close to them. Here Evelyn Wallace, who heads our team of Dedicated Cancer Nurses answers of your questions about prostate cancer.
Q. What is the prostate?
The prostate is a gland that sits just beneath the bladder and in front of the rectum (back passage). It is responsible for the production of seminal fluid, which nourishes sperm produced in the testes.
It’s usually the size of a walnut and it gets bigger as you get older, making enlarged prostate (also known as benign prostate enlargement) extremely common in men over 50. Symptoms of enlarged prostate include changes when you urinate. Not everyone will experience any symptoms and if they do, or they become troublesome, they can be treated. Often simple lifestyle changes can help, but there are the options of medication or surgery if required. Enlarged prostate is not cancerous and it doesn’t increase your risk of getting prostate cancer.
Risk of developing prostate cancer
Q. Does a family history of prostate cancer increase my dad's risk of developing it?
A: If a first degree relative (i.e. father or brother) has had prostate cancer, this puts a man at an increased risk of getting it. The risk is greater if the relative was under 60 when diagnosed or if you have more than one close relative with prostate cancer. Note that you’re not necessarily at increased risk if family members are diagnosed when older, i.e. 70 years old or more.
A family history of breast cancer in someone’s mother or sister can also increase their risk of getting prostate cancer. It’s important to remember that having a family history of prostate (or breast) cancer doesn’t mean someone will get it. But if your dad’s over 50 it would be worth him discussing the matter with his GP so he’s aware of the signs and the testing options available.
Q. Can having a vasectomy increase my risk of prostate cancer?
A. The latest research has found no connection between vasectomies and overall risk for prostate cancer, or of dying of prostate cancer1.
Q. How much does diet impact the chances of male cancers?
A. Though there are claims that green vegetables, green tea, soy, foods containing lycopenes (including tomatoes and some other red fruits and vegetables) and selenium (found in Brazil nuts, fish, seafood, liver and kidney) may reduce your risk, a recent review of research in this field concluded that there was insufficient evidence that any specific foods can reduce prostate cancer risk.
Instead try to stick to a healthy diet, one that,
- is low in saturated fats but includes healthy fats, such as olive oil
- contains plenty of fruit and vegetables
- includes lean meat and oily fish, such as salmon, tuna and mackerel
- includes whole grains, pulses, nuts and seeds
- includes only small amounts of dairy, such as milk, butter, cheese and yoghurt
- contains limited amounts of sugar and salt (so stay away from most ready meals)
- limits processed meats, such as bacon, sausages, salami and burgers.
To find out more, visit our diet and nutrition centre.
Q. How does drinking alcohol affect the risk of developing prostate cancer?
A: A high alcohol intake can increase your risk of developing prostate cancer. If you’re concerned about your intake, read our article “How much is too much alcohol?”
Q. Will exercise reduce my risk of prostate cancer?
A. Exercise can help to reduce your risk, as can maintaining a healthy body weight, being overweight has been linked to an increased risk of prostate cancer.
Symptoms of prostate cancer
Q. What are the symptoms of prostate cancer that I should look out for?
Prostate cancer can have no symptoms for a long time, which is why screening is so important. Often the first signs that there’s something wrong with the prostate gland are changes when men pee. These changes may include:
- an urgent need to pee
- needing to pee more often, especially at night
- difficulty starting to urinate
- a weak flow when you do go
- feeling unable to empty the bladder fully
- dribbling after you urinate
If prostate cancer spreads outside the prostate it can cause the following symptoms:
- pain in the back, hip or pelvis
- erectile problems
- blood in the urine or semen
- unexplained weight loss
These symptoms could be caused by something else, such as an infection of the prostate (prostatitis) but you should see a doctor to establish the true cause and right treatment.
Checking for prostate cancer
Q. At what age do men need to have their first prostate exam?
A. For most men, it would be at or around 50 years old. Your doctor will check for unusual enlargement, lumps or changes in texture. Enlargement of the prostate gland doesn't necessarily mean cancer, the gland can enlarge naturally as you age.
Diagnosing prostate cancer
Q. How is prostate cancer diagnosed?
Your GP will usually carry out a combination of the following to check for a prostate problem.
The three main tests for a prostate problem are:
- A urine test – to detect an infection
- A digital rectal examination – physical examination of the prostate via the rectum to detect any abnormalities
- A blood test to measure levels of a protein called Prostate Specific Antigen (PSA). This isn’t a foolproof test as the protein can be produced by normal prostate cells as well as cancerous ones. It is also possible to have prostate cancer and receive a negative PSA result.
Depending on the results, your medical history, and risk factors, they may then refer you for further tests to determine what treatment, if any, is appropriate.
Hospital tests for prostate cancer include:
- TransRectal Ultrasound (TRUS) – examination of the prostate gland using ultrasound to detect any abnormalities
- MRI scan – creates a clear image of the prostate to show up any abnormal areas
- Biopsy – tissue samples are taken from the prostate to test for cancer cells.
Q. I am being treated for an enlarged, cancer free, prostate with medication. Given that Finestaride gives a false PSA reading, how often should I have my prostate checked for cancer?
A. If your PSA was normal to start with I would recommend annually. You must however inform your doctor that you are taking Finasteride.
Treating prostate cancer
Q. Is prostate cancer curable?
A: In many cases it is. It depends on how early it’s diagnosed and how well the patient responds to treatment. Survival rates have improved in the past few years with better treatment and early diagnosis.
Q. I have heard that some men don't get treated immediately. If I have cancer, shouldn't I get it taken out right away? Why wait?
A: Prostate cancer treatment can be a dilemma in that not all men require treatment. For some low risk cases it may be most appropriate to monitor the condition until symptoms become worse.
- Watchful waiting is most likely to be recommended for early stage prostate cancers with mild or no symptoms, older men when the cancer or cancer treatment is unlikely to affect their lifespan, and cases when the patient’s general health rules out treatment.
If the condition deteriorates, hormone therapy may be used to treat symptoms and slow progression.
- Active surveillance - This approach is used for slow growing cancer in patients who are otherwise fit and well. The aim here is to delay or avoid unnecessary treatment – and the side effects that go with it – until necessary. As the name suggests patients are monitored closely, with regular PSA tests and MRI scans for example, so that at the first sign that the cancer may be progressing it can be treated.
For other types, where the cancer has spread beyond the prostate (locally advanced or advanced prostate cancer), different treatments may be more appropriate.
- Surgery – to remove all or part of the prostate gland, or to remove the testicles.
- Radiotherapy – to kill cancerous cells with a view to curing localised cancer.
- Hormone therapy – to control the progression of advanced cancer and help treat the symptoms by blocking the effects of the testosterone hormone that prostate cancer needs to grow.
- High-intensity focused ultrasound (HIFU)
Prostate Cancer UK has lots of information on the full list of treatment options available and more on what drives the decision making process.
Q. What types of surgery are available for men with prostate cancer?
Surgery can treat prostate cancer that’s confined to the prostate (localised prostate cancer) or which has spread only just beyond that (locally advanced prostate cancer). It may be used to remove the cancer, to alleviate symptoms or to slow the growth of the cancer. It isn’t suitable for everyone.
There are three types of surgery for prostate cancer:
- Removal of the prostate gland (prostatectomy)
Here the aim is to cure the cancer by removing the whole prostate and the prostate cancer cells with it. This can be done in one of three ways: keyhole (laparoscopic) surgery, robot-assisted keyhole surgery (robotic prostatectomy) or open surgery. The three techniques are equally effective in treating the cancer and have the same side effects. However keyhole surgery has the advantage over the other two in that it generally results in less blood loss, less pain, less time in hospital and a shorter recovery time post-surgery.
- Removal of part of the prostate gland (TURP)
Both cancer and benign swellings within the prostate can press on the urethra making it difficult to urinate. The aim of this type of surgery is to remove some of the tissue in the inner prostate – whether it’s cancerous or not – to remove the obstruction and relieve symptoms. It won’t provide a cure for prostate cancer.
- Removal of the testicles (orchidectomy).
This type of surgery may be recommended to help slow the growth of the cancer. Again its purpose isn’t to provide a cure for prostate cancer. Instead, removing the testicles removes the source of the male hormone testosterone, which the cancer needs to grow. After removal the level of testosterone in the blood falls rapidly. This type of treatment is less common than using hormone therapy to manage testosterone levels. However it does have the advantage of being one single treatment as opposed to regular hormone injections.
Q. What kinds of treatments for prostate cancer are being developed?
A: New treatments include High Intensity Focused Ultrasound (HIFU), which aims to kill the cancer cells with high frequency sound waves. HIFU doesn't pass through solid bone or air, so it's not suitable for every cancer. As a new treatment, we can’t be sure of the long-term effectiveness of HIFU in treating prostate cancer. However, early indications are that it may be as successful as removal of the prostate or radiation therapy, but with fewer side effects such as incontinence and erectile dysfunction.
Q. I've heard of prostate cancer vaccines. Are they available yet?
A: There are some vaccines in drug trials, but nothing has been licensed yet.
Supporting a loved one with prostate cancer
Q. My Dad has just been diagnosed with prostate cancer, I'm finding it difficult to know how to support him, what's the best thing I can do to help?
A: Talk to him. Some men find it difficult to voice their worries and fears. Prostate Cancer UK http://prostatecanceruk.org/ have some helpful information which could be a good starting point for conversations.
If you have a health question, we here to help – Ask the Expert.
Prostate cancer – NHS factsheet
Benign prostate enlargement – NHS factsheet
Prostate problems – NHS factsheet
Cancer centre – AXA PPP healthcare
Prostate Cancer UK
AXA PPP healthcare Dedicated Cancer Nurses
1 In one of the largest studies to date, cancer epidemiologist Dr. Eric Jacobs and colleagues at the American Cancer Society compared data from 42,000 men over 40 participating in the Cancer Prevention Study II who’d had a vasectomy with a study of 7,400 prostate cancer deaths that occurred over the same 30 year timespan. They found no connection between vasectomies and overall risk for prostate cancer, or of dying of prostate cancer. [DOI: 10.1200/JCO.2015.66.2361 Journal of Clinical Oncology 34, no. 32 (November 10 2016) 3880-3885.]