Prostate cancer Q&A

Is there a prostate cancer screening service in the UK?

Currently there is no prostate cancer screening service on the NHS. This is because there is no reliable test that can screen for prostate cancer in men. The current PSA test is far from reliable and must be backed up with other diagnostic tests.

A number of new prostate cancer screening tests are in clinical evaluation trials, but they won't be available on the NHS until researchers can demonstrate that they are reliable.

The UK government does have a Prostate Cancer Risk Management scheme in place to advise men who are concerned about the risk of prostate cancer. The Department of Health has sent GPs fact sheets and information booklets to give to men concerned about prostate cancer.

If you are worried you have prostate cancer symptoms, you should see your GP.

What is the PCA3 test?

PCA3 stands for Prostate CAncer gene 3. Prostate cells contain PCA3 genes that make them produce a small amount of a specific protein. Prostate cancer cells make much more of this protein than normal cells. If your PCA3 protein level is high, it will leak into your urine and be detected by the test.

The idea behind the PCA3 test is to reduce the number of painful and invasive tissue biopsies of the prostate, which can cause complications in some patients. The current PSA test is not reliable enough on its own to accurately diagnose or screen for prostate cancer.

Clinical trials continue to assess whether the detection of high levels of PCA3 protein in the urine will accurately diagnose prostate cancer. At the moment, however, the PCA3 test is not accurate enough to be used on its own as a test for prostate cancer. You will still need to have a PSA test to help your doctor decide if you need a prostate biopsy.

The PCA3 test happens in two parts:

  • Urine test
  • Rectal examination

The rectal examination is still necessary as this will massage the prostate to make some of the PCA3 protein leak into the urine. You then give a urine sample straight after the rectal examination. The results will come back in a few days.

The PCA3 test is not currently offered on the NHS, but may be available at some private hospitals and clinics for about £350 (1). If you are being treated privately, ask your insurance company if a PCA3 test is available at one of their clinics.

Isn't there a hormone replacement therapy patch for prostate cancer?

Clinical trials are now testing whether hormone replacement therapy patches could work as a treatment for men with advanced prostate cancer.

Usually, hormone replacement therapy (HRT) patches are used by women to relieve symptoms and risks of the menopause, such as hot flushes and osteoporosis. The patches contain the hormones oestrogen and progesterone.

Small-scale studies have found that men who were treated with HRT patches felt that they had an improvement in their quality of life. However, in these studies there was no comparison made with any standard type of prostate cancer treatment.

In order for this treatment to be available to patients, it will have to be studied in large-scale randomised clinical trials, which will compare the new treatment of HRT patches with the standard hormone treatment currently given to men with prostate cancer.

Can dietary supplements help me avoid getting prostate cancer?

If you want to take dietary supplements you should talk to your doctor first to check that the ingredients do not interact with any medication you are taking.

One dietary supplement that has undergone small-scale clinical trials is the isoflavone Trinovin. The chemical structure of isoflavones is very similar to that of the female hormone estrogen. Because of this similarity, isoflavones may reduce or activate the activity of estrogen.

One study (2) looked at 38 men with prostate cancer who were going to have surgery to remove their prostate glands. Half of the group took 160mg of Trinovin for the eight weeks before their surgery, while the other half did not.

The researchers measured the following before and after the men had their surgery:

  • PSA levels
  • The grade of the cancer (Gleason score)
  • Levels of testosterone in the blood
  • Examining the surgically removed prostate glands to see how many cancer cells had died
  • Isoflavone levels in the body's waste products

Researchers found no significant differences in the PSA, Gleason score or testosterone levels of men in the two groups. However, for the men who took Trinovin there was a significantly higher rate of cell death in the prostate cancer cells compared with the other group. In men who had low grade cancers, there was proportionally more abnormal cell death.

The study findings suggest that isoflavones taken as diet supplements may have some effect on the growth of prostate cancers. However larger and more rigorous studies will be needed to confirm these results.

Isn't there a new drug that helped cure men with advanced prostate cancer?

In June 2009, reports came out that a new drug treatment for prostate cancer had cured two men with inoperable prostate cancer.

Ipilimumab belongs to a class of drugs called monoclonal antibodies (MABs), which stimulate the immune system to fight disease. The drug is being tested on skin cancer, Hodgkin's disease, lung cancer and prostate cancer.

In a Mayo Clinic study (3) of prostate cancer, researchers say that standard hormone treatment greatly increased the immune response in the patients given ipilimumab.

The two men had been told that their cancer had spread beyond the prostate. Normally, when prostate cancer has spread into the abdomen and beyond, the outlook for survival is not good. In this study, after the two men had been given ipilimumab alongside conventional hormone therapy, their tumours shrank enough to be surgically removed. Both men have since made a full recovery.

It is important to be cautious about such encouraging results, however, as ipilimumab performed less successfully in the other types of cancer. How well the drug works will needed to be tested in much larger clinical trials to rule out that the hormone therapy they were already on did not bring about the tumour shrinkage.

Infolinks:

Refs:

  1. Cancer Research UK | The PCA3 test for prostate cancer | Accessed Oct 2009 | Last updated Sep 2009
  2. Jarred, Keikha & Dowling et al | Induction of Apoptosis in Low to Moderate-Grade Human Prostate Carcinoma by Red Clover-derived Dietary Isoflavones | Journal of Cancer Epidemiology, Biomarkers & Prevention (Dec 2002): 11; p 1689 | Online ISSN: 1538-7755 | Print ISSN: 1055-9965
  3. Clinical Trials.gov | MDX-010 for Advanced Prostate Cancer | First received Sep 2005 | Last updated Aug 2009

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