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Prostate cancer

Published by Bupa's health information team, August 2008.

This factsheet is for men who have prostate cancer, or people who would like information about it.

A prostate tumour is a lump created by an abnormal and uncontrolled growth of cells. It can either be malignant (cancerous) or benign (non-cancerous). Each year about 35,000 men are diagnosed with prostate cancer in the UK, making it the most common cancer in men. It mainly affects men aged over 50.

• Animation - How cancer develops
• About prostate cancer
• Symptoms of prostate cancer
• Causes of prostate cancer
• Diagnosis of prostate cancer
• Treatment of prostate cancer
• Help and support
• Questions and answers
• Related topics
• Related Bupa products and services
• Further information
• Sources

How cancer develops

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About prostate cancer

The prostate is a gland that produces the liquid part of semen. It's about the size of a walnut and lies at the base of your bladder.

The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis. Any change in the size or shape of the prostate can narrow this tube, making it difficult for you to urinate.

The male pelvis

Cancerous tumours can grow through your prostate and spread to other parts of your body (through the bloodstream or the lymph system) where they may grow and form secondary tumours. This is called metastasis.

Symptoms of prostate cancer

Symptoms of prostate cancer include:

• difficulty in starting to pass urine
• a weak, sometimes intermittent flow of urine
• dribbling of urine before and after urinating
• a frequent or urgent need to pass urine
• pain when passing urine
• rarely, blood in the urine
• erectile dysfunction

These symptoms are similar to those produced by a common non-cancerous disease where the prostate becomes enlarged (benign prostatic hyperplasia).

If you have any of these symptoms, it's very important that you visit your GP for advice. If prostate cancer is found early, it can often be cured.

If prostate cancer spreads to other parts of your body, other symptoms can develop. The most common site for prostate cancer to spread to is the lower back, pelvis and hips. These bones can become painful and tender.

Causes of prostate cancer

The cause of prostate cancer isn't fully understood at present, but you are more likely to develop prostate cancer if:

• you're over 50
• you have close relatives who have had prostate cancer
• several women in your family have had breast cancer - you may have inherited a faulty gene which may increase your risk of prostate cancer
• you're African-Caribbean or African-American
• your diet is high in fat
• you're overweight

Diagnosis of prostate cancer

Your GP will ask you about your symptoms and will examine you. He or she may also ask you about your medical history and may do some of the following tests or will refer you to a urologist (a surgeon specialising in the urinary system).

• A digital rectal examination (DRE) is an examination of your prostate. Your doctor will insert a lubricated, gloved finger into your rectum (the lower part of the large intestine, ending at the anus) and feel your prostate through the wall of your rectum. If there is prostate cancer, it may feel harder than usual, or knobbly.
• A prostate-specific antigen (PSA) blood test will test the amount of PSA in a sample of your blood. PSA is a protein which is made by both normal and cancerous prostate cells. A high PSA level doesn't always indicate cancer and can be caused by other prostate diseases.
• In a prostate biopsy, your surgeon will remove a small piece of tissue. The sample will be sent to a laboratory for examination to find out if it's cancer and if so, how fast it's growing.
• CT, MRI and bone scans can help your surgeon see how far the cancer has spread (if at all). A CT scan uses X-rays to make a three-dimensional picture of your body. An MRI scan uses magnets and radiowaves to produce images of the inside of your body.

Treatment of prostate cancer

Your treatment for prostate cancer will depend on a number of factors, such as your age and whether the cancer has spread, and if so, how far. There are various treatments available. Some can have serious side-effects so it's important to speak with your doctor who will advise you on the best treatment for you.

Active monitoring

Sometimes, particularly for slow-growing tumours, no treatment is the best course of action. This is often called active monitoring or watchful waiting. Your condition will be monitored closely with routine check-ups. Your doctor may start treatment if your tests show that the cancer is growing or causing symptoms.

Surgery

Surgery is a common treatment for prostate cancer. It's most suitable for otherwise healthy men (usually, those under 70) whose cancer hasn't spread beyond the prostate.

The most common technique is a radical prostatectomy. This is a major operation, which removes the whole of the prostate and some surrounding healthy tissue.

New surgical developments include keyhole surgery (a laparoscopic prostatectomy) where the prostate is removed through smaller incisions and robot-assisted surgery.

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells. Techniques for treating prostate cancer include conformal radiotherapy (CRT), high-resolution intensity modulated radiotherapy (IMRT) and brachytherapy.

Hormone therapy

Hormone therapy blocks the action of the male sex hormone (testosterone) that helps cancer grow. This can slow the growth and spread of prostate tumours but won't kill the cancer cells.

Medical hormone therapies include goserelin (Zoladex) and bicalutamide (Casodex).

Alternatively, surgical hormone therapy involves removing your testicles, which permanently gets rid of the main source of testosterone. This operation is called an orchidectomy.

Chemotherapy

If hormone treatment stops working (hormone refractory cancer) your doctor may recommend chemotherapy. Drugs such as docetaxel (Taxotere) are used to destroy cancer cells.

Cryotherapy

This is surgery to freeze the prostate with liquid gas and kill cancer cells. This treatment may be used if you have a recurrent or refractory prostate cancer.

Ultrasound

High intensity focused ultrasound (HIFU) is a treatment given using a machine that gives off high frequency sound waves. This heats up the targeted cancer cells and destroys them.

Help and support

Remember - if you have any of the symptoms listed, it's very important to see your GP. Prostate cancer can often be cured if it's treated early.

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.

Related topics

• Cancer - a general overview
• Chemotherapy
• CT scan
• Enlarged prostate (BPH)
• High intensity focused ultrasound (HIFU)
• MRI scan
• Radiotherapy
• Pelvic ultrasound

Further information

• Prostate UK
  020 8877 5840
  www.prostateuk.org
• Cancer Research UK
  0808 8004040
  www.cancerhelp.org.uk

Sources

• UK prostate cancer statistics. Cancer Research UK, 4 February 2008. http://info.cancerresearchuk.org
• Prostate cancer. Cancerbackup. www.cancerbackup.org.uk, accessed 2 January 2008
• Excellence (NICE), 2005, Information about NICE Clinical Guideline 27. www.nice.org.uk
• Prostate cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 2 January 2008
• Urological cancer-suspected. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 2 January 2008
• Skolarus TA, Wolin KY, Grubb RL. The effect of body mass index on PSA levels and the development, screening and treatment of prostate cancer. Nat Clin Pract Urol 2007; 4(11):605-614. www.nature.com
• Laparoscopic radical prostatectomy. National Institute for Health and Clinical Excellence (NICE), 2006, Interventional Procedure Guidance 193. www.nice.org.uk
• Low dose rate brachytherapy for localised prostate cancer. National Institute for Health and Clinical Excellence (NICE), 2005, Interventional procedure guidance 132. www.nice.org.uk
• High dose rate brachytherapy in combination with external-beam radiotherapy for localised prostate cancer. National Institute for Health and Clinical Excellence (NICE), 2006, Interventional Procedure Guidance 174. www.nice.org.uk
• British National Formulary (BNF). BMJ Publishing Group, 2007. 54:464; 479-481
• Docetaxel for the treatment of hormone-refractory metastatic prostate cancer. National Institute for Health and Clinical Excellence (NICE), 2006, Information about NICE technology appraisal guidance 101. www.nice.org.uk
• Cryotherapy as a primary treatment for prostate cancer. National Institute for Health and Clinical Excellence (NICE), 2005, Interventional procedure guidance 145. www.nice.org.uk
• Cryotherapy for recurrent prostate cancer. National Institute for Health and Clinical Excellence (NICE), 2005, Interventional Procedure Guidance 119. www.nice.org.uk
• High-intensity focused ultrasound for prostate cancer. National Institute for Health and Clinical Excellence (NICE). 2005, Interventional Procedure Guidance 118. www.nice.org.uk

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Simon Cawthorn, MS, FRCS, Spire Hospital, Bristol; Consultant Surgeon, National Clinical Lead, The Cancer Services Improvement Programme, England, and by Bupa doctors. It has also been reviewed by Cancer Research UK Information Nurses The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2008.