What is prostate cancer?

Prostate cancer is a cancer that arises in the prostate gland. In the UK, it is the second most common cancer in men. (The most common is non-melanoma skin cancer.) Just under 35 000 men each year are told they have prostate cancer. The vast majority are over 50; prostate cancer is very rare in younger men, unlike testicular cancer. 

Some studies of post mortem samples have shown that the risk of cancer of the prostate increases with age. Researchers estimate that all men who live to be 100 years old have prostate cancer. Many men develop prostate cancer in their later years but are never aware of it because it doesn’t cause any symptoms. They eventually die of something completely unrelated.

This article on prostate cancer is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

Prostate cancer survival rates are good

Treatments for prostate cancer have been refined in the last 30 years and survival rates have increased. In 1986, 42% of men diagnosed with prostate cancer lived for at least 5 years – but by 1999, this had risen to 65%. More recent figures from the USA suggest that close to 100% of men found to have prostate cancer now survive for at least 5 years – and 91% survive at least 10 years. The prospects for successful treatment of prostate cancer are now excellent.

In rare cases, prostate cancer can be quite aggressive and it can spread beyond the prostate gland and to other parts of the body, particularly to the bones.

What is the prostate gland?

The prostate gland is a gland about the size of a small plum that is just under the bladder in men. It wraps around the urethra, the tube that takes urine from the bladder to outside the body. This tube also carries semen out of the body during a man’s orgasm. The prostate gland provides the seminal fluid that mixes with sperm to make the semen.

What are the symptoms of prostate cancer?

Early stage prostate cancer usually produces no symptoms at all. If the cancer causes the prostate gland to enlarge, this can press on the urethra. This can cause a great urge to pass urine, or it can make passing water very difficult, because of the pressure on the tube. Diagnosing prostate cancer on the basis of symptoms only is hard because the same symptoms are caused by non-cancerous enlargement of the prostate gland. This is known as benign prostatic hyperplasia.

Screening for prostate cancer 

In the UK, there is no national screening program for prostate cancer as there is for breast cancer, cervical cancer and colon cancer. This is because there is no easy and reliable screening test available yet.

Prostate cancer must be suspected in a man over 50 who is having difficulty urinating, or who is having the urge to pass water often. A doctor will check this out by doing several tests:

• In a rectal examination, the prostate is felt through the front wall of the rectum. It is also possible to examine the prostate using a rectal ultrasound. Both tests can show if the prostate gland is enlarged. This indicates something is wrong, and explains the symptoms, but it cannot show whether prostate cancer is present or not.

• A blood test to measure Prostate Specific Antigen (PSA) is carried out. Generally it is more likely that a man might have prostate cancer if his PSA level is higher than normal, but, again, it cannot prove that prostate cancer is definitely the problem. The higher the PSA level, the more likely that cancer is the cause and the more likely the prostate cancer will spread.

• A PCA3 urine test is quite a new development. It measures the level of the protein produced by the Prostate Cancer Gene 3. Prostate cancer cells over produce this protein and it leaks into the urine. The test is still being trialled but if PCA3 levels and PSA levels are high, a man is usually then given a biopsy.

• A needle biopsy is carried out if the prostate gland feels hard or lumpy in the rectal examination and/or if the PCA3 and/or PSA level is very high. A few cells are taken by putting a needle through the rectum, guided by ultrasound. The cells are then examined to see if they are cancerous.

Treatment for prostate cancer

The treatment chosen for prostate cancer depends on the stage of the cancer and also an assessment of how likely the cancer is to spread:

• Men with early stage, localised prostate cancer whose PSA level is only slightly raised are regarded as being at low risk of their cancer spreading. Treatment may involve regular monitoring without treatment. Later treatment by surgery and/or radiotherapy is possible if the cancer starts to grow.

• Those with a slightly more advanced stage of prostate cancer, even though it is still within the prostate gland, and a higher PSA level are regarded as being at medium risk of their cancer spreading. Surgery to remove the prostate gland and/or radiotherapy is likely as the first line of treatment.

• Men with localised prostate cancer whose cancer is more advanced still, and who have a very high PSA level are at high risk of cancer spread. It is though likely their cancer will move out of the prostate gland within two years. Surgery and/or radiotherapy may also be followed by hormone treatment to prevent the prostate cancer spreading.

Living with prostate cancer

Prostate cancer is now a chronic disease. Many men live with it for 20 years or more, and it is then only sometimes related to their eventual death. The most important thing for anyone diagnosed with prostate cancer is to read up on the treatments available, get medical advice early and follow the recommended advice. Dealing with prostate cancer emotionally can be difficult, despite the good survival rates. If prostate cancer is worrying you and affecting the way you feel about life, counselling and help is available.

Profile of the author

Dr Kathryn Senior is an acclaimed medical journalist who has written over 500 feature articles for leading international journals within The Lancet group. As Senior Writer at Freelance Copy she produces high quality scientific and medical content for websites and printed publications for companies and organisations in the health, medical and pharmaceutical sectors.

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