Understanding prostate cancer: symptoms, causes and treatment

More than 52,000 men are diagnosed with prostate cancer every year on average

More than 52,000 men are diagnosed with prostate cancer every year on average

Prostate cancer: a brief guide

Prostate cancer is the most common cancer in men. More than 52,000 men are diagnosed with prostate cancer every year on average – that’s 144 men every day. One in eight men will be diagnosed with prostate cancer in their lifetime. Around 490,000 men are living with and after prostate cancer.

Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way.

Some prostate cancer grows too slowly to cause any problems or affect how long you live. Because of this, many men with prostate cancer will never need any treatment.

But some prostate cancer grows quickly and is more likely to spread. This is more likely to cause problems and needs treatment to stop it spreading.

What is prostate cancer?

Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way.

Some prostate cancer grows too slowly to cause any problems or affect how long you live. Because of this, many men with prostate cancer will never need any treatment.

But some prostate cancer grows quickly and is more likely to spread. This is more likely to cause problems and needs treatment to stop it spreading.

What is the prostate?

The prostate is a small gland in the pelvis and is part of the male reproductive system. It’s about the size of a walnut and is located between the penis and the bladder, and surrounds the urethra.

The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.

Recognising the signs and symptoms of prostate cancer

Symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder out of the penis (urethra).

When this happens, you may notice things like:

  • an increased need to pee
  • straining while you pee
  • a feeling that your bladder has not fully emptied

These symptoms should not be ignored, but they do not mean you have prostate cancer.

It’s more likely they’re caused by something else, such as prostate enlargement.

Understanding the causes of prostate cancer

What causes prostate cancer is relatively unknown. But certain things can increase your risk of developing this cancer.

As you get older, the chances of developing prostate cancer increase. Most cases develop in men aged 50 and above.

It is not yet understood why prostate cancer is more common in black men and less common in Asian men.

Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.

Recent research also suggests that obesity increases the risk of prostate cancer.

Prostate cancer diagnosis and PSA testing

If you have symptoms that could be caused by prostate cancer, you should visit a GP.

There’s no single, definitive test for prostate cancer. The GP will discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety.

The GP is likely to:

  • ask for a urine sample to check for infection
  • take a blood sample to test your level of prostate-specific antigen (PSA) – called PSA testing
  • examine your prostate by inserting a gloved finger into your bottom – called digital rectal examination

The GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels and the results of your prostate examination, as well as your age, family history and ethnic group.

If you’re at risk, you should be referred to hospital to discuss the options of further tests.

MRI scan

If you have a raised PSA level, your doctor may refer you to hospital for an MRI scan of your prostate. If the scan shows a problem, it can be targeted later with a biopsy.

Having a biopsy to diagnose prostate cancer

There are a few types of biopsy that may be used in hospital, including the following. A biopsy may also be taken during a cystoscopy examination.

  • A transperineal biopsy
  • A transrectal biopsy

Exploring the treatment options for prostate cancer

If you have prostate cancer, you may not need treatment.

If the cancer is at an early stage and not causing symptoms, your doctor may suggest either “watchful waiting” or “active surveillance”.

The best option depends on your age and overall health. Both options involve carefully monitoring your condition.

Some cases of prostate cancer can be cured if treated in the early stages.

Different types of treatment for prostate cancer

Some prostate cancer cases are only diagnosed at a later stage, when the cancer has spread. If the cancer spreads to other parts of the body and cannot be cured, treatment is focused on prolonging life and relieving symptoms.

  • surgically removing the prostate
  • radiotherapy – either on its own or alongside hormone therapy
  • Brachytherapy – a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It’s also known as internal or interstitial radiotherapy.
  • Hormone therapy is often used in combination with radiotherapy. For example, you may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment.
  • Cryotherapy – is a method of killing cancer cells by freezing them. It’s sometimes used to treat localised prostate cancer that has not spread beyond the prostate gland.
  • Chemotherapy – is often used to treat prostate cancer that’s spread to other parts of the body (metastatic prostate cancer). Chemo destroys cancer cells by interfering with the way they multiply. It does not cure prostate cancer but can keep it under control to help you live longer.
  • Steroids – Steroid tablets are used when hormone therapy no longer works because the cancer is resistant to it. This is called castration-resistant prostate cancer (CRPC). Steroids can be used to try to shrink the tumour and stop it growing.

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Treatment risks

All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary symptoms, such as needing to use the toilet more urgently or more often.

For this reason, you may choose to delay treatment until there’s a risk the cancer might spread.

Newer treatments, such as high-intensity focused ultrasound (HIFU) and cryotherapy, aim to reduce these side effects.

Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy. But the long-term effectiveness of these treatments is not known yet.

Navigating the path to recovery after prostate cancer treatment

A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.

In extremely rare cases, problems arising after surgery can be fatal.

It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation (IVF).

There are side effects associated with radiotherapy. Short-term effects of radiotherapy can include:

  • discomfort around your bottom
  • diarrhoea
  • loss of pubic hair
  • tiredness
  • inflammation of the bladder lining, which can cause pain when peeing and needing to go more often (cystitis)

Long-term side effects of radiotherapy can include erectile dysfunction (impotence).

Living with prostate cancer

As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.

Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.

You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.

Financial support is also available if prostate cancer reduces your ability to work.

Returning to everyday life after prostate cancer

If you have no symptoms, prostate cancer should have little or no effect on your everyday activities. You should be able to work, care for your family, carry on your usual social and leisure activities, and look after yourself.

However, you may be understandably worried about your future. This may make you feel anxious or depressed and affect your sleep.

If your prostate cancer progresses, you may not feel well enough to do all the things you used to. After an operation or other treatment, such as radiotherapy or chemotherapy, you’ll probably feel tired and need time to recover.

If you have advanced prostate cancer that has spread to other parts of your body, you may have symptoms that slow you down and make it difficult to do things. You may have to reduce your working hours or stop working altogether.

Whatever stage your prostate cancer has reached, try to give yourself time to do the things you enjoy and spend time with those who care about you.

Living beyond prostate cancer

It’s perfectly normal to be left with anxiety and concerns after treatment – sometimes for a long time – and following discharge, it’s hard to know where to go for help.

While there can be relief when cancer treatment comes to an end, the weeks and months that follow can be far from straightforward. Many people who have experienced cancer can feel isolated, and struggle with low mood or anxiety, finding it hard to deal with what they have been through. When cancer treatment finally finishes, family and friends often expect cancer patients to feel better, but for many, it’s when they feel worst of all.

Our Cancer Coach support groups can help. Cancer Coach offers self-management techniques and peer support for anyone over the age of 18 who has completed treatment for cancer, regardless of whether they finished treatment a few months ago or a few years ago. To access post treatment cancer support, apply to join a Cancer Coach support group online now. Or call our Cancer Coach team on 020 3983 7616 for an informal chat about Cancer Coach.