Cancer Care Operations Manager, Nurse Evelyn Wallace, and her team of Dedicated Cancer Nurses at AXA PPP, answer common questions about prostate health, as well as the symptoms, diagnosis and treatment of prostate cancer.
About the prostate
The prostate is a small gland that sits just beneath a man’s* bladder and in front of the rectum. Its main job is to produce the fluid that mixes with sperm to create semen. 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 an enlarged prostate include changes when you urinate (go for a pee). Not everyone will experience 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 needed. Having an enlarged prostate is not cancerous and it doesn’t increase your risk of getting prostate cancer.
Prostate cancer and risk factors
Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way. It tends to develop quite slowly, often has no symptoms, particularly in the early stages and, in many cases, there’s no need for treatment.
Prostate cancer is the most common cancer affecting men in the UK. According to Prostate Cancer UK, 1 in 8 men will be diagnosed with prostate cancer in their lifetime. Men over 50 years old tend to be most at risk (and it increases with age), as are those with a family history. For example, if a first degree relative, such as father or brother, has prostate cancer aged 60 years old or younger, this puts you at increased risk.
For reasons not yet understood, black men carry an even greater risk of developing the disease (1 in 4 in the UK).
Prostate cancer hasn’t yet been linked to any preventable risk factors, although some research has found that being overweight may increase a man’s risk of developing aggressive or advanced prostate cancer. So, maintaining a healthy weight, eating a healthy, balanced diet and keeping physically active might help to lower your risk of developing prostate cancer, as well as a number of other long-term conditions.
A healthy diet is 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.
Symptoms of prostate cancer
There are often no signs or symptoms of prostate cancer and those that exist may be very subtle and hard to detect. Often the first signs that there’s something wrong with the prostate gland are changes when a man needs to urinate. These changes may include:
• needing to urinate urgently
• difficulty in urinating (if the flow stops, starts or you have to strain to urinate)
• urinating frequently (particularly at night)
• feeling you can't fully empty your bladder
• pain when urinating (this is rare)
• blood in the urine or semen (this is rare).
Other symptoms that you should check with your GP include:
• severe weight loss
• lower back pain
• bone pain
• blood in your urine and/or erectile dysfunction (when you've had no previous problems).
It’s important to remember that many of the symptoms of prostate cancer can be caused by common, benign conditions, including prostate enlargement and inflammation of the prostate (prostatitis). Prostate cancer is the least likely scenario, however, if you’re worried, it’s always best to contact your GP.
How do you test for prostate cancer?
The NHS doesn’t offer a screening programme for prostate cancer in the UK, so if you’re at risk, or worried about any symptoms, speak to your GP.
Your GP will usually carry out a combination of the following to check for a prostate problem.
• A urine test – to detect an infection
• A digital rectal examination – a doctor will insert his finger via a man’s rectum to check for unusual enlargement, lumps or changes in texture to the prostrate
• A blood test to measure levels of a protein called Prostate Specific Antigen (PSA). This isn’t a fool proof 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.
As there isn’t a national screening programme yet, diagnosis of prostate cancer can differ depending on where you live. Anecdotally, in many cases men are given a (often unnecessary) biopsy before or instead of a detailed MRI scan.
A biopsy involves taking small samples of tissue for analysis via needle insertion into the prostate gland through the wall of the rectum. It’s an invasive procedure; uncomfortable for obvious reasons, with a chance of serious infection. In addition, significant cancer is missed up to 50% of the time.
In most cases, having an MRI scan can negate the need for invasive procedures. And if a biopsy is needed, a scan can help give a clearer picture of exactly where tissue samples should be collected, thereby maximising the likelihood of a correct diagnosis.
How is prostate cancer treated?
There are several different types of treatment depending on the stage of cancer, how aggressive (or fast growing) it is and your age.
For some low risk cases it may be most appropriate not to treat the cancer, but instead to monitor the condition until symptoms become worse – also known as watchful waiting.
Watchful waiting is most likely to be recommended for early stage prostate cancers with mild or no symptoms and older men (when the cancer or cancer treatment is unlikely to affect their lifespan).
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. These include:
Radiotherapy – where radiation beams are used to kill cancer cells.
Brachytherapy – this is also known as internal radiotherapy as radioactive materials are inserted directly into the tumour or prostate to kill cancerous cells.
High-intensity focused ultrasound (HIFU) – where high frequency sound waves are used to try and kill cancerous cells.
Hormone therapy – used to stop or slow the production of testosterone to stop or slow prostate cancer.
There is some research to show that radiotherapy is more effective when combined with hormone therapy.
Surgery – this could be keyhole surgery or open surgery and could include removing the prostate.
Surgical treatment of 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 robotic 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.
Side effects of prostate cancer treatment
The side-effects of prostate cancer treatment can vary greatly from person to person both in terms of the actual side-effects experienced as well as the degree and duration of these side-effects. Side-effects are therefore difficult to predict but can include:
• Incontinence – this often improves after treatment. Medications and pelvic floor exercises can help
• Erectile dysfunction – there are several different treatments for erectile dysfunction which can be effective
• Loss of libido
• Bladder problems
The management of treatment related side-effects is becoming increasingly effective and you should discuss any specific concerns with your treating specialist.
There’s lots of support and information available to you and your family. If you’ve got a health question our Ask the Expert service allows you to ask our team of friendly and experienced nurses, midwives, counsellors and pharmacists about any health topic.
Don’t feel alone. You can ask us anything about your health, any time. Find out more.
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* This information is based on guidance and evidence in men. If you’re a trans woman, male-assigned non-binary or intersex, this information is still relevant to you – but your experience may be slightly different. For more information, head to Prostate Cancer UK.
[ii] Prostate Cancer UK