Most cases of prostate cancer develop in older men. In many cases the cancer is slow-growing, does not reduce life expectancy, and may not need treatment. In some cases it is more aggressive, spreads to other parts of the body, and may benefit from treatment. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.
The prostate gland (just called prostate from now on) is only found in men. It lies just beneath the bladder. It is normally about the size of a chestnut.
The urethra (the tube which passes urine from the bladder) runs through the middle of the prostate. The prostate's main function is to produce fluid which protects and enriches sperm.
The prostate often gets bigger (enlarges) gradually after the age of about 50. By the age of 70, about 8 in 10 men have an enlarged prostate. It is common for older men to have urinary symptoms caused by a benign (non-cancerous) enlargement of the prostate. Some men also develop prostate cancer.
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control.
A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage.
Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.
Some cancers are more serious than others, some are more easily treated than others (particularly if diagnosed at an early stage), and some have a better outlook (prognosis) than others.
So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook.
See separate leaflet called 'Cancer - What are Cancer and Tumours?' for further details about cancer in general.
Prostate cancer is a cancer which develops from cells in the prostate gland. It is the most common cancer in men in the UK. Each year, about 35,000 men are diagnosed with prostate cancer in the UK. It affects about 1 in 12 men in the UK at some point in their life. Most cases develop in men over the age of 65.
Prostate cancer is different to most other cancers because small areas of cancer within the prostate are actually very common, especially in older men. These may not grow or cause any problems for many years (if at all).
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control.
Although the exact cause is unclear, certain risk factors increase the chance that prostate cancer may develop. These include:
Prostate cancer is often slow-growing. There may be no symptoms at first, even for years. As the tumour grows, it may press on and irritate the urethra, or cause a partial blockage to the flow of urine. Symptoms may then develop and can include one or more of the following:
Note: all the above symptoms are common in older men. Most men who develop the above symptoms do not have prostate cancer but have a benign (non-cancerous) enlargement of the prostate. However, it is best to get any new symptoms checked out by a doctor.
Other symptoms such as pain at the base of the penis or passing blood occasionally occur. (These do not occur with benign prostate enlargement.)
If the cancer spreads to other parts of the body, various other symptoms can develop. The most common site for the cancer to spread is to one or more bones, especially the pelvis, lower spine and hips. Affected bones can become painful and tender. Sometimes the first symptoms to develop are from secondary tumours in bones.
If a doctor suspects that you may have prostate cancer, he or she will usually:
A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. A biopsy can usually confirm the presence of prostate cancer.
A biopsy is not always necessary to confirm a diagnosis of prostate cancer. Your doctor will be able to discuss the reasons for you to have a biopsy, if appropriate, with you in more detail.
A small biopsy of the prostate is taken by using a fine needle. This is usually done with the aid of a special ultrasound scanner. The probe of the scanner is about the size and shape of a finger. It is passed through the anus into the rectum to lie behind the prostate. This finds the exact position of the prostate. The doctor then pushes a fine needle into the back of the prostate from within the rectum to obtain the biopsy. Several samples are usually taken from different parts of the prostate.
Having a prostate biopsy can be uncomfortable. Therefore, local anaesthetic is used to reduce the pain as much as possible.
The severity of the disease is mainly based on three factors - the grade of the cancer cells, the stage of the cancer, and the blood PSA level.
Biopsy samples are looked at under the microscope to asses the cancer cells. By looking at certain features of the cells, the cancer can be graded. The common grading system used is called the Gleason Score.
A Gleason score of between 2 and 6 is a low-grade prostate cancer. It is likely to grow very slowly. A Gleason score of 7 is an intermediate grade that will grow at a moderate rate. A Gleason score of 8 to10 is a high-grade cancer that is likely to grow more quickly.
If you are confirmed to have prostate cancer, further tests may be advised to assess if it has spread. These tests are not advised in all cases. It depends on factors such as your age and the grade of the tumour cells. Tests which may be done include a bone scan, a CT scan, an MRI scan, an abdominal ultrasound scan or other tests. See separate leaflets called 'Bone Scan', 'CT Scan', 'MRI Scan' and 'Ultrasound Scan' for details of these tests. This assessment is called staging of the cancer. The aim of staging is to find out:
See separate leaflet called 'Cancer - Staging and Grading Cancer' for further details.
Doctors and patients can use Decision Aids together to help choose the best course of action to take.Compare the options for Prostate Cancer.
The treatment of prostate cancer is complicated. It varies tremendously between different cases. In addition, different men may choose to have different treatments compared to others with a similar type of prostate cancer.
Treatment options which may be considered include: surgery, radiotherapy, hormone treatment and, less commonly, chemotherapy. Often a combination of two or more of these treatments is used. The treatments used depend on:
For example, certain types of prostate cancer are confined to the prostate, are slow-growing and are unlikely to affect your life expectancy. Some types are more aggressive, more likely to spread and may cause serious illness and lead to death unless treated. The risks and possible side-effects of treatment are another consideration.
The treatment options are usually different for early prostate cancer that is confined to the prostate gland, local advanced prostate cancer, and late or advanced prostate cancer.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
The following is an overview of treatment options which you may have after discussion with your doctor.
Many prostate cancers are diagnosed at an early stage by PSA testing. Prostate cancer is often very slow-growing and, for many men with prostate cancer, the disease may never progress or cause any symptoms. In other words, many men with prostate cancer will never need any treatment. Treatments for prostate cancer can cause side-effects, which can affect your lifestyle. By monitoring the cancer with active surveillance, you can avoid or delay the side-effects of treatment.
Active surveillance aims to find those cancers that are likely to grow and cause symptoms if they are not treated. These cancers can then be treated at an early stage.
Active surveillance may be suitable if you have low- to medium-risk prostate cancer. It will involve regular check-ups with PSA tests, rectal examination of the prostate and possibly repeat prostate biopsies.
Removing the prostate (radical prostatectomy) can be curative if the cancer is in an early stage (confined to the prostate and not spread). It is a major operation and so tends to be advised more often for younger men whose general health is good, especially if the cancer grade means the cancer is likely to spread in the future. Side-effects such as impotence and/or incontinence of urine may occur following a prostatectomy.
Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. See separate leaflet called 'Radiotherapy' for more details.
Radical radiotherapy may be used as an alternative to surgery. Two types of radiotherapy are used for prostate cancer - external and internal. Again, the type chosen depends on various factors such as the size, grade and stage of cancer.
Radiotherapy is often more suitable for men who are not fit enough to have an operation or choose not to have an operation.
When the cancer has spread into the capsule of the prostate or into the surrounding tissues near to the prostate then it is called locally advanced prostate cancer.
You may be offered hormone treatment with radiotherapy. The radiotherapy given is usually similar to that given for men with early prostate cancer although the radiotherapy may include the surrounding structures in addition to the prostate. Some men just receive hormone treatment. As the choice of treatment depends on many factors, your doctor will discuss the treatment with you in more detail.
Prostate cancer cells need the male hormone called testosterone to grow and multiply well. Testosterone is made in the testes and circulates in the bloodstream. Hormone treatments aim to stop you from making testosterone or to block the effect of testosterone on prostate cancer cells. Hormone treatments do not cure prostate cancer but may greatly slow down the growth of the cancer for a number of years.
Two groups of medicines are available:
Hormone treatments can cause side-effects such as erectile dysfunction (impotence), hot flushes, sweating and other problems.
Late or advanced prostate cancer is when the cancer has spread to other parts of the body. Hormone treatments are usually given, as the cancer cells in other parts of the body still need testosterone to grow and multiply.
Another type of hormone treatment which may be offered is surgical removal of the testes (orchidectomy). Without testes you no longer make testosterone.
You may decide not to start hormone treatment until you develop symptoms. Your doctor will be able to discuss the timings of treatments with you in more detail.
Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. See separate leaflet called 'Chemotherapy' for more details. Chemotherapy is not commonly used for the treatment of prostate cancer. It may be used for more advanced cancers.
Even if the cancer is advanced and a cure is not possible, radiotherapy may have a place to ease symptoms. For example, radiotherapy may be used to shrink secondary tumours which have spread to bones and are causing pain. Brachytherapy (a form of radiotherapy in which radiation is targeted directly at the prostate gland) in combination with external-beam radiotherapy is a treatment option for localised prostate cancer.
In some cases it may be best not to have any active treatment but to see how the cancer develops. This is called watchful waiting. Various factors are taken into account such as the stage of the cancer, your age, general health, the impact and the potential side-effects if treatment were to be used. Watchful waiting may be more appropriate for men where the cancer is not causing much in the way of symptoms, and is slow-growing, especially in older men. With a watchful waiting approach you will still have regular check-ups and the decision about treatment can be reviewed at any time.
Cryotherapy (also known as cryosurgery) is an alternative treatment for men with early prostate cancer and recurrent prostate cancer. It is not yet available in all hospitals in the UK. It involves placing a number of metal probes through the skin and into the affected area of the prostate gland. The probes contain liquid nitrogen, which freezes and destroys the cancer cells.
High-intensity focused ultrasound (HIFU) treatment may be offered to some men, again with early prostate cancer. As this is still a relatively new procedure, it is not yet available in all hospitals in the UK. HIFU involves inserting a probe into the rectum. It is then pushed through the wall of the bowel into the prostate gland. The probe produces a high-energy beam of ultrasound which then heats and destroys the cancer. The probe is surrounded by a cooling balloon to protect the normal prostate tissue from damage.
The outlook for prostate cancer is very variable. Some prostate cancers are slow-growing and do not affect life expectancy. On the other hand, some have already spread to other parts of the body when they are diagnosed. The response to treatment is also variable.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer are likely to respond to treatment.
Screening for prostate cancer is controversial. A routine blood test which shows a high PSA may indicate that you have prostate cancer. However, there are other causes of a high PSA. Also, many prostate cancers are slow-growing and do not cause problems, particularly in older men. Some experts believe that if all men were screened then there may be many men found with a raised PSA level. Many men may then be investigated and treated unnecessarily with all the possible risks and side-effects of the investigations and treatment. Put simply, some people believe that screening for all men may do more harm than good.
Currently there is no national screening programme in the UK. However, you can decide for yourself if you would like a PSA test. It is best to discuss the pros and cons of the test with your GP. After counselling, if you decide that you would like the test, many GPs will do the test on request. See separate leaflet called 'PSA Testing for Prostate Cancer' for further details on the PSA screening test.
Helpline: 0845 300 8383 Web: www.prostate-cancer.org.uk
Provides support and information for patients and their families.
Helpline: 0845 6010766 Web: www.prostatecancersupport.info
Provides support and information for patients and their families.
Tel: 020 8788 7720 Web: www.prostateaction.org.uk
A national charity dealing with all prostate diseases, including prostate cancer.
Tel: 0808 800 1234 Web: www.macmillan.org.uk
Provides information and support to anyone affected by cancer.
Web: http://cancerhelp.cancerresearchuk.org/ provides facts about cancer, including treatment choices.
Provides information as to why there is no organised screening programme for prostate cancer but an informed choice programme instead.
See www.patient.co.uk/selfhelp.asp for a list of support groups for cancer patients.