Prostate cancer Dr Rob Hicks Prostate cancer is the most common male cancer in the UK, accounting for almost a quarter of male cancers. Each year, nearly 35,000 men are diagnosed and more than 10,000 die from the disease.

In this article

Symptoms Causes and risk factors

Treatment and recovery Advice and support

The prostate gland is located below the bladder and in front of the rectum. It’s about the size of a walnut, producing the liquid that nourishes, protects and carries sperm on ejaculation. It tends to increase in size with age, called benign prostatic hypertrophy, causing symptoms in some men like urinary frequency.

Often prostate cancer doesn't have any symptoms, but when they do occur they may include:

• The need to urinate more frequently
• Disturbed sleep because of the need to urinate
• Difficulty or pain when passing water
• Delay or hesitancy before urinating
• A feeling that the bladder has not completely emptied

It's important to be aware that there are a number of other, non-cancerous medical conditions that may also cause these symptoms.

In advanced prostate cancer, the following symptoms may occur:

• Weight loss
• Bone pain
• Pain in the loins, pelvis or lower back
• Blood in the urine

Cases are rare in men aged under 50, and risk factors include:

• Being overweight or obese.
• Having a father or brother with prostate cancer.
• Being of African-Caribbean or African-American descent and in western countries.

If diagnosed early, treatment can be quite successful. Therefore, it's important to be aware of the symptoms and to see a GP as early as possible. Currently in the UK there are no routine screening programmes for prostate cancer.

Most men with early prostate cancer are diagnosed because they have problems with bladder habits. A GP will perform a digital rectal examination (DRE) and arrange for any blood tests (a prostate specific antigen or PSA test). If this is elevated there is a possibility it may have been caused by prostate cancer. Patients are then referred to a specialist (urologist) for further investigations.

A specialist may then arrange a biopsy of the prostate. This should indicate whether or not prostate cancer is present and whether or not it's aggressive. Other tests, such as x-rays or scans may be necessary, assessing the extent of the cancer. These results will also influence the types of treatment available.

Treatment depends on a number of factors, primarily whether the cancer is contained within the prostate (localised) or has spread around the body (advanced).

Localised disease, where the cancer is small and contained, is generally managed by one of the four different treatment options:

• Surveilance Policy (monitoring of PSA tests and no immediate treatment)
• Surgery to remove the prostate
• Brachytherapy (radioactive seeds implanted in the prostate)
• Conformal radiotherapy (targeted) or Intensity modulated radiotherapy (highly focused radiotherapy)

Not all treatment options are suitable for everyone. Generally, for very early, good prognosis prostate cancer, all four options can be considered but have their pros and cons, so you should discuss what’s best for you with your doctor.

Patients with more aggressive cancers may need a combination of hormone therapy and radiotherapy, which requires daily treatment over a period of seven to eight weeks. Another option is radical surgery; this is a major operation requiring hospital admission for seven to ten days and a recovery time of two to three months. Laproscopic and laproscopic robotic surgery are alternative procedures which have advantages and disadvantages compared to open surgery.

Advanced forms of prostate cancer are often treated using hormone therapy, reducing the amount of testosterone in the body to slow down or stop the growth of the cancer cells, which can work for many months.

If hormone therapy is no longer effective, there are a number of treatments to control the cancer and improve quality of life, which you should discuss with your specialist.

There are a number of clinical trials available for people with prostate cancer which you should discuss with your specialist for suitability.

Prostate Cancer Charity

Tel: 0800 074 8383
Email: info@prostate-cancer.org.uk
Website: www.prostate-cancer.org.uk

This article was last medically reviewed by Dr Isabel Syndikus of Clatterbridge Centre for Oncology in March 2009.
First published in February 1999.