If you’ve just been diagnosed with prostate cancer, or you’re the friend or loved one of someone who has, or perhaps you might have a few symptoms and not know what to do next, you’ll no doubt have a number of questions.

Read on to find out more about prostate cancer, including symptoms and treatments.

The prostate is a gland in the male reproductive system whose job is to produce the majority of fluid that protects and nourishes sperm cells in semen, the thick fluid that carries sperm. The prostate is only found in males. It sits below the urinary bladder, in front of the rectum and surrounds the upper part of the urethra, the tube that carries urine from the bladder.

Prostate function is regulated by the male sex hormone testosterone.

The size of the prostate changes with age. It grows rapidly during puberty, fueled by the rise in male hormones (called androgens) in the body, such as testosterone and dihydrotestosterone (DHT).

The prostate usually stays about the same size or grows slowly in adults, as long as male hormones are present. In younger men, it is about the size of a walnut, but it can be much larger in older men.

Different men have different symptoms of prostate cancer. Some men do not have symptoms at all, especially in the early stages, until cancer has grown large enough to put pressure on the tube that carries urine from the bladder (urethra).

Some symptoms of prostate cancer are:

• Difficulty starting urination
• Weak or interrupted flow of urine
• The need to urinate more often, especially at night
• Difficulty emptying the bladder completely
• Pain or burning during urination
• Loss of bladder control
• Blood in the urine or semen
• Pain in the back, hips, chest (ribs) or pelvis that doesn’t go away
• Weakness or numbness in the legs or feet
• Difficulty getting an erection (erectile dysfunction)
• Painful ejaculation

If you have any symptoms that worry you, be sure to see your doctor right away. Keep in mind that these symptoms may be caused by conditions other than prostate cancer.

Prostate cancer occurs mainly in older men. The average age for a man to be diagnosed with prostate cancer is about 66. Prostate cancer in men under the age of 40 is rare.

• 1.4 million men were diagnosed with Prostate cancer globally in 2020 and it is the most common cancer in men in the UK, Australia and New Zealand. However, Prostate cancer is 99% treatable if detected early (Source: Prostate Cancer Foundation Guide).
• Statistics reveal there were 12,031 deaths from the disease and 48,561 men were newly diagnosed with prostate cancer in the UK in 2017 (Source: Office for National Statistics)
• An estimated 19,500 males were diagnosed with Prostate cancer in Australia in 2019 with 3,306 deaths (Source: AIHW 2018 Cancer Data in Australia), and over 3,000 men are diagnosed each year in New Zealand. In America the number of diagnosed cases in 2019 was 174,650. (Source American Cancer Society website).
• 55% of men were 70 years or older when diagnosed with Prostate Cancer (Source American Cancer Society website).
• About 1 in 6 men will be diagnosed with prostate cancer during their lifetime (Source: ONS). About 1 in 7 men are at risk of having prostate cancer by the age of 75 (Australia)
• Prostate cancer occurs mainly in older men and men of African-Caribbean descent.
• Your risks are higher if your father or brother has had prostate cancer.
• In the UK 84% of men survive prostate cancer for 10 or more years (2010-11, England and Wales Cancer Research UK)
• 95% of men survive at least 5 years in Australia (95 out of a 100 men, 2011-2015 https://prostate-cancer.canceraustralia.gov.au/statistics)

As with all types of cancer, an exact cause of prostate cancer isn’t easy to determine. There are often many factors involved, but ultimately what leads to the growth of cancerous cells are mutations in your DNA, or genetic material. These mutations cause normal cells in your prostate to start growing abnormally.

Abnormal or cancerous cells continue to grow and divide until a tumour develops. In cases of aggressive cancer, the cells may leave the original tumour and spread to other parts of the body.

Genetics

In some cases, the mutations that lead to prostate cancer are inherited. If you have a family history of prostate cancer, you’re at greater risk of developing the disease because you may have inherited damaged DNA.

Approximately 5-10 percent of prostate cancer cases are caused by inherited mutations. One such mutation is known as the hereditary prostate cancer gene 1, or HPC1. Other inherited mutations, such as BRCA1 or BRCA2, may also lead to a greater risk of developing prostate cancer.

Two tests are commonly used to screen for prostate cancer:

1. Digital rectal exam (DRE): A doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
2. Prostate-specific antigen (PSA) test: Measures the level of PSA in the blood. PSA is a substance made by the prostate.  It is a protein produced by both normal and cancerous prostate cells. It’s normal for all men to have some PSA in their blood. 

The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others. PSA levels also can be affected by:

• Certain medical procedures
• Certain medications
• An enlarged prostate
• A prostate infection

It is important to understand that the PSA test is not perfect. Most men with elevated PSA levels have non-cancerous prostate enlargement, which is a normal part of ageing. Conversely, low levels of PSA in the bloodstream do not rule out the possibility of prostate cancer.

A PSA test on its own doesn’t normally diagnose prostate cancer. Men over 50 can ask their doctor for a prostate specific antigen (PSA) blood test. The PSA test can be unreliable, however, most cases of early prostate cancer are found following a PSA blood test. Your GP will discuss the risk and benefits with you.

If your prostate specific antigen (PSA) test or digital rectal exam (DRE) is abnormal, doctors may do more tests to find or diagnose prostate cancer.

 1. MRI Scan: An MRI (magnetic resonance imaging) scan uses magnets to create a detailed picture of your prostate and the surrounding tissues.

In many hospitals you may have a special type of MRI scan, called a multi-parametric MRI (mpMRI) scan, before having a biopsy. This can help your doctor see if there is any cancer inside your prostate, and how quickly any cancer is likely to grow.

In other hospitals, you may have a biopsy first, followed by an MRI scan to see if any cancer found inside the prostate has spread.

An MRI scan may not be possible if you have a pacemaker or other metal inside your body.

2. Transrectal ultrasound: A probe the size of a finger is inserted into the rectum, and high-energy sound waves (ultrasound) are bounced off the prostate to create a picture of the prostate called a sonogram. This test may be used during a biopsy.

3. Transperineal Biopsy: A small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells.

Gleason score: This score is determined when the biopsy is looked at under the microscope. If there is a cancer, the score indicates how likely it is to spread. The score ranges from 2–10. The lower the score, the less likely it is that the cancer will spread.

If prostate cancer is diagnosed, other tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. This process is called staging. Staging is a way of explaining how far the cancer has spread, if at all. It can also help to determine treatment.

Prostate cancer classified as stage 1 is present in only a tiny portion of your prostate. It is not fast growing and hasn’t spread beyond the original location. Stage 2 means the cancer is small, but fast growing. It can also mean that the tumor is large or has spread through the entire prostate gland. In stage 3 prostate cancer, cancerous cells have invaded seminal vesicles or adjacent tissues. Stage 4 means the cancer has spread from the prostate to other organs. Usually, it spreads to the lymph nodes, bones, bladder, or lungs

LDR brachytherapy is a targeted form of internal radiotherapy, delivering radiation to the tumour site, and an effective, minimally invasive treatment for prostate cancer with significant quality of life benefits over alternative treatments such as surgery and chemotherapy. [1],[2],[3]  

Patients with suspected prostate cancer are usually referred by their GP to a surgeon. Some will need surgery to remove the prostate and/ or chemotherapy, which may mean taking weeks out of ‘normal life’ and can permanently damage sexual and bladder function.

Many patients are suitable for LDR brachytherapy, a one-stop treatment – usually day surgery – with a much lower risk of sexual and bladder problems. However, LDR brachytherapy is frequently overlooked as a treatment option, because the standard route for patients with suspected prostate cancer does not always recognise LDR brachytherapy as an option.

Click here to find out more about LDR Brachytherapy

References

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancerregistrationstatisticsengland/2017

https://www.aihw.gov.au/getmedia/f4f2b22f-8189-4c51-9e2a-66384cbca683/aihw-can-126.pdf.aspx

https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/survival

https://prostate-cancer.canceraustralia.gov.au/statistics