Prostate Cancer: Know the early warning signs

With nearly 40,000 diagnoses every year in the United Kingdom, Prostate Cancer is the most common cancer in men. Over the last few years, celebrities such as Bill Turnbul and Stephen Fry have come forward to share their Prostate Cancer journeys, raising awareness in the process, and ultimately leading to more men getting themselves checked.

By checking over any potential symptoms and getting an earlier diagnosis, men can increase the treatment options available to them, as well as their survival rate. However, many still remain unaware of the symptoms, particularly around the loss of bladder control. With pharmacists fulfilling a significant role in the delivery of integrated primary care services, they can also be instrumental in helping to educate men on these symptoms. Saheed Rashid, Managing Director, BXTAccelyon, discusses some of the early warning signs of prostate cancer and the potential side effects of some treatments that pharmacists should know.

Signs & Symptoms

Typically, prostate cancer occurs in older men, with the average age of diagnosis being around 66 years of age. Different people have different symptoms for prostate cancer. While some men do not experience any symptoms, especially in the early stages, many early warning signs are linked to a loss of bladder control. This more commonly occurs when the prostate is large enough to affect the urethra, the tube that carries urine from the bladder out of the penis, which can increase the need to pee, while having difficulty in starting to pee, or the feeling that your bladder has not emptied fully.

These symptoms should not be ignored, or brushed aside “just as part of getting older” – but men must also keep in mind that these signs do not necessarily mean you have prostate cancer, and could be caused by other conditions, such as a prostate infection or reactions to medications. However, by having an increased knowledge of these particular symptoms of prostate cancer, men can double check these concerns with their GP or Pharmacist if they experience any unusual feeling when urinating.

The PSA Test & Prostate Cancer Diagnosis

David Robb, a 69 year old retired secondary school teacher from Scotland experienced Lower Urinary Tract Symptoms (LUTS) over a three year period, with an increased need to go which often became uncontrollable. Over this period of time, he was provided medication by his doctor to try and control his urine, and had his PSA (prostate-specific antigen) level monitored.

The PSA test is a test to screen for prostate cancer, which is free to any well man, aged 50+ who requests it. It’s a quick blood test that measures the level of the antigen in the blood. Typically, the higher the PSA level in the blood, the more likely a prostate problem is present. It can therefore be helpful to establish a baseline PSA, to monitor variation over time, which is what David was able to do. From his first check in January 2017 to July 2019, his score had risen by 0.4, which is when he was referred for further investigation and diagnosed with prostate cancer. Fortunately, his confirmed cancer was contained on one side of the prostate and at an early stage of progression, meaning it was treatable without too many problems.

By noticing these symptoms and getting them checked early, David was able to have the cancer successfully treated and maintain his quality of life, highlighting the importance of encouraging men  to go to their GP to discuss any concerns, particularly regarding urination problems. Or indeed, encouraging them to get their baseline PSA level established once they turn 50.

Once the cancer has been diagnosed, whether it’s through a transrectal ultrasound, an MRI scan or a biopsy, other tests are then conducted to see if the cancer has spread within the prostate or to other parts of the body. Survival rates tend to be much higher if the disease is caught earlier and hasn’t spread further than the prostate, with more treatment options available too.

Treatment Options & Side-effects

It’s vital that patients are aware of all treatment options available to them, and their potential side effects, rather than opting for the first discussed treatment. The first consultation must be open and honest, discussing all potential routes, not just surgery to remove the prostate, which remains in many cases the deferential treatment option.

For example, this treatment option (radical prostatectomy,) is widely recognised as having incontinence as a significant side effect due to damage to the nerves and muscles during the treatment. Other treatment options such as hormone therapy and external radiotherapy can cause similar side-effects as a bi-product of the treatment. This can go on to affect the gentleman long-term, including impacting their lifestyle choices, diet and exercise patterns.

By being educated on all treatment options, including brachytherapy, which has a lower incidence of severe side-effects, such as impaired sexual function and incontinence, men can make more informed and knowledgeable choices of the best treatment option for them.  In order for men to have as many options available to them, early diagnosis is key. Taking action over potential early symptoms around urinary and bladder issues is the vital first step.