Prostate cancer is a serious disease, but in many cases it is a slow-growing cancer. Some men may have prostate cancer but experience no symptom because it is in the very early stages.

In other cases, particularly in younger men, there may be more symptoms and the cancer may be more aggressive and need active treatment. For some, it can spread to other parts of the body, particularly the bones.

Prostate cancer accounts for nearly a quarter (24 per cent) ⁽¹⁾ of all new male cancer diagnoses. In 2004, for example, the number of new cases diagnosed in the UK reached approximately 35,000 ⁽¹⁾. It is largely a disease of older men, as most who are diagnosed with the disease are aged 50 years and above ⁽¹⁾, so risk increases with age.

What is the prostate gland?

The prostate is only found in men. It is a small gland about the size of a walnut, which lies at the base of the bladder, just in front of the back passage (rectum).

The prostate wraps around the tube (the urethra) that carries urine as it passes from the bladder to the penis. When healthy, the prostate adds a special fluid to semen (sperm) and it also produces a protein called prostate specific antigen (PSA), which turns semen into liquid form.

What are the symptoms of prostate cancer?

Early prostate cancer rarely shows symptoms. And confusingly, the following signs and symptoms that may occur can also be a sign of other prostate problems which have nothing to do with prostate cancer, such as benign enlargement of the prostate or inflammation of the prostate.

Symptoms of prostate cancer can include:

• Needing to urinate more often, especially at night
• Needing to urinate urgently
• Dribbling urine after using the toilet
• Difficulty in beginning to urinate or a weak flow
• A feeling that the bladder has not emptied properly
• Pain on passing urine
• Bone pain
• Problems getting or keeping an erection
• Blood in the urine or semen (this happens rarely)

If you experience any of these symptoms, you should consult your GP to find out what is causing the problem.

The causes of prostate cancer are presently unknown, but according to The Prostate Cancer Charity, there are a number of risk factors that increase a man's chance of developing the disease ⁽²⁾:

Age

The risk of getting prostate cancer increases with age. Although it can affect men in their 40s, most men diagnosed with prostate cancer are over the age of 50

Family history

Prostate cancer often clusters in families. If a close relative (father, brother, uncle) has been diagnosed with prostate cancer, patient risk increases. If the affected relative was under the age of 60 at the time of diagnosis, or if more than one relative has been diagnosed with prostate cancer, the risk is becomes greater.

Ethnic background

African-Caribbean and African-American men are three times more likely to be diagnosed with prostate cancer than white men. It is also more common in Western countries. It is thought that diet and genes may play an important part

Diet

A diet high in saturated animal fats and proteins may increase the risk of prostate cancer

How is prostate cancer diagnosed?

Rectal examination (DRE)

The doctor will examine the prostate by inserting two fingers of a gloved hand into the rectum (back passage). This allows the doctor to feel if the prostate is enlarged in size and if it is irregular in shape. If it is, you will be referred for more tests. A rectal examination can be somewhat uncomfortable, but will not be painful.

PSA test

Prostate specific antigen (PSA) is a protein produced by the prostate which is released into the blood stream. A PSA test is a simple blood test that measures these levels. Although a high level of PSA can be an indication of cancer, it can also be an indication of other non-malignant conditions such as enlargement or infection of the prostate. If the PSA levels are raised, you may be referred to a urologist

Transrectal ultrasound guided prostate biopsy (TRUS)

During a TRUS biopsy, small tissue samples are removed (often under a local anaesthetic) for examination under a microscope. Side-effects of the biopsy can include passing blood in the urine and faeces, which can last for two to three days. Results can take up to two weeks. Examination of the tissue samples will show whether they contain cancer. Even if no cancer if discovered, your doctor may want to keep an eye on your condition with further PSA tests and rectal examinations

Further tests

If the biopsy confirms cancer, further tests will help your doctor see the size of the cancer and if it has spread. Tests include a CT scan, MRI scan or bone scan

How is prostate cancer graded?

If the biopsy shows cancer cells, they will be 'Gleason graded'. The Gleason grade tells the doctor how aggressive the cancer is likely to be and how quickly it may spread.

Gleason grading uses a scale from one to 10.

• Grade one cancerous tissue looks like normal prostate cells. From two to four, the cancer is less likely to spread.
• Grade five to seven: the cells look less like normal prostate cells and are more likely to spread.
• Grade eight to ten: the cancer is more aggressive and most likely to spread.

In other words the lower the grade, the closer the malignant cells' appearance and function to normal cells. Two samples of abnormal tissue patterns are usually analysed, and their individual score is added together.

The lowest possible Gleason score is two (where both samples are grade one) and the highest score is ten. Higher Gleason scores would normally indicate that the cancer is more active, but this is not always the case.

What will my treatment be?

Treatment options for prostate cancer depend on the grade and stage of the cancer (how aggressive it is and whether it has spread), as well as the patient's age and state of health. It is important to discuss them with your doctor.

Active monitoring or watchful waiting

Prostate cancer patients are seen on a regular basis for PSA tests, but no other treatment is prescribed unless their condition deteriorates. Watchful waiting may be used for small, slow-growing non-aggressive cancers in elderly men where the cancer will not shorten their life expectancy

Prostate surgery

A prostatectomy is an operation where the whole prostate is removed. It is only effective in younger men who have aggressive small cancers that have not spread outside the prostate. A prostatectomy is major surgery with serious side-effects. These include: mild to severe urinary incontinence; difficulty in obtaining or maintaining an erection; infertility.

Radiotherapy

This can be given either externally or internally, which is called brachytherapy. It is carried out under a general anaesthetic, or sometimes an epidural (spinal anaesthetic). The surgeon will place small radioactive metal seeds into the tumour within the prostate gland. The seeds release small doses of radiation very slowly over a period of time. The seeds are not removed, but stay in the prostate tissue, while the radioactivity fades away gradually over about a year. The radiation affects only the area a few millimetres around the seeds, so does not damage other internal organs.

Hormone therapy

Prostate cancer needs the hormones testosterone and androgens (the hormones produced by the testicles) in order to grow. Hormonal therapies reduce the amount of testosterone and androgens in the body. They can be given as injections or tablets, and occasionally an operation (subcapsular orchidectomy) will be done to remove the part of the testicles that produces testosterone.

What happens after treatment?

When your treatment is finished, you will have check-ups (PSA tests) on a regular basis. If you notice any new symptoms between check-ups, or if you are having problems (side-effects from treatment), you should let your doctor know.

Infolinks:

• The Prostate Cancer Charity
• Prostate UK
• CancerBACUP
• Cancer Research UK
• Macmillan Cancer Support
• The NHS Cancer Screening Programmes and CancerBACUP have produced a downloadable booklet called Understanding the PSA Test for men requiring further information