Prostate Cancer
The prostate is a small gland that sits just below the bladder and surrounds the urethra (the tube that carries urine from the bladder into the penis).
Good-quality research has shown that screening for breast cancer, for example, is an effective way of saving lives. However, little good-quality research has been carried out on prostate cancer screening. There are strong reasons to think that screening for prostate cancer will not have the same benefits as screening for breast cancer
As men get older, the prostate can get bigger and may cause problems with passing urine. In most cases, the prostate getting larger is not caused by cancer. Men who have prostate cancer might or might not have symptoms.
You should see your doctor if you have any worries or symptoms such as:
1. Difficulty passing urine
2. Getting up regularly at night to pass urine.
3. Blood in your urine.
Prostate cancer is the third commonest cause of cancer death among men in the UK, after lung cancer and large-bowel cancer. Every year 19,000 men are diagnosed with it and 10,000 die on the disease. Prostate cancer mostly affects older men 80% of the cases occur in men over 65. At the age of 80, 50% of men will have some cancer cells in their prostate glands. It is normally however is a slow-growing cancer. Most men over 65 with the disease will die of something else, usually without even knowing they have prostate cancer.
Risk Factors. The complete picture is unclear, but there are some risk factors. A family history of one first degree relative doubles the risk and two quadruples the risk. Diet is likely to play a part with a possible increase risk with high fat diets with protective effects from a diet rish in Vitamin E, Selenium and Lycopene. This would ideally be one including brasil nuts, tomato's and brocholi.
Is screening for prostate cancer useful?
One way which may reduce the number of deaths from some cancers is to find the disease at an early stage before and' symptoms have appeared. (This is sometimes called screening.) Treatment may be more likely to be successful if it is started early.
How useful screening is depends on several things, including:
1. The accuracy of the test;
2. How good the test is at finding out who does and who doesn't have the disease; and
3 Whether effective treatments are available.
This explains what is known and what is not about a screening test for prostate cancer and about how effective current treatments are.
The PSA test
Screening test for prostate cancer involves a blood test for a substance called prostate specific antigen (PSA). Like most screening tests, it only gives an idea of whether the disease is present. If your PSA test result is high, you will normally need further investigations to reach a definite diagnosis.
PSA is made by the prostate gland. Men with prostate cancer often have higher levels of PSA in their blood than normal. However:
1. Some men who have prostate cancer do not have higher levels of PSA;
2. Some men who do not have prostate cancer do have higher levels of PSA; and
3. Two thirds of men who have higher levels of PSA do not have prostate cancer.
This means that the PSA test is not totally accurate in seeing whether there is cancer. PSA levels in the blood can be raised by several other conditions that affect the prostate gland. At the moment, the PSA test cannot tell the difference between men who have slow-growing prostate cancer and those who have the more aggressive disease.
If you have a PSA test, you will have to make several decisions. You need to think about what might happen when you get the test results.
What if the test result is normal?
If the test is normal, you probably do not have prostate cancer. Some men feel reassured by a normal result. However, the PSA test is not totally accurate. Up to 1% of men under the age of 50 will go on to develop 'invasive prostate cancer' (prostate cancer that spreads) in the next ten years. Among older age groups, slightly more men will go on to develop the disease.
What if the test result is high?
An unusually high level of PSA in your blood does not necessarily mean you have prostate cancer. Of every three healthy men who have a high PSA level, only one will have prostate cancer.
If the PSA test result is high, the test must be repeated. If it is still raised most patients are examined by a digital rectal examination to assess the gland through the rectum and then usually referred to a urologistsThese tests might include another PSA test, who will decide on the need for a needle biopsy and ultrasound scan.
The doctor might also use ultrasound to help take a needle biopsy. A needle biopsy normally involves the doctor putting a needle up your rectum and into your prostate gland to take small samples of tissue. The samples are then examined under a microscope to see if they contain any cancer cells. If they do, a doctor can estimate the grade and type of cancer by looking at the cells. He or she can then estimate how likely the cancer is to grow quickly. However, he or she cannot give any firm guarantees about the likely outcome.
On average, of every 100 men who have a needle biopsy, between one and five will develop a complication. The main complications are infection and, more rarely, bleeding which lasts a long time.
If the ultrasound or biopsy tests confirm you have prostate cancer, you and your doctor then face decisions about what to do about it.
Treatment options for prostate cancer
There are three options for people with prostate cancer that has not spread to other parts of the body:
1. An operation to remove the prostate;
2. Radiation therapy,
3. Brachytherapy
4. Watchful waiting.
There is no clear research evidence to tell us whether any of these treatment options do more good than harm. The studies which have been done do not suggest that any one option is better than the others.
Surgery (an operation to remove the prostate)
A surgeon will carry out an operation called a 'radical prostatectomy' to remove the prostate gland and the cancer cells it contains.
However, there is no clear research evidence to tell us whether men with prostate cancer who have their prostate removed live longer than those who do not.
For every 1,000 men with prostate cancer treated with surgery:
1. Between three and 20 will die because of the treatment;
2. Between 200 and 850 will experience impotence (when you can't get an erection); and
3. Between 10 and 270 will develop urinary incontinence.
It is difficult to predict who may benefit from surgery and who is likely to experience complications
Radiation therapy
A beam of X-rays can be directed to the prostate gland to destroy cancer cells.
Again, there is no clear research evidence to suggest that this treatment makes men with prostate cancer live longer.
For every 1,000 men with prostate cancer treated with radiation therapy:
1. Between two and five will die as a result of the treatment;
2. Between 400 and 670 will experience impotence (when you can't get an erection); and
3. Between 10 and 30 will develop urinary incontinence.
Brachytherapy
Radiotherapy seeds are inserted in to the prostate gland. The results of this are not yet fully known. It appears that bladder radiation side-effects may be greater than external beam radiation but there is a lower risk of impotence and bowel problems.
Watchful waiting
Watchful waiting involves keeping the cancer under review. A series of PSA tests may be taken to see whether your PSA levels are rising. The cancer is only actively treated if it grows quickly or causes problems.
Watchful waiting has no immediate risks, but of course the cancer may grow and cause problems during the waiting period.
Prostate Help Association