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The prostate is a small gland in the pelvis that's found only in men. It's located between the penis and the bladder and surrounds the urethra, the tube that carries urine from the bladder to the penis.
The main function of the prostate is to help in the production of semen. The prostate produces a thick white fluid that is then liquefied by a special protein known as prostate-specific antigen (PSA). The fluid is then mixed with sperm, produced by the testicles, to create semen.
Prostate cancer is the most common cancer in men. It is responsible for 25% of newly diagnosed cases of cancer in England and Wales.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 65 or older.
For reasons that are not understood, prostate cancer is more common in men who are of Afro-Caribbean or African descent and less common in men of Asian descent.
The causes of prostate cancer are largely unknown.
The outlook for prostate cancer is generally good despite it being relatively challenging to treat. This is because, unlike many other cancers, prostate cancer usually progresses very slowly. It can take up to 15 years for the cancer to spread from the prostate to other parts of the body (metastasis), typically the bones. In many cases, prostate cancer won't affect a man's natural life span.
Once the cancer has spread to the bones it can't be cured, and treatment is focused on prolonging life and relieving symptoms. Approximately 9,000 men die from prostate cancer every year in England and Wales.
Prostate cancer can be cured when treated in its early stages. Treatments include removing the prostate, hormone therapy and radiotherapy (using radiation to kill the cancerous cells).
All the treatment options carry the risk of significant side effects including loss of sexual desire (libido), the inability to maintain or obtain an erection (sexual dysfunction) and urinary incontinence. For this reason many men decide to delay treatment until there is a significant risk that the cancer might spread.
Not enough is known about the causes of prostate cancer to prevent the condition from occurring. However, several studies have shown that eating plenty of tomatoes may reduce the risk. This could be because tomatoes contain a substance called lycopene which can help prevent damage to the DNA in our cells (antioxidant).
Symptoms of prostate cancer
Prostate cancer does not normally cause any symptoms until the cancer has grown large enough to put pressure on the urethra. This normally results in problems associated with urination.
Symptoms can include:
- having a sudden need to urinate,
- having pain during urination,
- frequent urination, especially during the night,
- the flow of your urine is weak and irregular,
- having problems beginning urination,
- feeling that your bladder is not empty after urination, and
- less commonly, blood in your urine.
It should be stressed that having the above symptoms does not mean you have prostate cancer. Many men's prostates get larger as they get older due to a non-cancerous (benign) condition known as benign prostatic hyperplasia.
Symptoms that the cancer is progressing to a potentially more serious stage include a loss of appetite, weight loss and constant pain.
Causes of prostate cancer
Cancer is caused when something affects the genetic material of our cells. This causes the cells to reproduce in an uncontrollable manner producing a lump of tissue, known as a tumour.
What causes the cells in the prostate to become cancerous is unknown.
There are a number of known risk factors for developing prostate cancer, which are discussed below.
- Age - 70% of all prostate cancer cases occur in men over the age of 65.
- Ethnic group - prostate cancer is more common amongst men of Afro-Caribbean and African descent. While the condition is relatively rare amongst men of Asian and South and Central American descent.
- Family history - having a close male relative - such as a brother, father or uncle - who had prostate cancer seems to increase the risk of you developing prostate cancer. Research also shows that having a close female relative who developed breast cancer may also increase the risk of you developing the condition.
- Diet - a diet high in dairy products and red meat has been linked to an increased risk of developing prostate cancer. Conversely, prostate cancer rates are lower in people who eat a mainly, or entirely, vegetarian diet, especially a diet containing lots of tomatoes which contain the antioxidant lycopene.
Diagnosing prostate cancer
Prostate-specific antigen (PSA) testing
The main test for prostate cancer is the PSA (prostate-specific antigen) test, which looks for raised levels of PSA in the blood. Prostate cancer increases the production of PSA, so the test may be able to detect prostate cancer in its early stages.
However, the test is problematic:
- Up to 20% of men who do have prostate cancer will not have a raised PSA level;
- Over 65% of men with a raised PSA level will not have cancer. PSA levels tend to rise in all men as they get older.
Digital rectal examination
The next step to confirming a diagnosis of prostate cancer is a digital rectal examination (DRE). This can be done by your GP.
During a DRE, your GP will insert a finger into your rectum (back passage). The rectum is close to your prostate gland, so your GP is able to check to see if the surface of the gland has changed. This will feel a little uncomfortable but it should not cause you pain.
Prostate cancer can cause the gland to become hard and bumpy. However, in some cases, the cancer causes no changes to the gland and a DRE may not be able to detect the cancer.
DRE is also useful in ruling out benign prostatic hyperplasia, as this causes the gland to feel firm and smooth.
Your GP will assess the risk of you possibly having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE and associated risk factors such as age, family history and ethnic group. If it is felt that the risk is significant you will be referred to a hospital to discuss the options of further tests.
The most commonly used test is known as a transrectal ultrasound-guided biopsy (TRUS).
During a TRUS biopsy, an ultrasound scanner (a machine that uses sound waves to build up a picture of the inside of your body) is used to study your prostate. This also allows the doctor to guide a needle through your rectum which is then used to take small samples of tissue from your prostate (biopsy).
The procedure can be uncomfortable and sometimes painful. You may be given a local anaesthetic to minimize any discomfort. The biopsy may also cause complications such as bleeding and infection.
Although it is much more reliable than a PSA test, a biopsy may miss up to 20% of cancers. Therefore, you may need to undergo another biopsy if your symptoms persist, or your PSA level continues to rise.
The samples of tissue from the biopsy are then studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread.
This is done by giving the samples a grade, known as a Gleason score. The lower the score, the less likely the cancer will spread.
- a Gleason score of 6 or less means the cancer is unlikely to spread,
- a Gleason score of 7 means that there is a moderate chance of the cancer spreading, and
- a Gleason score of 8 or above means that there is a significant chance that the cancer will spread.
If it is felt that there is a significant chance that the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
Two tests that are commonly used are:
- A magnetic resonance imaging (MRI ) scan - which uses magnetic waves to build up a detailed picture of the inside of your body. A MRI scan can tell if the cancer has spread beyond the prostate to the surrounding tissue.
- An isotope bone scan - this test uses radiation to detect any abnormalities in your bones. An isotope bone scan can tell if the cancer has spread to your bones.
Should I have a PSA test?
Treating prostate cancer
Staging of prostate cancer
The recommended treatment for your prostate cancer will be largely based on both your Gleason score, and what stage the cancer has progressed to. The stages of prostate cancer are explained below.
- T1 - there is a small tumour within the prostate gland. The tumour is too small to be detected with a rectal examination, but it may be detected during a biopsy. Generally the tumour will cause no symptoms.
- T2 - the tumour is still within the prostate gland but it is large enough to be detected with ultrasound or a rectal examination.
- T3 & T4 - the cancer has spread to the surrounding tissue.
- N1 - the cancer has spread to nearby lymph nodes (lymph nodes are glands that are found throughout our body.)
- M1a - the cancer has spread to other lymph nodes not near the prostate gland.
- M1b - the cancer has spread to the bones.
T1 and T2 tumours are known as localised prostate cancer.
T3 and T4 are known as locally-advanced prostate cancer.
Once the cancer has reached the N1 stage it is known as metastatic prostate cancer. It is unlikely that it will be able to be cured at this stage though the progression of the cancer can be slowed with treatment.
Deciding on a treatment plan
Once the cancer has been detected you will need to discuss possible treatment plans. It is likely that the discussion will take place with several doctors and other health professionals who each specialise in different aspects of treating cancer. They make up what is known as a multi-disciplinary team (MDT).
MDT often include:
- a clinical oncologist (a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy),
- a pathologist (a specialist in diseased tissue),
- a urologist (a specialist in the surgical treatment of prostate cancer),
- a social worker,
- a psychologist,
- a specialist cancer nurse, and
- a counsellor.
There are several factors that you will need to take into account when deciding on your treatment. They include:
- your age,
- the likely progression of your cancer,
- the stage of your cancer, and
- the possible side-effects of treatment.
No-one will try to hurry you into making a decision, and you should feel free to talk to as many people as you want, including friends, family and your partner.
Many people find that writing a list of questions at home to ask the MDT is helpful.
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision will be yours.
Treatment options for prostate cancer are outlined below.
If the cancer is in its early stages, and is causing no symptoms, you may decide to delay any treatment and then wait to see if any symptoms of progressive cancer develop. This is often recommended for older men when it is unlikely that the cancer will impact on their natural life span.
This is also a treatment option for the early stages of prostate cancer. It is normally recommended for younger men where there is a chance that the cancer will impact on their natural life span.
Active surveillance involves you having regular PSA tests and biopsies to closely monitor the progression of the cancer. If these tests reveal that the cancer is likely to spread beyond the prostate you can then make a decision about further treatment.
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer.
Like any operation, this surgery carries some risks and there may be some side effects. These are outlined below.
- Some men have problems with urinary incontinence. This can range from leaking small drips of urine, to leaking larger amounts. However, for most men, this often clears up within 3-6 months of the operation. Less than 5% of men have long-term problems.
- Some men have problems getting an erection (erectile dysfunction). For most men, this improves with time, but some men will experience long-term problems.
- In extremely rare cases, problems arising after surgery can be fatal. For example, 0.1% of men who are under 65 years of age, and 0.5% of men who are over 65 years of age, will die following a radical prostatectomy.
For many men, having a radical prostatectomy will get rid of the cancer cells. However, for around two in five men, the cancer cells may not be fully removed, and for around one in three men, the cancer cells may come back some time after the operation.
Radiotherapy involves using radiation to kill cancerous cells. The levels of radiation are safe but they can cause side effects (see below).
Radiotherapy can be used to cure prostate cancer in its early stages, and also to slow the progression of advanced prostate cancer and relieve symptoms.
Radiotherapy is normally given in short sessions over the space of seven weeks. There are both short term and long term side effects associated with radiotherapy.
Short term effects of radiotherapy can include:
- discomfort around the rectum and anus (the opening through which stools pass out of your body),
- loss of pubic hair,
- tiredness, and
- cystitis - which is an inflammation of the bladder lining which can cause you to urinate frequently and urination may be painful.
Possible long term side effects can include:
- an inability to obtain an erection - this effects between 30 to 50% of men, and
- urinary incontinence.
As with radical prostatectomy there is a one in three chance the cancer will return.
Brachytherapy is a form of radiotherapy where a number of tiny radioactive seeds are surgically implanted into the tumor.
The risks of sexual dysfunction are the same as with radiotherapy, but the risks of urinary incontinence are a lot lower.
Hormone therapy is often used in combination with other therapies. For example, you may receive hormone therapy before undergoing radiotherapy or a radical prostatectomy, in order to increase the chances of these therapies being successful. Or hormone therapy may be recommended after other treatments, to reduce the chances of cancerous cells returning.
Hormone therapy can also be used to slow the progression of advanced prostate cancer and relieve symptoms.
Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow. So the purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone.
Most hormone therapies will cause loss of sexual desire and the ability to obtain an erection. These side effects should pass once the therapy is completed.
Other possible side effects include:
- hot flushes,
- weight gain, and
- swelling of the breasts.
A surgical alternative to hormone therapy is to surgically remove the testicles. This has proved effective in treating the symptoms of prostate cancer of 90% of cases. Though many men are reluctant to undergo the treatment because of its considerable psychological impact.
Trans-urethral resection of the prostate (TURP)
This is a surgical procedure similar to a TURP biopsy, except a larger piece of your prostate gland is removed. This is done to relieve pressure from the urethra in order to treat any problematic symptoms you may have with urination.
Treating advanced prostate cancer
Once the cancer has reached an advanced stage it is no longer possible to cure it. But it is possible to slow its progression, prolong life, and relieve symptoms.
Treatment options include:
- hormone treatment,
- and the use of painkillers (analgesics)
Information on chemotherapy and pain relief is provided below.
Chemotherapy uses special medicines that kill cancerous cells.
Possible side effects of chemotherapy include:
- loss of appetite,
- hair loss, and
- mouth ulcers.
You will also be more prone to infection when receiving chemotherapy. You should see your GP if you suddenly feel ill, or your temperature rises above 38ºC (100.5ºF).
There are many different medicines that can be used to relive pain (analgesics).
The analgesics used will depend on the severity of your symptoms. If you are experiencing mild pain then paracetamol can be used.
If you have more severe symptoms, an opiate-based analgesic, such as codeine or morphine may be required.
Constipation is a common side effect of these types of analgesic, so you may also be given a laxative
It is important to contact your MDT if you feel that the painkillers you have been given are not effective in controlling pain.
Deciding against treatment
As many of the treatments above have unpleasant side effects that can affect your quality of life you may decide against treatment. Especially if you are at an age when you feel treating the cancer is unlikely to significantly extend your life expectancy.
This is entirely your decision and your MDT will respect it. Of course, pain relief and nursing care will be made available as and when you need it.
For more information
The Prostate Cancer Charity offers advice on the different types of treatment available for prostate cancer. Go to www.prostate-cancer.org.uk (links to external site).
Complications of prostate cancer
If you have erection problems, or have loss the ability to obtain an erection, you should contact your GP. It may be possible to treat you with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis.
The most commonly used PDE5 is sildenafil (Viagra). Other PDE5s are available if sildenafil is not effective.
Another alternative is a device called a vacuum pump. It is a simple tube connected to a pump. You place your penis in the tube and then pump out all the air. This creates a vacuum which causes the blood to rush to your penis. You then place a rubber ring around the base of your penis which keeps the blood in place allowing you to maintain an erection for around 30 minutes.
If your urinary incontinence is mild you may be able to control it by learning some simple exercises. Pelvic-floor exercises can strengthen your control over your bladder.
To carry out pelvic-floor exercises following the instructions below.
- Sit or lie comfortably with your knees slightly apart.
- Squeeze or lift at the front as if you were trying to stop the passage of urine, and then at the back as if you were trying to stop the passage of wind.
- Hold this contraction for as long as you can (at least two seconds, increasing up to 10 as you improve).
- Relax for the same amount of time before repeating.
If your urinary incontinence is more severe it may be possible to treat with surgery. This would involve implanting an artificial sphincter - a sphincter is a muscle that is used to control the bladder.
Preventing prostate cancer
Routinely screening all men to check their PSA levels is a controversial subject in the international medical community.
In some countries, such as the USA, all men over 50 are recommended to have annual PSA test.
However, many European countries, including the UK do not offer routine PSA screening.
There are several reasons for this.
PSA tests are unreliable and often produce results that suggest the presence of prostate cancer when no cancer exists (a false-positive result). This means that many men undergo often invasive and sometimes painful biopsies for no reason.
Also some experts have questioned whether an early diagnosis of prostate cancer is actually worthwhile.
While it is true that treating the condition in its early stages is normally more successful, the side effects of the various treatments are potentially so serious that most men choose to delay treatment until it is absolutely necessary.
Also many men who received an early diagnosis then reported that they wish they have never been told. This is because they had to live for many years with the anxiety that the diagnosis gave them, yet the actual condition itself caused no significant physical pain.
Finally, there is no compelling evidence that a routine screening PSA programme affects the number of people dying from prostate cancer.
However, if you decide that you wish to have your PSA levels tested even if you do not have any symptoms, your GP will be able to arrange it for you.
As mentioned eating foods high in lycopene may prevent prostate cancer. Lycopene is what is known as an antioxidant - a special molecule that can help prevent damage to cells.
Foods high in lycopene include:
- tomatoes (tomato sauce (ketchup), soup and juice are all particularly high in lycopene),
- pink grapefruit, and
CHEN L, STACEWICZ-SAPUNTZAKIS M, DUNCAN C, SHARIFI R, GHOSH L, VAN BREEMEN R, ASHTON D, BOWEN PE (2001). Oxidative DNA damage in prostate cancer patients consuming tomato sauce-based entrees as a whole-food intervention. Journal of the National Cancer Institute. 93(24):1872-1879; doi:10.1093/jnci/93.24.1872
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ILIC D, O'CONNOR D, GREEN S, WILT T. (2006). Screening for prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004720. DOI: 10.1002/14651858.CD004720.pub2.
KUMAR, J., BARQAWI, A.B, CRAWFORD, E.D. (2004). Epidemiology of Prostate Cancer. Business Briefing: US Oncology Review.
KUMAR S, SHELLEY M, HARRISON C, COLES B, WILT TJ, MASON MD (2006). Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006019. DOI: 10.1002/14651858.CD006019.pub2.
NICE (2007). Draft guidelines on the diagnosis and treatment of prostate cancer.
MILES CL, CANDY B, JONES L, WILLIAMS R, TOOKMAN A, KING M. Interventions for sexual dysfunction following treatments for cancer (2007). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005540. DOI: 10.1002/14651858.CD005540.pub2.
Dr Chris Parker on the questions to ask
We asked Chris Parker, senior lecturer and honorary consultant in clinical oncology at the Institute of Cancer Research and Royal Marsden Hospital, what he would want to know about prostate cancer.
I have been diagnosed with prostate cancer. Can it be cured?
When men are told they've got prostate cancer, the word cancer obviously makes them they feel extremely anxious. But it is important to realise that prostate cancer is not like other cancers and in particular it is the only one that often does not require any treatment at all. Men can live with prostate cancer for decades without it causing them any problems whatsoever.
What is a risk group?
Most cases of prostate cancer are localised (confined to the prostate gland). Localised prostate cancer is divided into three risk groups:
- Low risk.
- High risk.
The risk groups are based on:
- What the prostate feels like when the doctor examines you.
- What the tissues samples look like under the microscope.
- What the prostate specific antigen (PSA) is in the blood.
If the prostate feels normal, the tissue samples look relatively normal under the microscope and the PSA level is less than 10, that's a low-risk prostate cancer. At the other end of the scale, if the prostate feels very abnormal and the tissue samples look aggressive under a microscope and the PSA level is more than 20, that is a high-risk localised prostate cancer.
Will I need treatment?
The treatment is very different for the three risk groups. Men with low-risk localised prostate cancers are often observed rather then treated immediately.
During this period of observation they have regular blood tests, to measure the PSA and will usually have repeat biopsies over the few years. As long as the cancer doesn’t progress, they can continue with observation.
If the PSA level rises significantly, or the biopsies show cancer progression, then they can go on to have either surgery or radiotherapy. This is called an active surveillance policy.
What is the best treatment for me?
The cure rate is no different between surgery or radiotherapy. They do, however, differ in terms of convenience and side effects. All treatment can cause adverse effects on bladder function, bowel function and sexual function, which is why not all men with prostate cancer require treatment. If treatment had no side effects then we would treat everyone, but treatment can have significant adverse effects so we aim to target treatment only to those who need it.
Support for carers
Being a carer isn’t an easy role. When you’re busy responding to the needs of others, it can deplete your reserves of emotional and physical energy and make it easy for you to forget your own health and mental wellbeing. Research on carers’ health shows that high numbers of carers suffer health effects through caring. And if you're trying to combine caring with a paid job or looking after a family, this can cause even more stress.
But putting yourself last on the list doesn’t work in the long-term. If you are caring for someone else, it’s important to look after yourself and get as much help as possible. It's in your best interests and those of the person you're caring for.
Look after your health
Eat regularly and healthily. If you don’t have time to sit down for every meal, try to make time to sit down for at least one of your day's meals. Instead of relying on fast food snacks, go for healthier options, e.g. fruit.
Look after your emotional health
It’s understandable if there are times when you feel resentful and then guilty for feeling like this. Combine that with exhaustion, isolation and worries about the person you’re caring for and it’s easy to forget about you. Don’t be hard on yourself – you’re human and those feelings are natural.
Look for support
Friends and family may not always understand what you’re going through and it can be helpful to talk to people in the same situation. Carers UK has a lot of useful information on its website and runs a helpline. Visit the website at www.carersuk.org (links to external site) or call CarersLine on 0808 808 7777.
Download the Carers UK booklet New To Caring (links to external site).
The Princess Royal Trust for Carers has a chatroom on its website and also runs 129 carers centres nationwide which provide information and advice and emotional support. For more information visit www.carers.org (links to external site).
Find out what benefits you're entitled to
You can find out the services available in your area by contacting your social services or local carers’ organisation or by visiting Carers UK's Finding Help page at www.carersuk.org/.
Other people to contact:
- Your GP and primary care team.
- Social services.
- For details of government services and information for carers, go to www.direct.gov.uk/carers (links to external site).
For more on support for patients and carers:
Social care for people with cancer
If you've been diagnosed with cancer, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it’s important to know exactly what kind of assistance is available and where you can get it.
If you're finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will be responsible for assessing exactly the kind of help you need. There are so many sources of help that it’s essential to have a social worker to guide you towards the correct course.
Social services can provide assistance with meals, laundry and/or a sitting service, where someone can come to your home. For more advanced care, an occupational therapist will be able to provide a more detailed assessment of your needs at home, making life easier by arranging equipment and making adaptations to your home.
A care attendant may also be organised to come and help with housework, dressing and washing, or even just to keep you company and give your carer a break. Look into this as soon as you can, as many care attendants have waiting lists.
Social care options include:
Crossroads is an organisation in England and Wales that helps carers for patients by visiting homes and taking over the responsibilities of care for a while. Visit the Crossroads website at www.crossroads.org.uk (links to external site), or phone 0845 450 0350.
Meals on wheels
Contact your local council about its meals on wheels service. It will usually be able to offer financial assistance to help pay for this. Go to www.local.direct.gov.uk (links to external site) for details of your eligibility.
You may be eligible for income support, disability living allowance or attendance allowance. Get in touch with the Benefit Enquiry Line for more details on 0800 882200 (textphone 0800 243355) or online at www.dwp.gov.uk (links to external site).
Your occupational therapist will assess your home and make changes to create a comfortable and practical place to live during your treatment. This could mean anything from putting a shower downstairs to adding handrails around the house.
For more on support for patients and carers:
'The first reaction I had was sheer horror'
Ian Liston was diagnosed with prostate cancer nearly five years ago, following what he thought would be a routine, annual check-up with his GP.
“I thought I was in perfectly good health. My doctor asked if I'd had any problem urinating. I'd been going to the toilet two or three times at night, which seemed a bit unusual, and I never felt that I'd completely emptied my bladder.
"When somebody tells you you have cancer, your first reaction is one of sheer horror. Not just for me, but also my wife. We were extremely shocked.
"When I calmed down, I found out what was going to happen, how long the disease was likely to last, and what treatments I would need. I tried to find out as much as possible. Knowing as much as I did and preparing myself made the illness a lot easier for me.
"When I was diagnosed with prostate cancer, there was evidence that the cancer had spread to my bones. Once it's escaped the prostate, you have to leave the prostate where it is rather than removing it, and try to control the cancer from outside.
"One of the most effective ways of doing that is hormone therapy, mainly Casodex and Zoladex. Zoladex is an easy drug to take: I take it either once a month or once every three months as an injection in my tummy, so I don't have to take pills every day.
"The main adjustment I made was changing my eating patterns. I stopped eating so many dairy products, and started using soya milk and soya yoghurt. I also cut down on red meat. I try to eat more fish and chicken. I’m trying to live a better lifestyle, including going to the gym.
"My advice to other men is to be aware of their bodies and not wait until diagnosis. I would say that if a man notices any changes, such as wanting to urinate two or three times a night, feeling pain, or feeling that your bladder is never quite empty after a pee, then you really should see your GP, because it could be an indicator of cancer.
"It might not necessarily be prostate cancer, but I think if you're ever in any doubt about what's happening in that part of your body you should talk to your GP because he or she will check you properly. Like any disease, the earlier it's found, the more that can be done to help you."
NHS Choices links
- Carers Direct
- Carers: end of life issues
- NHS Guide: prostate cancer
- News: genetic test
- News: obesity link
- News: green tea protects?
- News: lifestyle impact
- Live Well: the prostate
- The Prostate Cancer Charity
- UK Prostate Link
- Cancer Research UK
- Healthtalkonline: real stories
- Healthtalkonline: PSA Test