What is the prostate?
The prostate is a small, walnut-sized gland found only in men. It lies in the pelvis just below the bladder exit, surrounding the tube known as the urethra. Its job is to make some of the fluid in the semen which men ejaculate on orgasm.
Despite its modest size the prostate can cause serious problems in middle age. Like all illnesses, the faster any problems are diagnosed, the better the prognosis is likely to be.
What can go wrong
Although prostate cancer is the most commonly publicised disease affecting the prostate, there are several other ways in which it can malfunction. These include Benign Prostatic Hyperplasia (BPH) and prostatitis, which is an inflammation of the gland, occurring mainly in younger men.
Prostate cancer has become the most common cancer in men. Over 30,000 cases will occur in UK this year. It mainly, though by no means exclusively, affects men aged over 45. Every man is unique and this means that every case of the cancer will behave slightly differently. In some, the cancer will grow aggressively and in others it may grow so slowly as to cause no major problems during a lifetime. There are different stages in the growth of the cells. Initially it will be localised within the prostate itself but in time it may become malignant and start to invade surrounding cells. If unchecked, it may ultimately spread to other areas of the body forming what are called secondaries or mestastases.
The Early Signs
Symptoms of prostate cancer will vary according to exactly where the cancer starts and how it develops.
There is no particular symptom which confirms the presence of prostate cancer but the most common are those associated with urination.
Hesitancy, reduced flow, increased frequency (such as regularly getting up in the night) or lack of bladder control could all be signals. Other signs could be lower back pain; difficulty in getting or maintaining an erection; pain in the back, hips or pelvis or blood in the urine
.Anyone concerned in any away or in any doubt should consult their GP without delay.
What happens next
Your GP will ask you a series of questions to assist with a diagnosis and any further examination or tests they may consider necessary.
The initial step is likely to be a digital rectal examination. Generally uncomfortable rather than painful, this is a short procedure which allows the doctor to identify the physical nature of the prostate. You will usually be asked to lie on your side whilst the doctor inserts a lubricated finger into your back passage
.They may also ask for a urine sample to identify any infection or blood in your urinary system.
The most common way of diagnosing prostate cancer is the PSA test. This is a simple blood test to identify whether PSA, a normal product of the prostate gland, is appearing in the blood at “above normal” levels. Generally, though by no means always, men with a higher incidence of PSA in their blood are found to have prostate cancer. The higher the reading, the more aggressive the cancer is likely to be but this is neither a precise nor 100% reliable measurement and for this reason the medical profession view the result of any such test with great care. If the level is high however, the doctor will generally direct further tests to be carried out.
This will probably lead to a referral to the outpatients department at your local Dept of Urology where some of the tests may be repeated and where they may also conduct new explorations. These may include taking a tissue sample (biopsy) via the back passage and also scanning the prostate and surrounding area with radiographic (x-ray) equipment. These techniques will seek to establish the presence of a cancer and to identify how far, if at all, it may have spread.
How do they treat the cancer
This is a highly complex subject and not within the scope of this web site. However, the treatments adopted will depend upon how advanced the cancer is, your age and general state of health.
There are several different options because not all treatments are suitable for all patients. Generally the doctor will allow sufficient time for you to familiarise yourself with the available options before allowing you to make an informed decision.
The principal treatments currently in use are:
Active Surveillance (Watchful waiting)
Where no specific or immediate actions will be undertaken but where the patient will meet regularly and continuously with the consultant for check-ups to establish the progress and nature of the disease and to decide if and when further action may be pursued.
Chemotherapy
Powerful drugs, normally administered intra-venously and which may be used if the cancer has spread or hormone treatment has started to wear off.
Cryotherapy
Where hollow needles are inserted into the prostate and gases producing sub zero temperatures are used to freeze the prostate and kill the cancerous cells . Mainly used for salvage treatment after radiotherapy
.Hormone Therapy
May be used in conjunction with other therapies or on its own. Seeks to halt the production of testosterone (which encourages the tumour in the prostate cancer to grow) in the body. May involve tablets or injections of hormones or minor surgery to the testicles.
Hi Intensity Focused Ultra Sound (HIFU)
A new treatment not yet widely available in UK but viewed as an important option for the future. Carried out under spinal or general anaesthetic. A probe, incorporating an ultrasound scanner, is passed into the rectum. The probe emits a beam of ultrasound which is focused to reach a high intensity in the target area. Absorption of the energy creates an increase in temperature which destroys tissue. A cooling balloon protects the surrounding area from colateral tissue damage. May be used as a primary or salvage treatment and can be repeated if necessary. Treatment only takes between 1 and 3 hours.
Radiotherapy
An alternative to surgery whereby radiation, usually administered in a series of treatments, is accurately targeted at the prostate and surrounding area to destroy cancerous cells
.This includes Brachytherapy, a technique where radio-active seeds, offering a slow and controlled release of irradiation, are implanted into the prostate by hollow needles, administered under anaesthetic.
Surgery
Involving an operation carried out under general anaesthetic (Radical Prostatectomy) to remove the whole of the prostate gland. There are recently developed techniques which seek to minimise the trauma and impacts of this long-established procedure
Future developments?
