Q. What is the prostate?

A. The prostate is a small gland located underneath the bladder in men. It is shaped like a doughnut and fits around the tube (called the urethra) which carries urine out of the bladder. The prostate produces the fluid that mixes with sperm when a man ejaculates.

 

Q. What is prostate cancer?

A. Prostate cancer is now the most common cancer in men in many western countries. However, most prostate tumours are slow-growing and may not need treatment. Others grow quickly and eventually spread to the bones, where they can cause severe pain. Currently there are 30,000 new cases a year in the UK; 215,000 in the USA; 20,000 in Canada and 12,000 new cases a year in Australia.

 

Q. What are the symptoms of prostate cancer?

A. The main symptoms are difficulty passing urine, inability to urinate, passing urine often (particularly at night), weak or interrupted urine flow, pain when urinating, blood in the urine and pain in the lower back, hips and upper thighs. However, all of these symptoms can also be caused by other conditions such as benign prostate enlargement. Men with any of these symptoms should consult their doctor.

 

Risk Factors

Q. What causes prostate cancer?

A. In most cases, we do not yet know the cause of prostate cancer. Exposure to high levels of radiation is one known cause, but this only accounts for a tiny proportion of cases. However, between 5% and 10% of cases run in families, where the patient inherits a high risk of this type of cancer.

 

Q. Which men are at risk?

A. Prostate Cancer is very rare in men under 50. The risk increases after the age of 50 with half of all cases occurring in men over 75. Men from families with a history of prostate cancer are at higher risk than normal.

 

Q. Is diet linked to prostate cancer?

A. Some evidence suggests that a low-fat diet can reduce the risk of prostate cancer. Other studies have suggested that a diet high in tomatoes, Vitamin E, cruciform vegetables (such as broccoli, cabbage, cauliflower and brussel sprouts) and selenium can also reduce your risk. However, apart from selenium (see below), these findings have not been confirmed.

 

Q. Will a vasectomy increase the risk of prostate cancer?

A. It was thought that a vasectomy increased the risk of getting this cancer, but more recent research has suggested that there is no real difference in risk between men who have had a vasectomy and those who have not.

 

Q. Can prostate cancer be prevented?

A. Although there is no known way of preventing prostate cancer, studies have shown that men who took 200 microgrammes of selenium each day substantially reduced their risk of prostate cancer.

 

Q. Does prostate cancer run in families?

A. Some families have a higher risk of prostate cancer than others. The normal risk of getting prostate cancer some time in your life is 1 in 13. Having one or more close relatives (father or brother) who got prostate cancer under the age of 70 increases your risk by two or three times (ie your lifetime risk is between 1 in 7 and 1 in 4).

 

Testing / Screening

Q. Is early diagnosis important?

A. If prostate cancer is diagnosed early, it can be treated very successfully. However, when the cancer is advanced, it becomes very difficult to cure. All men over 50 should be aware of the warning signs and take themselves to their doctor.

 

Q. What tests can be used to detect prostate cancer?

A. A number of different tests are used, but none of them is conclusive on its own.

· Rectal examination - by inserting a gloved finger into the back passage your doctor can actually feel the prostate gland, to find out whether it is larger than it should be. Even if it is enlarged, this does not mean that it is cancerous.

· PSA blood test - if the level of Prostate Specific Antigen (PSA) in your blood is too high, this suggests that there is a prostate cancer, but there are several other conditions which cause an increase in blood PSA levels.

· Ultrasound - a small probe is inserted into the back passage and used to do an ultrasound scan, showing the exact size of the prostate.

· Biopsy - this involves taking a tiny sample of tissue from the prostate. A probe is inserted into the back passage and a small needle jabbed into the prostate itself.

· X-rays - an x-ray can reveal whether there is any cancer which has spread to the bones near the prostate.

 

Q. Is 'screening' available for prostate cancer?

A. At the moment, routine screening for prostate cancer is not carried out in any country, because none of the available tests are accurate enough. Screening men with the existing tests, such as the PSA blood test, would pick up many men without the cancer and would miss many who do have the cancer. However, if you have a family history of prostate cancer, screening may be available. You should talk to your doctor about this.

 

Q. Can prostate cancer be cured?

A. In half or more of patients the cancer is detected at an early stage and treatment is successful for nine out of ten of these cases. The other half of the patients are not diagnosed until the cancer is advanced and has spread. Treatment can give these patients several extra years of life and stop the pain of the disease, but cannot normally cure them.

 

Treatment

Q. What treatments are available for prostate cancer?

A. Sometimes prostate cancers are so slow growing that no treatment is needed. However, when treatment is necessary, there are three main types used:

· Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.

· Radiotherapy - in radiation treatment, high energy rays kill the cancer cells. This will help destroy the original tumour and also reduces the pain caused by tumour cells which have spread to the bones.

· Brach therapy;- this is a newer type of radiotherapy in which small radioactive pellets or wires are inserted directly into the prostate tumour, killing it from the inside. This is at least as effective as the other treatments and sometimes more so. There are also usually fewer side-effects with Brach therapy.

· Hormone therapy - since the growth and division of the prostate cancer cells depends on androgens (the male hormones), drugs can be used to either reduce the level of androgens produced by the body or block the effect of androgens on the cancer cells. These stop the growth of the tumour and sometimes shrink it. However, after about five years, most prostate cancers go on to develop the ability to grow without androgens and the hormone therapy stops working.

· Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.

 

Q. What are the side-effects of prostate cancer treatment?

A. There are normally no side-effects from surgery, although there is a risk of impotence as an after-effect.. Radiotherapy causes general side-effects such as tiredness, diarrhoea and nausea. These will all go away after the treatment has finished. The only long- term effect is impotence, which happens in about half of patients having long-term radiotherapy. Almost all patients receiving hormone therapy experience impotence while the treatment is being taken. Hot flushes, tiredness and weight gain are also common, but will cease when the treatment stops.