Prostate cancer

What is it?
- The prostate is a small gland at the base of the male bladder. It produces prostate-specific antigen (PSA), an enzyme that liquefies semen after it has clotted.

- Prostate cancer affects more men in the UK than any other cancer, with around 27,000 cases diagnosed each year and 9,000 deaths. It is unusual in young men but incidence increases with age. It is common in men over 80.

- Prostate cancer is slow to develop. It only affects a small area of the gland and grows at such a slow rate that it often does not need treatment and has no symptoms. However, in young men it can metastasise, particularly to the bones.

Symptoms
- In the early stages of the cancer there may be no symptoms. But as the prostate enlarges there can be problems with passing urine.

- Symptoms include:

- Having to urinate more frequently;

- Waking up in the night in order to urinate;

- Sudden urges to urinate;

- Difficulty controlling the flow of urine;

- 'Dribbling' after urinating.

- It is important to note that most men with these symptoms will not develop prostate cancer. l Benign enlargement (benign prostatic hyperplasia) is very common in men over 50.

- Rarer symptoms include:

- Blood in the urine or semen;

- Prostate pain (located between the penis and anus);

- Pain in the hips, back or legs (because of bony metastasis).

Diagnosis
- On rectal examination a cancerous prostate is irregular and hard whereas a normal one is smooth and softer.

- If the prostate is enlarged, infected (prostatitis) or cancerous the level of PSA can be raised on blood test.

- A biopsy is used in order to confirm diagnosis.

Treatment
- Treatments depend on how advanced and aggressive the cancer is. They include:

- Observation - in slow-growing cancers in elderly men the patient has regular PSA blood tests. There is no treatment unless the cancer advances;

- Prostatectomy (removing the prostate) is followed by regular PSA tests to make sure there is no recurrence. It is only effective where the cancer has not metastasised. Side-effects include erection problems and incontinence;

- Radiotherapy - the prostate is treated with X-rays, either with an external beam or brachytherapy (radioactive seeds are placed in the tumour). As with surgery, it is indicated in younger men where the cancer has not spread. Side-effects include skin and bowel problems;

- Hormone therapy - prostate cells have testosterone receptors and grow when exposed to the male hormone. Hormone therapy reduces levels and works best in cancer that has metastasised. Side-effects include reduced libido, impotence and breast enlargement.

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