Prostate cancer: What you need to know

Prostate cancer remains a significant health concern, affecting approximately one in six men in the UK during their lifetime. In his latest online article, Professor Rakesh Heer delves into the various risk factors contributing to prostate cancer development and explores preventive measures to reduce these risks. From age and ethnicity to genetic predispositions and lifestyle factors, understanding these influences is crucial for early detection and prevention efforts.

What are the risk factors for developing prostate cancer, and are there any preventive measures to reduce the risk?

Around one out of every six men in the UK will likely experience prostate cancer at some stage in their lives. Several key factors contribute to this risk, including age, with older individuals facing a higher likelihood of diagnosis. Ethnicity also plays a role, particularly for black men, who face an elevated risk not only of receiving a prostate cancer diagnosis but also of encountering a more severe, life-threatening form of the disease.

Family history emerges as a crucial consideration. If a man has a father, brother, grandfather, or uncle with a history of prostate cancer, his own risk increases. Additionally, certain genetic conditions, such as a family history of BRCA mutation, heighten vulnerability. Given that the BRCA gene is linked to breast cancer, it's important to note any instances of breast cancer in female relatives.

There's also a risk factor of obesity but, this can be reduced through lifestyle changes such as regular exercise and weight loss.

How is prostate cancer diagnosed, and what are the different stages and grades of the disease?

Patients commonly visit their GP expressing concerns related to urinary symptoms or potential prostate cancer. During this stage, a digital rectal examination may be conducted to assess the prostate gland for abnormalities. Additionally, a blood test is typically performed to measure levels of prostate-specific antigen (PSA). 

PSA is a protein produced by the prostate gland and if it's elevated, it puts you at a higher risk of having prostate cancer. Based on these initial assessments and considering individual risk factors, an MRI scan of the prostate may be recommended. This scan helps identify any suspicious lesions suitable for biopsy and provides guidance for biopsy placement.

Biopsies, involve inserting a needle into the prostate gland to obtain tissue samples for microscopic examination, aiming to detect cancer cells. These biopsies are administered either under local anaesthesia or general anaesthesia, ensuring patient comfort.

Depending on biopsy results and a confirmed diagnosis of prostate cancer, further tests may be conducted to determine the extent of the disease. These additional tests may include a CT scan, a PET scan, or a bone scan, enabling a comprehensive evaluation of the cancer's spread.

What are the treatment options for prostate cancer, and how do they differ based on the stage and grade of the cancer?

Prostate cancer that remains confined to the prostate gland typically carries a favourable prognosis. Treatment options may vary, with some cases suitable for active surveillance, particularly those exhibiting characteristics of slow-growing, low-grade localised disease. During surveillance, any changes suggestive of disease progression, such as elevated PSA levels or lesion growth, may prompt consideration for treatment.

Alternatively, if the cancer displays features indicating high-grade disease or extensive involvement within the prostate, initiating treatment from the outset may be warranted. Treatment options include surgical removal of the prostate (prostatectomy), radiotherapy, or targeted therapies aimed at addressing specific lesions within the prostate through focal therapy.

What are the potential side effects of prostate cancer treatments, and how can they be managed or minimised?

The primary treatment-related side effects predominantly involve urinary issues, such as incontinence, as well as effects on erectile function including potential loss of. Additionally, radiotherapy can lead to bladder and rectal irritation. There's also a slight increase in the risk of developing secondary cancers associated with radiotherapy.

Hormones may also be used for patients that have high-risk features undergoing radiotherapy, and those themselves can lead to an impact on the quality of life. In select cases, we may reduce these side effects through focal therapy, targeting only the cancerous area within the prostate with a needle insertion.

Professor Rakesh Heer is an esteemed urologist. You can schedule an appointment with Professor Heer on his Top Doctors profile.