_Prostate cancer awareness: James Hicks Consultant Urological Surgeon, West Sussex Hospitals Trust (based at St Richard’s Hospital)
For: Chichester Observer
Prostate cancer affects many men world-wide with 40 000 new cases in the UK yearly. 250 000 UK men live with prostate cancer but 10 000 of them die each year. The majority of prostate cancers are in men in their 70s to 80s and rarely < 50yrs.
Strong familial links exist with a 2.5 times increase risk if a brother has it. Black Caribbean and Africans have 3 times greater risk that white men.
The common symptoms of prostatic enlargement are reduced urine flow, increased number of voids (day or night), urgency, hesitancy of flow and dribbling towards the end. However, these symptoms merely indicate an increase in prostate size.
Prostate cancer is diagnosed with a digital rectal examination and a blood test called prostate specific antigen or PSA. This is specific to prostate problems but not prostate cancer. It may increase in prostate infection or inflammation. Frustratingly the PSA cannot prove the presence of prostate cancer. It is best thought of as helping to identify those men at higher risk , the higher the PSA the higher the risk.
Men with an abnormal examination or PSA are offered a transrectal ultrasound guided prostate biopsy. A probe is inserted into the rectum to scan the prostate. Local anaesthetic is injected and a needle takes cores for analysis.
Once cancer is diagnosed further tests are sometimes necessary. CT or MRI scans look for the local extent of the disease including lymph node enlargement. A bone scan looks for bony spread of disease.
Localised cancer may be successfully treated with surgery removing the whole prostate (radical prostatectomy) through an open abdominal or perineal incision or more commonly laparoscopically (key hole) or with robots in robotic assisted laparoscopic prostatectomy. External beam radiotherapy or brachytherapy (internal radioactive seed implants) are also commonly used to cure prostate cancer. Newer modalities such as HIFU or Cryotherapy are constantly being developed within strict trial conditions. However, most treatment may affect a man’s continence or erections to a variable degree.
Less aggressive prostate cancer may grow slowly over 10 or even 20 years making active surveillance popular. With this, no treatment is given but the patient watched carefully with regular PSA tests and a repeat biopsy after 18months.
Spread disease may be treated by reducing men’s testosterone with 3 monthly injections or daily tablets removing the hormonal “drive” that makes prostate cancers grow. Other tablets treatments such as oestrogens and steroids are also used. Chemotherapy is proving increasingly helpful when hormone treatments fail but is not curative.
Prostate cancer is an important disease and can be effectively treated if identified early. A PSA blood test through a GP or specialist will help identify men in a higher risk group helping early diagnosis and treatment and cure.