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Prostate Cancer Facts

“For men who have been diagnosed with prostate cancer there is tremendous hope that they’ll be able to live out their disease with fewer problems than their fathers or grandfathers did in the past”

Mr Marc Laniado,  Urological Consultant at The Focal Therapy Clinic

Mr Marc Laniado, consultant urologist at The Focal Therapy Clinic sitting at his office desk

WHAT IS PROSTATE CANCER?

Prostate cancer is cancer that begins in the prostate gland.

The prostate is a walnut-sized gland located beneath the bladder and surrounding the upper part of the urethra – the tube that carries urine from the bladder. The gland is a part of the male reproductive system that makes most of the semen that carries sperm.

Prostate cancer is the most common form of cancer found in men in the UK, with over 47,500 men diagnosed each year. Most men (78%) who are diagnosed will survive their prostate cancer for ten years or longer. When diagnosed at its earliest stage 100% of men will survive their disease for five years or more. This is compared with around half of men, when their disease is diagnosed at the latest stage.

Prostate cancer is essentially caused by changes to the DNA of a normal prostate cell. Normal cells grow, divide, and die on a regular schedule. Sometimes something goes wrong with this process and the cells don’t die as they should. Instead, they create a lesion or tumour. Tumours can be benign (not cancerous) or malignant (cancerous).

In localised prostate cancer the lesions are confined within the prostate gland and can be treated, often in a way which preserves the gland and its functionality.

While some prostate cancers confine themselves to the prostate gland, other types of prostate cancer can grow aggressively and need decisive treatment.

Like all cancers, the risk to life from prostate cancer is based on the cancer spreading out of the prostate gland and into lymph nodes, bones, and other vital organs. The best way to prevent this spread is to identify the cancer early. The earlier the cancer is detected, the better the chances are of the treatment being successful.

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Prostate cancer patient sits in a waiting room

SYMPTOMS OF PROSTATE CANCER

During the early stages of prostate cancer, many men will not experience any symptoms therefore a raised PSA (Prostate Specific Antigen) level is often the first indication of suspicion.

There are a number of quite common prostate symptoms which can indicate an increased risk of a prostate cancer diagnosis:

  • Increased frequency of urination
  • Increased urgency in the need to urinate
  • Weakened or interrupted flow
  • Straining to urinate
  • Erectile difficulty
  • Painful ejaculation
  • Blood in urine or semen

While these symptoms may indicate other non-life-threatening conditions such as BPH or Prostatitis, it is vital that the possibility of prostate cancer is ruled out.

If the cancer has spread beyond the prostate gland, your symptoms can also include the following:

  • Fatigue
  • Change in bowel habits
  • Unexplained weight loss
  • Swelling or fluid build-up in the legs or feet
  • Numbness or pain in the hips, legs or feet
  • Persistent bone pain which may lead to fractures

These symptoms can also be caused by prostate conditions other than cancer, such as BPH or an enlarged prostate.

What to do if you think you have prostate cancer

It is vital if you are experiencing these symptoms to speak with a doctor and have a thorough check-up to determine the underlying causes. Your physician will want to know how long and how often you have experienced these symptoms to help with your diagnosis.

Part of this check-up will include a Prostate Specific Antigen (PSA) test to see whether there are elevated PSA levels in your blood.

In the UK, men with a raised PSA, typically above 4, will be offered an MRI scan of their prostate gland.

Read more about investigation leading to diagnosis at the Diagnosis page.

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PROSTATE CANCER

RISK FACTORS

While there are no known direct causes of prostate cancer, there are some known factors that increase your lifetime risk of developing it – mainly family history and ethnic origin.

Men with a family history of prostate cancer have an increased risk. For example, if a man’s father or a brother has had it, his chances of also getting it are higher (and it would be strongly advised to have his PSA tested regularly from 50 years old and /or if he were showing prostate-related symptoms).

In addition, if you have a family history of genes which increase the chances of developing breast cancer (BRCA1 or BRCA2), or a strong family history of breast cancer, your risk of prostate cancer may be higher.

Age plays a large role as well. Prostate cancer rarely affects young men – affecting only around 1 in 10,000 men under 40 years of age. The ratio increases to 1 in 38 for men between 40 and 59 years of age, and jumps again to 1 in 14 men between 60 and 69.

The majority of such cases are men over 65 years old.

Black men in the UK are twice as likely than white men to develop prostate cancer, with an average lifetime risk of 1 in 4 men developing the disease. Black men are recommended to begin having their PSA tested from 45 years old.

Those who are obese also may have a higher risk of prostate cancer, although studies have been inconclusive. In obese people, prostate cancer tends to be more aggressive and more likely to come back after initial treatment.

How can I reduce the risks of prostate cancer?

Many studies have shown that certain behaviours and lifestyles can reduce the risk of developing prostate cancer.

Some of these include:

Exercising: getting exercise most days of the week improves your overall health, helps you maintain your weight, and improves your mood. Beginners can start slowly and work their way up to more exercise each day.

Watching your diet: eating a variety of nutrient- and vitamin-rich fruits, vegetables, and whole grains can improve your overall health, possibly even warding off prostate cancer.

Maintaining a healthy weight: aim to consume a constant and appropriate number of calories each day to keep your weight from fluctuating too widely. Consult your doctor to find your ideal weight and create a healthy weight loss plan.

Taking proper medication: your doctor may want to prescribe you certain medications if you are at a higher risk of prostate cancer. Drugs such as 5-alpha reductase inhibitors including finasteride and dutasteride can help bring down the overall risk.

Quitting smoking can also reduce your chances of developing it.

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TREATMENTS FOR LOCALISED

PROSTATE CANCER​

Choosing a treatment and health care team is an important decision. Take the time to get educated on all available options and potential negative side effects to make the best treatment decision for you.

Depending on your diagnosis you may have a choice of treatments for your prostate cancer.

The best treatment for one man may not be the best for another. The right treatment for you will depend on many factors including:

  • Risk of the prostate cancer spreading
  • Gleason grade of the tumour
  • Your age and general health
  • Side effects of the treatment

Treatments options might include:

Active Surveillance involves the monitoring of prostate cancer through regular PSA tests, MRI scans and biopsies. The Active Surveillance protocol is offered to men with early-stage prostate cancer, that is confined within the prostate gland and not deemed at risk of escaping withing the next 24 months.

There are many reasons why Active Surveillance is a part of the prostate cancer treatment journey, but in the main it is to delay radical treatments, which are likely to cause permanent side effects to the patient.

For about 50% of patients this can allow a delay before having radical treatment of about 5 years, during which time many men can enjoy a good quality of life although others find the constant monitoring of their condition to be stressful.

Surgery, known as a radical prostatectomy, is the removal of the entire prostate by a surgeon. The aim of radical prostatectomy is to cure prostate cancer. It is a major surgery which is an effective treatment for cancer however is invasive and has common side effects of erectile dysfunction and urinary incontinence.

Radiotherapy uses high energy waves similar to x-rays to destroy prostate cancer cells. The main types of radiotherapy administered for prostate cancer are External Beam Radiation Therapy (EBRT) – which directs radiotherapy beams at the prostate gland from a machine – and Brachytherapy (Internal Radiation) – which involves inserting radioactive seeds into the prostate gland.

It is now standard practice in the UK to have three to six months of Hormone Therapy before Radiotherapy, in order to shrink the size of the prostate gland and make the radiation treatment more effective.

Radiotherapy treatment is often offered to men who are not considered strong enough to have surgery, which is the preferred treatment for men under 65 years of age.

Radiotherapy with hormone therapy is effective at treating prostate cancer however is invasive and exhausting and takes a significant amount of time to recover from. 

Possible side effects include a loss of vitality, erectile dysfunction and bowel issues.

Within 10 years of Hormone / Radiotherapy treatment roughly 15% of men will have prostate cancer recurrence and will need further treatment. For many of these men, the only remaining treatment options are Hormone Therapy or Chemotherapy.

Prostate cancer can be reduced and controlled using Hormone Therapy, often referred to as Androgen Deprivation Therapy or ADT. ADT eliminates testosterone from a man’s body which significantly reduces the rate of growth of prostate cancer and shrinks the size of the prostate gland.

Hormone Therapy on its own will not cure prostate cancer, rather the treatment aims to control the cancer and delay or manage any symptoms.

Hormone Therapy has been demonstrated to significantly improve the effectiveness of all radiotherapy treatments by increasing the sensitivity of cells to radiation.

Hormone Therapy has significant side effects including lethargy, loss of libido, depression, cognitive impairment and loss of memory.

Focal Therapy is a general term for minimally invasive treatment for prostate cancer that uses a high dose of energy to kill cancerous cells. There are kinds of focal therapy but all target only the area of the prostate gland with the aggressive tumour while leaving the rest of the prostate and its surrounding structures alone. 

High Intensity Focused Ultrasound (HIFU) is the most popular and well-evidenced type of Focal Therapy treatment for prostate cancer. It provides effective cancer control whilst minimising risks of erectile dysfunction and urinary continence.

Read more about HIFU Focal Therapy treatment and whether it could be right for you.

“Traditional surgery often leaves men with long-term erectile dysfunction – four in ten patients will need a safety incontinence pad after a year and one in ten will be significantly incontinent. HIFU Focal Therapy would spare them these life-changing complications.”

Mr Tim Dudderidge, Urological Consultant at The Focal Therapy Clinic

Mr Tim Dudderidge, consultant urologist at The Focal Therapy Clinic


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    At The Focal Therapy Clinic we are passionate about prostate cancer sufferers knowing about all of their treatment options.

    We know that settling on the right treatment is a big decision for you. If you would like to speak to one of our friendly and knowledgeable patient advocates about your diagnosis and the HIFU Focal Therapy treatment option then please do not hesitate to get in touch today.

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