Prostate cancer: symptoms, diagnosis, treatment and beyond
Each year, over 47,000 men are diagnosed with prostate cancer in the UK, making it the second most common cancer in men. Surgical removal of the prostate is a common treatment for prostate cancer, but surgery is invasive and can have long-lasting effects such as incontinence and erectile dysfunction. Imperial College Healthcare NHS Trust is trialling a new alternative to surgical treatment for prostate cancer, in the hope it will help thousands of men with the disease to return to their normal lives with few or no side effects. In this week’s blog, Trust consultant urologist Dr Mathias Winkler explains the key symptoms of prostate cancer, what happens when a patient is diagnosed, and how the treatment being trialled could improve quality of life for some men with prostate cancer.
One of the tricky things about prostate cancer is that it is very often symptomless and currently there is no national screening programme. However, if you are seeing blood in your urine or experiencing lower back pain, book an appointment with your GP as these could be signs of prostate cancer. This is particularly important if you have a relative with breast, prostate or ovarian cancer because you may be genetically predisposed to developing prostate cancer.
During the appointment with your GP, they will do a digital exam of your prostate to see if they can feel any lumps or nodules and also perform a PSA blood test. PSA stands for prostate specific antigen, a protein produced by prostate cells which can be measured in a blood test. If the test result shows you have an elevated level of PSA or if your GP has felt a lump or nodule they will refer you to hospital for a biopsy. During the biopsy, the clinician will take samples from your prostate to be sent off for analysis. Increasingly, hospitals use MRI scans prior to the biopsy which helps guide clinicians to the most appropriate place to obtain tissue samples. At our Trust, we use a biopsy robot (Biobot ‘Mona Lisa’) to target the needle safely into the suspicious area in the prostate. This way, the type of tumour can be “described” very accurately in the results, which in turn helps your consultant to suggest the most appropriate treatment.
Monitoring and treatment
Should the biopsy results show you have prostate cancer you will be referred to a consultant urologist, like myself, who will discuss treatment options with you.
The average age of a person diagnosed with prostate cancer is 78 and around 12 per cent of men will develop prostate cancer during their lifetime. However, it’s important to know that prostate cancers are normally of the slow growing type. Because of this, prostate cancers are often not treated using invasive techniques. Instead, clinicians will monitor the size of the tumour with repeat biopsies and scans every three to six months after diagnosis. If the tumour starts to get bigger or changes in any way your clinician will explore other treatments options with you.
The most common treatments for prostate cancer are radiotherapy or surgical removal of the prostate. If you decided with your consultant that radiotherapy would be the best treatment option you would normally have a course of radiotherapy administered daily at hospital. This would usually take place every working day for seven weeks. With support from their employer, most patients can continue to work and lead a normal life while receiving radiotherapy but often find they are more tired than normal.
If you decide to have surgery, the surgeon will remove your whole prostate during an operation. This is a particularly invasive treatment and leaves men unable to have children naturally and can also cause erectile dysfunction and, in some cases, incontinence. Really, this method should be used in cases only where alternative treatments are not an option.
As well as the two standard treatments, our Trust is running a trial for a potential new treatment for prostate cancer that causes little in the way of side effects. The Trust is trialling a magnetic resonance imaging (MRI)-guided focused ultrasound device which uses MRI to guide clinicians to pinpoint the exact location of the tumour. Once the exact location of the tumour is known, intense heat from the high intensity focussed ultrasound waves is applied directly to the tumour, destroying it during the process. By guiding the high intensity focussed ultrasound using MRI, clinicians can “see” the tumour in real-time and monitor the treatment as they go, unlike other treatments currently available. By using this method, clinicians can be sure that they are only destroying cancerous tissue and not disturbing any healthy tissue nearby.
While this is much easier said than done, I always tell my patients the most important thing when you suspect you may have cancer, or if you are undergoing treatment for it, is not to panic. Prostate cancer has some of the highest survival rates, with many patients never requiring invasive or aggressive treatment. If you do need treatment, there are many options and in most cases you can continue to live your life as normal.
I would tell anyone who is worried or concerned that they may have prostate cancer to see their GP as soon as possible. This means, should you receive a positive diagnosis, we can do something about it sooner.
Finally, always remember that support is always available, from diagnosis to treatment and beyond. As well as friends and family and support groups, most trusts, like ours, have a counselling service on hand to help.