Prostate cancer develops when cells of the prostate (a small gland located below the bladder which is responsible for producing fluid that protects the sperm) mutate and start to multiply out of control. According to Cancer Research UK it is the most common type of cancer in men (with the exception of non melanoma skin cancer) and approximately 24% of cancers diagnosed in men are prostate cancers. In total around 35,000 men are diagnosed with this disease in the UK each year. It generally affects men over 50 and is uncommon in younger males.
Like with many cancers, it is unclear exactly what causes prostate cancer to develop. However, there are a number of associated risk factors which include:
1) AGE:- Your risk for developing prostate cancer increases with age. As I have already mentioned, prostate cancer is rare in men who are less than 50 years old and according to Cancer Research UK 63% of prostate cancer cases are diagnosed in men aged 70 or over.
2) DIET:- Although there is no strong evidence linking prostate cancer and diet, it is believed that a diet high in animal fats, high in calcium and low in fruit and vegetables may increase your risk of developing this disease. It is also believed that the antioxidants lycopene (found in tomatoes and tomato products) and selenium (found in meat, fish, eggs and cereal) can reduce your risk of contracting prostate cancer.
3) FAMILY HISTORY:- If one of your close relatives has prostate cancer then this increases your risk of developing the condition also. In particular having a father or brother with prostate cancer (particularly if they contracted the condition before reaching 60) is believed to magnify your risk. A family history of breast cancer is also believed to increase your risk of contracting prostate cancer (particularly if a close relative developed breast cancer before reaching 40). The reason behind this is that it is thought a faulty inherited gene may be responsible for the development of cancers in certain families (although a specific gene has not yet been identified).
4) RACE:- Black men and mixed race men have a greater chance of developing colon cancer than white or Asian men. This is again believed to be down to inherited faulty genes but an exact cause has not been identified.
The symptoms of prostate cancer are largely linked to growth of the prostate which then puts pressure on the urethra (the vessel used to excrete urine from the body). They include:
– Blood in the Urine.
– Difficulty Urinating.
– Erectile Dysfunction.
– Frequent Urinating.
– Pain when Urinating.
– Strong urgency when the need to urinate arises i.e. having to rush to the toilet.
If you notice any of the above symptoms then you should consult your doctor immediately. In a lot of cases the enlargement of the prostate is benign (non-cancerous) but on the other hand many men suffering from prostate cancer do not develop any symptoms. Therefore, if you have any concerns (however small) you should seek the advice of your doctor right away. They will then be able to perform a number of tests for prostate cancer which include:
1) PROTEIN SPECIFIC ANTIGEN (PSA) TEST:- PSA is a protein that is produced by the prostate. A small amount of PSA is normally found in the blood but higher than normal levels can be found in men with prostate cancer. The PSA test is a blood test which measures the level of PSA in your blood. Whilst the PSA test can be useful in detecting early prostate cancer it does have a number of limitations, mainly because PSA levels can also be affected by:
– Prostate Biopsies.
– Prostate Surgery.
– Urinary Catheters.
Even if the PSA test does uncover early prostate cancer there are still further complications. Since the majority of prostate cancers grow very slowly they may never grow large enough to affect an individual’s quality of life. In these cases, the negative side effects of treatment may be worse than the damage caused by the prostate cancer. Therefore, having a PSA test can actually create a dilemma as to whether you should opt for early treatment or not.
2) DIGITAL RECTAL EXAMINATION (DRE):- This test involves your doctor inserting a gloved finger into your rectum. Since the prostate gland is close to the rectum this will allow your doctor to feel for any abnormalities in your prostate. The main limitation of the DRE test is that your prostate may feel normal even when cancer cells are present.
3) TRANS RECTAL ULTRASOUND SCAN (TRUS):- This type of scan involves using sound waves to build a picture of your prostate. This picture can then be used to measure the size and thickness of the prostate. However, it has the same limitations as the DRE test in that a prostate may look normal even when it has become cancerous.
4) BIOPSY:- A biopsy involves samples of tissue being taken from the prostate for further examination. Biopsies can be performed at the same time as the TRUS and can allow your doctor to identify any cancerous cells in the prostate tissue. The main limitation of the biopsy is that it is not completely accurate with between 5% and 10% of biopsies coming back negative even when prostate cancer is present.
Although each of the tests have their limitations, collectively they work well in identifying prostate cancer. If prostate cancer is identified then your doctor will attempt to grade and stage the cancer. Grading refers to the appearance of cancer cells whilst stageing describes how far the cancer has spread. One of the most popular grading systems is the Gleason grade which gives the prostate cancer a score between 1 and 10 (with 1 being the least aggressive and 10 being the most aggressive). For stageing, prostate cancer usually falls under one of three bands:
1) LOCALISED (EARLY) PROSTATE CANCER:- This describes prostate cancers that are still relatively small and contained within the prostate gland.
2) LOCALLY ADVANCED PROSTATE CANCER:- This describes prostate cancers that have spread beyond the prostate gland into the nearby tissues.
3) ADVANCED PROSTATE CANCER:- This describes prostate cancers that have spread to other parts of the body.
After your prostate cancer has been graded and staged your doctor will then be able to recommend a suitable treatment. Your doctors decision will also take into account your age, your general health and your medical history. Based on this one of the following will then be recommended:
1) ACTIVE MONITORING:- If an early prostate cancer is identified with a low grade then the most appropriate solution may be to continue monitoring the cancer but to perform no immediate treatment. This method is particularly suitable for men who are over 70 because the prostate cancer is very unlikely to have an adverse impact on their life.
2) BRACHYTHERAPY:- This type of treatment involves your doctor using a needle to place radioactive seeds into your prostate gland. These seeds then deliver radiation to the prostate cancer directly. They remain in your prostate forever and over time they lose their radioactivity. This is a relatively new form of prostate cancer treatment but it is believed to be as effective as surgery. However, there are a number of side effects associated with this treatment. Approximately 30% of men will become impotent following brachytherapy and some men have also reported a temporary burning sensation when urinating after the treatment.
3) HORMONE THERAPY:- Prostate cancers depend upon the male hormone testosterone for growth. Hormone therapy uses drugs (and in some rare cases surgery too) to reduce the levels of testosterone in your body. This deprives the prostate cancer of testosterone in an attempt to halt its growth. This type of treatment is generally used to treat prostate cancers that are locally advanced or advanced. It is not 100% effective but it can successfully kill off some of the cancer cells and reduce the associated prostate cancer symptoms.
4) RADIOTHERAPY:- Radiotherapy involves aiming high doses of radiation at the prostate to kill of the cancerous cells. It is generally used to treat localised prostate cancer with a low grade. There are a number of side effects associated with this treatment with around 40% of men becoming impotent following radiotherapy and about 2% experiencing incontinence (unintentional passing of urine).
5) SURGERY:- Radical prostatectomy surgery involves the removal of the entire prostate gland. It is believed to be one of the most effective treatments for low grade localised prostate cancers. Although it is very effective, side effects are common with this type of surgery with 70% of men experiencing some form of erectile dysfunction, 40% of men using experiencing minor incontinence and 2% of men experiencing serious incontinence.
6) CHEMOTHERAPY:- Chemotherapy involves the use of anti-cancer medications to kill off or shrink any cancerous cells in the prostate. It may be offered as a treatment for prostate cancers that have become locally advanced or fully advanced. However, generally other prostate cancer treatments are opted for ahead of chemotherapy.
Deciding what to do after being diagnosed with prostate cancer creates a very difficult decision. Unlike the other types of cancer where treatment is generally a must, with prostate cancer there are a number of factors which can affect your decision. In some cases treatment will improve your life expectancy and quality of life but in other cases treatment can cause more problems than the prostate cancer ever will. On top of this there seems to be little preventative action that can be taken regarding prostate cancer. Although there are suggestions that the right diet can reduce your risk there is no solid evidence to support this. Ultimately, this is going to be a very difficult decision. Whilst this article provides you with some basic guidelines the best advice I can give you is to and see your doctor and fully discuss the eventualities of any decision you are considering. This will allow you to make the most informed decision possible.
Whilst every intention has been made to make this article accurate and informative, it is intended for general information only. Prostate cancer is a very serious, life threatening condition and you should discuss any concerns, treatments or lifestyle changes fully with your doctor.
Incontinence (NHS Direct)
Lycopene Information (Lycopene.org)
Prostate Cancer Information (Cancer Backup UK)
Prostate Cancer Information (Cancer Research UK)
Prostate Cancer Information (Net Doctor)
Prostate Cancer Information (Wikipedia)
Prostate Information (Wikipedia)
Selenium Information (Wikipedia)
Testosterone Information (Wikipedia)
Urethra Information (Wikipedia)