Prostate cancer is the most common cancer in men in the UK. It mainly affects older men, and is very common – about 1 in every 6 men will get it in their lifetime. But you have a very good chance of surviving prostate cancer. The prostate is a walnut-sized gland in men that produces seminal fluid, which helps sustain semen and transport sperm. It is located near the bladder. Prostate cancer is when cells in the gland change, causing abnormal growth. It develops slowly over time. Mostly it is confined to the parameters of the prostate gland and causes little serious harm, although it may cause troublesome symptoms. Less often, it can spread to other organs and threaten life. For this reason, prostate cancer found early has the best chance of treatment and therefore survival.
Symptoms occur when the prostate grows to a size where it starts pressing on the urethra (the tube that transports urine from the bladder out the penis). This may cause symptoms like urgency to pee, going to the loo more often, poor stream or a feeling of incomplete emptying. It is important to note that you can get these symptoms in a number of other conditions, so they do not necessarily mean you have prostate cancer. It doesn’t usually cause problems with getting or maintaining an erection, or with ejaculation. However, some of the treatments for prostate cancer may cause this as a side effect.
Age is the biggest risk factor for men getting prostate cancer, mostly affecting those over 50. For reasons poorly understood, it is much more common in black men than Caucasian men, and Asian men have the lowest risk. Obesity is a risk factor. There is also a genetic component, so those with fathers or brothers with prostate cancer are at a slightly increased risk.
There is no formal prostate cancer screening programme in the UK, but you can request a check-up if you are over 50. This will involve a blood test checking for prostate specific antigen (PSA), but this requires a discussion with the doctor first, as results are not clear-cut, they require interpretation and further investigations if positive. If negative, it doesn’t entirely rule out prostate cancer. If you are ethnically black, your doctor may consider checking your PSA from the age of 45, after discussion. Prostate cancer diagnosis requires several different investigations for confirmation. Along with checking PSA, your doctor will offer a physical examination of your prostate. This is an intimate exam that involves putting a gloved finger into the back passage and feeling the size and surface of the prostate gland. If the PSA level is raised and/or the examination of your back passage is concerning, your doctor will refer you urgently to a urology team for further cancer investigations. This may involve an MRI scan or taking a small sample of prostate tissue to be examined in the lab.
Some people have prostate cancer which is relatively stable, doesn’t cause any symptoms and therefore may not need any active treatment. This is especially true when caught early. In these scenarios, you may have regular (annual) scans to check the progress of the disease. If treatment is required, this can be done surgically by completely removing the prostate gland (or removing parts) or through radiotherapy with or without hormonal treatment. The side effects can include erectile dysfunction and problems with your urine, so it is important to consider the risks vs benefits. Your treating team will discuss this with you. It is always very important to manage the symptoms. If the cancer has spread to other areas of the body and cannot be cured, then the focus will be on that. There are some newer treatments available but their long-term effectiveness is not well known. Prostate cancer is very common but the chance of survival is very good. Almost 8 in 10 men will survive prostate cancer for ten years or more – the risk is improved the younger you are, and the earlier it is detected. The risk of death is, unfortunately, about twice as high for African or Caribbean men.