Prostate cancer

Symptoms occur when the prostate grows to a size where it starts pressing on the urethra (the tube that transports urine from the bladder to the penis and out). This may cause symptoms like urgency to pee, going to the bathroom more often, poor stream, or a feeling of incomplete emptying.

It is important to note that you can get these symptoms in several other conditions (such as harmless enlargement of the prostate gland), so they do not necessarily mean you have prostate cancer.

It doesn’t usually cause problems with getting or maintaining an erection or ejaculation. If the cancer spreads to other parts of the body such as the bones there may be other symptoms such as pain and weakness.

Age is the biggest risk factor for prostate cancer, mostly affecting men over 50. For reasons poorly understood, it is much more common in Black men than Caucasian men, and Asian men have the lowest risk. Obesity is a risk factor, and a high-fat diet also appears to increase the risk.

There is also a genetic component, so if you have a father or brother who was diagnosed with prostate cancer before the age of 60 you are at a slightly increased risk.

No standard prostate cancer screening program exists, but your doctor may recommend some tests. One will involve a blood test checking for prostate-specific antigen (PSA). Results are not clear-cut; they require interpretation and further investigations if positive. If negative, it doesn’t entirely rule out prostate cancer.

Prostate cancer diagnosis requires several different investigations for confirmation. Along with checking your PSA, your doctor will offer a physical examination of your prostate. This internal exam involves putting a gloved finger into the rectum and feeling the size and surface of the prostate gland.

If the PSA level is raised and/or the examination of your prostate is concerning, your doctor will refer you urgently to a urology team for further cancer investigations. This may involve an MRI scan or a small sample of prostate tissue to be examined in the lab.

PSA scoring system

The severity of prostate cancer is determined by three factors – the cancer cell grade, its stage and the blood PSA result. To grade the cancer, the biopsy sample is assessed and then scored using a system called the Gleason Score. This gives a rating of:

• 2-6 = low-grade prostate cancer that is likely to grow slowly
• 7 = intermediate prostate cancer, likely to grow at a moderate rate
• 8-10 = high-grade prostate cancer, likely to grow quickly

If tests are required to assess if prostate cancer has spread, these include bone scans, CT and MRI scans and abdominal ultrasound scans – this is known as ‘staging’ the cancer.

Some people have prostate cancer which is relatively stable, doesn’t cause any symptoms, and therefore may not need any active treatment. This is especially true when caught early and is often called ‘watchful waiting’. In these scenarios, you may have regular (annual) scans to check the progress of the disease.

If treatment is required, this can be done surgically by completely removing the prostate gland (or removing parts of it) or through radiotherapy with or without hormonal treatment. The side effects can include erectile dysfunction and problems with your urine, so it is important to consider the risks vs benefits. Your treating team will discuss this with you.

It is always very important to manage the symptoms. If cancer has spread to other areas of the body and cannot be cured, then the focus will be on that. Some newer treatments are available, but their long-term effectiveness is not well known.

Prostate cancer is very common, but the chance of survival is very good. Most men will survive prostate cancer for ten years or more – the outcomes improve the younger you are and the earlier it is detected.