Article by Saheed Rashid, Managing Director, BXTAccelyon 

Prostate cancer is the most common cancer in men in the UK, and arguably the most intimate too, which can cause many men to feel embarrassed when it comes to discussing their symptoms or treatment options with a specialist. Indeed, it can be all too easy to dismiss potential symptoms of prostate cancer as “just part of getting older”. Yet with diagnoses on the rise – and treatment options available that can suit even the most active of lifestyles – it’s more important than ever that men feel confident in discussing any health concerns they might have.

Here are some important things every couple should know about prostate cancer.

Signs & Symptoms

Prostate cancer occurs mainly in older men. The average age for a man to be diagnosed with prostate cancer is about 66. Different people have different symptoms for prostate cancer. Some men do not have symptoms at all, especially in the early stages. However, 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
  
  

Particularly in the current climate, with governmental concerns over cancer diagnoses being missed, any man with any worries really should go and see his GP.

The Prostate specific antigen (PSA) test is a commonly used test to screen for prostate cancer. It is also available free to any well man, aged 50 and over who requests it. The PSA test is a quick and simple blood test that measures the level of the antigen in the blood.

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 also simply make more PSA than others. While the PSA test is not perfect, most cases of early prostate cancer are found following a PSA blood test. It can therefore also be helpful to establish a baseline PSA, to monitor variation over time.

Diagnosis & Treatment

If the PSA test is abnormal, doctors may do more tests to find or diagnose prostate cancer. These may include a transrectal ultrasound, an MRI scan and / or a biopsy. Again, it’s important that you understand that you have options.

Recent advances in biopsy techniques now mean that the traditional method – a transrectal (TRUS) biopsy – is starting to be replaced by the transperineal biopsy under local anaesthetic within an outpatient setting (LA TP). Transperineal biopsies carry less risk of infection and have a higher cancer detection rate than TRUS biopsies.

When it comes to discussing your treatment options, the first person men speak to in the counselling process – whether that is an oncologist, urologist or specialist nurse – will of course have a very strong influence on the eventual decision regarding chosen treatment. Even patients opting for a second opinion will, more often than not, still follow the advice of the first clinician. It is therefore essential that the first discussion openly and honestly discusses all the potential options – not just surgery to remove the prostate (radical prostatectomy). Today, while clinical guidelines include low dose rate Brachytherapy (LDR-B), radical prostatectomy, hormone treatment, radiotherapy or active surveillance, the treatments being offered can be highly postcode dependent.

A recent study* revealed radical prostatectomy has the greatest impairment of sexual function and urinary continence when compared with active monitoring and radiotherapy with hormones. In addition, many radical prostatectomy patients go on to have further treatments at a later stage. With few patients being offered alternative treatments, it’s important that men feel confident to ask.

Dispelling Myths

Low dose rate Brachytherapy is one such example, which has been a highly effective treatment for prostate cancer for more than two decades. In addition to offering significantly improved outcomes regarding both sexual function and incontinence, according to data from the Prostate Cancer Results Study Group, LDR-B treatment achieves 95% of patients disease free at over 10 years.  So why are more patients not being offered this option?

One of the issues is without doubt closed thinking. Radical prostatectomy has been the default treatment for prostate cancer for many years – yet a shift from open surgery to robotics has had minimal impact on the overall patient outcome.  In contrast, brachytherapy has significantly evolved over the past two decades and now provides the ability to give a very effective, targeted prescription of radiotherapy, resulting in improvements in already excellent disease control, as well as potency preservation and continence.  Critically, it is not limited in its applicability: virtually any patient with localised prostate cancer can receive a brachytherapy implant if that is the desired treatment.

4D Brachytherapy

Low dose-rate brachytherapy is a kind of internal radiotherapy, which involves the insertion of tiny radioactive capsules, or seeds, into the prostate gland itself. It is targeted only at the site of the tumour so the radiation kills the cancer cells without causing major damage to surrounding healthy cells. Seeds the size of rice containing the radiation are passed through fine needles and positioned directly into the prostate gland. It is not major surgery and usually, patients will only spend one day in hospital. Generally, LDR brachytherapy has a low complication rate, and most men return to their usual pre-treatment activities within a couple of days.

4D Brachytherapy, an even quicker, one stage, real time implant technique, uses a simple clinic based ultrasound scan to calculate the number of stranded and loose seeds required for the procedure. The process offers better targeted treatment and, through the one stage process, a better patient experience. For patients, the replacement of one of the steps of the traditional procedure undertaken in the operating theatre (under a general anaesthetic) with a simple out-patient procedure significantly improves the process.

Conclusion

Patient choice is key – and that demands accurate, informed discussion about the pros and cons of every treatment, from outcomes to process. All of the treatments approved by NICE clearly have a role to play in successfully treating prostate cancer. But in order for men to have as many options available to them, early diagnosis is key. Being informed of your choices and taking action over potential symptoms is the first step to take.

Saheed Rashid, Managing Director, BXTAccelyon 

*http://www.nejm.org/doi/full/10.1056/NEJMoa1606221