About the prostate
The prostate is a gland that is only found in men. It lies just below the bladder and in front of the rectum. It makes fluid that forms part of the semen. It surrounds the urethra (the tube that carries urine and semen through the penis and out of the body).
What is prostate cancer?
Prostate cancer is when abnormal cancer cells grow in the prostate and may spread from the prostate to other parts of the body, especially lymph nodes and bones.
Grades of prostate cancer
Most prostate cancers are slow growing. However they are divided into low, intermediate and high risk categories. High risk prostate cancer can grow and spread rapidly compared to the low and intermediate grade prostate cancers and as such need to be treated appropriately at earlier stages of the disease.
Symptoms of prostate cancer
The early stages of prostate cancer does not exhibit any symptoms. However, in the more advanced stages it can cause
- Difficulty passing urine
- Blood in urine
A non-cancerous condition of the prostate called Benign Prostatic Hyperplasia (BPH) can also cause similar symptoms.
If the prostate cancer remains undetected and has spread to other parts of the body it is termed metastatic prostate cancer and causes pain in the pelvis and back bones. It can also block the tubes that drain urine from the kidney, leading to failure of the kidneys.
Risk factors for prostate cancer
- The older man gets the greater the chance of getting prostate cancer
- Family history
- Having a first degree relative with prostate cancer increases the risk 2 to 3 fold.
- Diet - some evidence does suggest that a diet high in processed meat, red meat or milk products can increase risk of prostate cancer.
- Examination (DRE)
This is where the urologist examines the prostate with their finger to assess size, abnormal texture or any nodularity of the prostate. While an abnormal examination may indicate prostate cancer a normal DRE does not exclude prostate cancer.
- Blood tests (PSA)
The prostate produces a protein called Prostate Specific Antigen (PSA). PSA prevents the semen from becoming too thick. While most of the PSA is in the semen, a very small amount gets into the blood. To determine the level of PSA in the blood, a blood test is done. PSA blood tests have a role in diagnosis and treatment of prostate cancer. In men with prostate cancer, PSA can leak from the prostate into the blood causing the PSA level to be higher than normal. However, a high PSA level does not automatically mean that prostate cancer is present. PSA levels in blood can also be elevated in other situations such as:
Urinary tract infection
Enlargement of prostate
After sexual activity
- Imaging (MRI)
Due to the recent advent of the more powerful MRI machines (3T), scanning the prostate with an MRI machine can detect abnormal areas in the prostate more accurately. This allows more precise targeting of these areas during a biopsy.
- Prostate biopsy
To confirm a diagnosis of prostate cancer one requires a small piece of prostate tissue from the abnormal area to be assessed under a microscope. This is what a biopsy aims to do. Prostate biopsy can be done via the rectum or via the perineum using ultrasound or MRI guidance.
Treatment of prostate cancer depends on stage of cancer at the time of diagnosis. If detected early enough it is termed Localised prostate cancer (ie: cancer contained within the prostate).
Localised prostate cancer
This can be treated with:
If the cancer is of low volume and low grade. This requires regular surveillance of the cancer using PSA, prostate biopsy and MRI. If the cancer shows signs of progression then definitive treatment is advised.
This is when the whole prostate is removed. This operation can be done either via:
- An open approach
- Key hole (laparoscopic) approach
- Robotic approach
This is where radiation is used to eradicate the cancer cells in the prostate. Patients who opt for this treatment will be referred to a radiation oncologist.
Locally advanced prostate cancer
This is where the cancer has left the confines of the prostate and started to spread to nearby structures. In such situations treatment options are:
- Combined radical prostatectomy and radiotherapy. This is also called multimodal therapy and provides the best chance of cure.
- Radiotherapy alone. In such cases higher doses of radiotherapy are used. Also called high dose rate (HDR) brachytherapy.
Metastatic prostate cancer
This is where the prostate cancer has spread to other organs such as lymph nodes and bone. In such cases cure as yet is not possible and attention turns to slowing the growth of prostate cancer and controlling symptoms.