What is Prostate Cancer?
The prostate is a small gland at the base of the male bladder. It produces a protein called prostate specific antigen (PSA). Around 27,000 new cases of prostate cancer are diagnosed each year in the UK with around 9,000 deaths. The most common age of presentation is between 65 – 85 years of age. It is rare before 50 years.
Cancer of the prostate is a serious disease but is often slow to develop. It may only affect a small area of the gland and may grow at such a slow rate that often it does not need treatment and has no symptoms. However, in younger men the cancer tends to be more aggressive, causing more symptoms and can spread to outside the prostate (particularly to the bones).
Causes of Prostate Cancer
The cause of prostate cancer is unknown, however, some factors appear to increase the likelihood of this type of cancer developing such as a family history, ethnic origin and diet.
Symptoms of Prostate Cancer
In the early stages of cancer there may be no symptoms. But as the prostate enlarges problems with passing urine may occur. It is important to note that most men with urinary problems will not go on to develop prostate cancer. Benign enlargement of the prostate (benign prostatic hyperplasia) is very common in men over 50. Symptoms of further advanced cancer of the prostate include blood in the urine or semen, prostate pain and pain in the hips, back or legs due to spread to the bones.
Diagnosis of Prostate Cancer
Men presenting to their GP with prostate symptoms or concerns about cancer will have a digital rectal examination (DRE). A cancerous prostate will feel irregular and hard whereas a normal one is smooth and soft. A blood test will also be taken to establish the PSA level. This can be raised if the prostate is enlarged, is infected or is cancerous. Antibiotics will be given to exclude infection. If the levels are still raised then urgent referral to a specialist is necessary to ensure prompt diagnosis and swift treatment. A biopsy will confirm whether the prostate is cancerous. Tests will then be undertaken to check if it has spread to elsewhere in the body.
Treatment of Prostate Cancer
This depends on how advanced and aggressive the cancer is and on the age and general health of the patient. In the elderly the cancer tends to be slow growing and therefore observation is the only treatment unless the cancer advances. A prostatectomy (removal of the gland) is followed by regular PSA testing to ensure there is no recurrence. Radiotherapy and hormone therapy may be necessary if the cancer is more advanced.
Although this is a slow growing cancer prompt diagnosis and treatment is necessary to improve prognosis. GP's should refer urgently when screening shows any abnormality and when symptoms are present, to prevent a delay in diagnosis. It is also important to regularly screen patients who have undergone treatment for prostate cancer so as to detect any recurrence early.
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