Prostate cancer: symptoms, diagnosis and new treatment

Did you know that each year there are over 47,000 men who are diagnosed with prostate cancer in the UK? That makes it the second most common cancer in men. Prostate removal through surgery is a common treatment, but surgery is invasive and can have long-lasting effects such as erectile dysfunction and incontinence.

We recently spoke to leading consultant urologist Mr Mathias Winkler to find out the key symptoms. We also found out what happens when a patient is diagnosed.
 

What are the symptoms of prostate cancer?

What is difficult about prostate cancer is that it is often symptomless. Currently, there is no national screening programme. A key sign however, is seeing blood in your urine or experiencing lower back pain, and it is essential that an appointment with your GP is booked if you have these signs. It's particularly important to see a GP if you have a relative who has/had prostate, breast or even ovarian cancer because you may be genetically predisposed to developing prostate cancer.
 

How is it diagnosed?

During your consultation with a GP, they will do a digital exam of your prostate, and they will see if they can feel any lumps or nodules. They will also perform a PSA blood test. PSA stands for prostate-specific antigen. It's a protein produced by prostate cells; these can be measured through a blood test. If the test result shows you have an elevated level of PSA or if your GP has felt a nodule or lump, you will be referred to a hospital for a biopsy.
 

During the biopsy, the clinician will make sure to take samples from your prostate, and they will send it for analysis. Increasingly, hospitals use MRI scans before carrying out a biopsy, this helps guide clinicians to the most appropriate place to obtain tissue samples. At my practice, we use a biopsy robot (Biobot 'Mona Lisa') as it targets the needle safely into the suspicious area of the prostate. Through this method, the type of tumour can be described very accurately in the results. This helps your consultant to suggest the most appropriate treatment.
 

How should prostate cancer be monitored and treated?

Should the biopsy results show that you have prostate cancer, you will need to be referred to a consultant urologist, like myself, to discuss treatment options with you.
 

The average age of a person who is diagnosed with prostate cancer is 78, and around 12% of men will develop prostate cancer during their lifetime. However, it's crucial to know that prostate cancers are normally of the slow-growing type.
 

Due to this, prostate cancers are usually not treated using invasive techniques. Instead, clinicians monitor the size of the tumour with repeat biopsies and scans every three to six months after a diagnosis. If the tumour starts to get larger or changes in any way, your clinician will look into other treatments options with you.
 

The most common treatments for this disease are radiotherapy or the surgical removal of the prostate. If it's decided that radiotherapy would be the best treatment option for you, you may have a course of radiotherapy administered daily at the hospital. This would usually take place every working day for seven weeks. Patients can usually continue to work and lead a normal life while receiving radiotherapy but often find that they are more tired than normal.
 

If you decide to go ahead with surgery, the surgeon will remove your whole prostate during an operation. This is an invasive treatment and leaves men unable to have children naturally. It can also cause erectile dysfunction and, in some cases, incontinence. This method should be used only in cases where alternative treatments are not an option.
 

As well as the two standard treatments, at the Imperial College Healthcare NHS Trust, we are running a trial for a new treatment for prostate cancer that causes little in the way of side effects. We have been trialling a magnetic resonance imaging (MRI)-guided focused ultrasound device which uses MRI to guide clinicians to locate the exact location of the tumour. Once the location of the tumour is known, intense heat from the high intensity focussed ultrasound waves are applied directly to the tumour. It destroys the tumour during the process. Using the high intensity focussed ultrasound using MRI, clinicians can “see” the tumour in real-time and monitor the treatment. 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.
 

What advice would you give to patients?

It's easier said than done, but I always tell my patients the most important thing is, if you suspect you may have cancer and you're undergoing treatment for it, do not panic.
 

Prostate cancer has some of the highest survival rates, with many patients never requiring aggressive or invasive treatment. There are many treatment options, and in most cases, you can continue to live your life as normal.
 

Anyone who is worried or concerned that they may have prostate cancer should see their GP as soon as possible. That way, 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 support from friends and family, there are groups and trusts, like the one I work with, that have a counselling service on hand to help.
 

If you’re looking for treatment for prostate cancer, we recommend booking an appointment with a leading consultant urologist such as Mr Mathias Winkler . Visit his Top Doctors profile today for more information.