What is the prostate?

The prostate is a small, walnut-sized gland found only in men. It lies in the pelvis just below the bladder exit, surrounding the tube known as the urethra. Its job is to make some of the fluid in the semen which men ejaculate on orgasm. Despite its modest size the prostate can cause serious problems in middle age. Like all illnesses, the faster any problems are diagnosed, the better the prognosis is likely to be.

What can go wrong?

Although prostate cancer is the most commonly publicised disease affecting the prostate, there are several other ways in which it can malfunction. These include Benign Prostatic Hyperplasia (BPH) and prostatitus, which is an inflammation of the gland, occurring mainly in younger men.

Prostate cancer has become the most common cancer in men and according to Prostate Cancer UK, one in eight men will get prostate cancer in their lifetime. Over 47,000 cases occur in the UK each year and UK-wide, 3000 in Scotland. In the UK, 300,000 men are living with or after prostate cancer. Prostate cancer mainly, though by no means exclusively, affects men aged over 45. Every man is unique and this means that every case of the cancer will behave slightly differently. In some, the cancer will grow aggressively and in others it may grow so slowly as to cause no major problems during a lifetime. There are different stages in the growth of the cells. Initially it will be localised within the prostate itself but in time it may become malignant and start to invade surrounding cells. If unchecked, it may ultimately spread to other areas of the body forming what are called secondaries or mestastases.

What are the symptoms?

There are many simple steps to help identify prostate cancer in order to receive the best possible treatment and support. Note that there is currently no National Screening Programme for Prostate Cancer in place in the UK and the reasons are set out on the NHS web site, click here.

It is important to make sure you know your body and can identify any changes to it. Symptoms of prostate cancer can be: dribbling, an urgency to urinate or needing to get up frequently at night to urinate. Often, however, these symptoms can be for benign prostatic hyperplasia (BPH) rather than prostate cancer. However, early prostate cancer may not show any symptoms.

If you experience any of these problems go to your doctor immediately, no matter how small, it is better to be safe than sorry and the doctor will be able to prescribe medication or investigate further problems. Your doctor can always help no matter what the problem. Don’t be embarrassed your life is more important. No matter how small your problem seems to be your doctor will identify it and put your mind at rest.

Deciding on the best treatment is not always straight forward. The doctor will take into consideration the following:-

• How long you’ve had the cancer
• How much of the tumor was removed
• The likelihood/amount the cancer has spread
• Your age and general level of health

Anyone concerned in any away or in any doubt should consult their GP without delay.

What happens next?

Your GP will ask you a series of questions to assist with a diagnosis and any further examination or tests they may consider necessary.

The initial step is likely to be a Digital Rectal Examination (DRE). Generally uncomfortable rather than painful, this is a short procedure which allows the doctor to identify the physical nature of the prostate. You will usually be asked to lie on your side whilst the doctor inserts a lubricated finger into your back passage.They may also ask for a urine sample to identify any infection or blood in your urinary system.

The most common way of diagnosing prostate cancer is the PSA test. This is a simple blood test to identify whether PSA, a normal product of the prostate gland, is appearing in the blood at “above normal” levels. Generally, though by no means always, men with a higher incidence of PSA in their blood are found to have prostate cancer. The higher the reading, the more aggressive the cancer is likely to be but this is neither a precise nor 100% reliable measurement and for this reason the medical profession view the result of any such test with great care. If the level is high however, the doctor will generally direct further tests to be carried out.

This will probably lead to a referral to the outpatients department at your local Dept of Urology where some of the tests may be repeated and where they may also conduct new explorations. These may include taking a tissue sample (biopsy) via the back passage and also scanning the prostate and surrounding area with radiographic (x-ray) equipment. These techniques will seek to establish the presence of a cancer and to identify how far, if at all, it may have spread.

How do they treat Prostate Cancer?

When a man is diagnosed with prostate cancer (PCa), he may feel that he is entering a twilight world. Usually in a state of shock at hearing the dreaded “C” word, the patient also is confronted with the additional burden of making an Informed Choice of treatment. For advice on how to determine treatment choice go to our Newly Diagnosed page here to help you make an Informed Choice and ask the right questions of a clinical specialist.

Here is a list of the more common treatments:

Radiotherapy (including Brachytherapy)

An alternative to surgery whereby radiation, usually administered in a series of treatments, is accurately targeted at the prostate and surrounding area to destroy cancerous cells. This includes Brachytherapy (link here has more information), a technique where radio-active seeds, offering a slow and controlled release of irradiation, are implanted into the prostate by hollow needles, administered under anaesthetic.

Surgery

Involving an operation carried out under general anaesthetic (Radical Prostatectomy) to remove the whole of the prostate gland. This is more commonly done now as a key- hole procedure (Laproscopic).There are recently developed techniques which seek to minimise the trauma and impacts of this long-established procedure. This procedure via laproscopic procedure is increasingly being done by Robotic machinery in England  (da Vinci) and Scotland are hoping to get their first robot machine very soon. Robot technology provides greater consistency of result and more accuracy.

Active Surveillance

The new guidelines from NICE (click HERE ) on Active Surveillance are the basis of the treatment or not decison making (See Newly Diagnosed page for more information). Patients considering Active Surveillance who want to know about steps they can take to manage their PCa are also recommended to read “NATURAL APPROACHES TO PROSTATE CANCER”: A personal perspective by Christopher Garner, a member of Edinburgh & Lothian Prostate Cancer Support Group and available (while stocks last) from Maggie’s Centre at The Stables, Western General Hospital, Crewe Road, Edinburgh EH4 2XU or free download HERE

Chemotherapy

Powerful drugs, normally administered intra-venously and which may be used if the cancer has spread or hormone treatment has started to wear off.

Cryotherapy

Where hollow needles are inserted into the prostate and gases producing sub zero temperatures are used to freeze the prostate and kill the cancerous cells . Mainly used for salvage treatment after radiotherapy.

Hormone Therapy

May be used in conjunction with other therapies or on its own. Seeks to halt the production of testosterone (which encourages the tumour in the prostate cancer to grow) in the body. May involve tablets or injections of hormones or minor surgery to the testicles.

Hi Intensity Focused Ultra Sound (HIFU)

A new treatment still at an eraly stage in the UK but viewed as an important option for the future. Carried out under spinal or general anaesthetic. A probe, incorporating an ultrasound scanner, is passed into the rectum. The probe emits a beam of ultrasound which is focused to reach a high intensity in the target area. Absorption of the energy creates an increase in temperature which destroys tissue. A cooling balloon protects the surrounding area from colateral tissue damage. May be used as a primary or salvage treatment and can be repeated if necessary. Treatment only takes between 1 and 3 hours.

Prostate Scotland

Prostate Scotland publish a very wide range of up-to-date information leaflets about the prostate, and prostate cancer diagnosis and treatment. Please click here to view and download the material.

If you are newly diagnosed with prostate cancer and would like to find out what support is available in Edinburgh and the Lothians, please click here. See also the LINKS PAGE for more web sites with information on treatments.