What is it?
The prostate is a small gland about the size of a walnut situated at the base of the bladder and in front of the rectum. It is only found in men. The prostate produces a protein called Prostate Specific Antigen (PSA), which turns semen into liquid form.

Prostate cancer develops from cells within the prostate gland. Cancer of the prostate is a serious disease but is often slow to develop; so many men are unaware that they have this cancer.

Even if prostate cancer is diagnosed, it doesn’t mean it’s life threatening; in fact curative treatment many not even be required. Slow growing prostate cancer may not cause any problems during a man’s natural lifespan.
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Diet - Diets high in animal fats and milk products may be associated with a higher risk, and diets high in green vegetables may be protective. Vegetarians are half as likely to get prostate cancer compared to meat eaters. This supports the scientific theory that selenium and lycopenes (found in vegetables, particularly tomatoes) offer protection against prostate cancer. Age - Prostate cancer is rare in men under the age of 50. Family history - Men with a brother, uncle or father who have, or had, prostate cancer are at a slightly higher risk. Race - Afro-Caribbean/ African men are more affected than caucasian men, and the illness is rare among men of Far Eastern origin. Radioactive substances - Exposure to certain radioactive substances may increase the risk of prostate cancer.

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Symptoms

In its early stages, prostate cancer often does not cause symptoms. But when they do occur, they may include any of the following problems:

Having to rush to the toilet to pass urine. Passing urine more often and/or at night. Difficulty starting the flow of urine. Starting and stopping whilst passing urine. Discomfort (pain or burning) whilst passing urine. A feeling of not having emptied the bladder fully. Weak flow of urine. Blood in urine or semen. Pain in the back, hips or pelvis.

Most men with these symptoms do not have prostate cancer. Benign (non-cancerous) enlargement of the prostate gland is very common and effects over half of all men over the age of 60. This is called Benign Prostatic Hyperplasia or BPH.

However, it is vital that you do go and see your doctor as soon as possible if you are suffering from any of these symptoms so that the cause can be diagnosed straight away.
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Self-examination
There is no examination that you can do yourself, so the best thing is to be aware of the symptoms of prostate cancer and to see your GP if you think you are experiencing any.
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Ultrasound scan - sound waves are transmitted through the prostate to produce an image that can be examined by the specialist. Biopsy – a small tissue sample is taken, under local anaesthetic, to be examined under the microscope .

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Getting treated
There are many different treatments for prostate cancer and deciding what is right is not always straight forward, as there is a balance between treatment and side effects. Urologists often discuss individual cases with specialists in treating cancer (oncologists) as there are many issues to consider.

The type of treatment offered depends on the grade and stage of the cancer (how aggressive it is and whether it has spread outside the prostate), the age, and general health. There are four main types of treatment:

‘Watchful waiting’ - men are seen regularly and have PSA blood tests, but no treatment is given unless their condition deteriorates. Useful for slow growing, non-aggressive cancers in elderly men where the illness does not affect their life expectancy. Surgery - Depending on the type and stage of the cancer, doctors will remove part or all of the prostate gland (prostatectomy). This is particularly effective if the cancer is diagnosed early. Regular PSA blood tests are carried out afterwards to make sure the cancer does not come back. Surgery is only effective in younger men who have aggressive small cancers that have not spread outside of the prostate. It is a major operation with serious side effects. Many men afterwards find it difficult to get or keep an erection, and a minority will be incontinent. Despite this, some men prefer this treatment, since the long-term outcome is usually good. Radiotherapy - x-rays are delivered to the prostate either through the skin from the outside (external beam) or by placing small radioactive seeds directly in the prostate (brachytherapy) to kill cancer cells. It is effective on the same group of men as surgery and often a decision between the two has to be made, as the long-term results are similar. The risk of impotence and incontinence after radiotherapy is lower than after surgery, but radiotherapy has its own side effects including skin damage and bowel problems. Hormone Therapy - prostate cancer cells are very sensitive to the male hormone testosterone. By removing this hormone the cancer cells shrink and then remain static. Testosterone levels can be lowered by drugs. Men with metastatic prostate cancer, i.e. cancer that has spread either locally (around the area of the prostate) or to distant areas (usually the bones) are most suitable for hormone therapy. It is sometimes used before radiotherapy to shrink the cancer. It can be very effective in controlling the pain associated with cancer that has spread to the bones, and in many men controls their cancer sufficiently for them to live a normal life. Side effects can include lowered libido, possible impotence, hot sweats and breast enlargement, but generally it is tolerated well. In some circumstances combinations of different treatments are used. It is important for men with prostate cancer to be informed of all the benefits and risks when deciding what treatment is best for them.

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FAQs

Is there anything I can do to reduce the risk of developing prostate cancer?
Little is known about the genes and molecular mechanism of prostate cancer. Men with a brother or father with prostate cancer have a 3-5 fold increased risk. The illness has few symptoms in its early stages. When symptoms occur they may include difficulties in urinating or pain and/or stiffness in the lower back and hips. However, these symptoms are more commonly caused by other conditions, such as benign (non-cancerous) enlargement of the prostate or arthritis. If you have concerns, you should consult with your doctor.

Is the chance of developing prostate cancer influenced by dietary or environmental factors?
Eating a diet high in animal fat and low in fresh fruit, vegetables and fish and being exposed to cadmium (a heavy metal) or 'radiation' have been identified as possible risk factors which may be associated with prostate cancer. However research is still continuing in this area. Some preliminary research suggests that Lycopene (the compound that gives the tomato its appealing red colour), selenium and vitamin E in the diet could play a preventative role in the development of prostate cancer.

Will any treatment affect my sex drive and will I still be able to father children?
Different treatments for prostate cancer can cause impotence, reduced ejaculation, a lowered sex drive, urinary incontinence, bowel problems, hot flushes and sweats and tiredness. Surgery, radiotherapy and hormone therapy all have different side effects which need to be considered in any decisions about treatment.

I have heard about PSA screening. Is it necessary for all men over a certain age to be screened?
The PSA test (Prostate Specific Antigen) can be used to screen for early prostate cancer. A raised result does not necessarily mean you have cancer; a positive biopsy is needed to confirm the diagnosis. There is controversy whether PSA testing should be used in routine screening. Many medical professionals feel it will be wrong to introduce national screening because its effectiveness is unproven and the side effects of treatment can be significant. As a result there is no NHS PSA testing programme because it has not been demonstrated that it leads to an improvement in mortality.
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