How is prostate cancer normally treated?
Written in association with:Here, revered consultant urologist, Mr Biral Patel, talks all about prostate cancer, including symptoms, risk factors, and treatment.
What is prostate cancer, and how common is it?
Prostate cancer is now the most common cancer affecting men in the UK. Whilst the risk increases with age, and the disease typically affects men over the age of 50, we are now seeing increasing numbers of younger men with the disease.
The prostate is a small gland located just below the bladder and in front of the rectum, responsible for producing seminal fluid. The urethra and hence urine pass through the gland.
Prostate cancer typically grows slowly compared to some other cancers and may initially remain confined to the prostate gland, without causing immediate and significant harm. However, over time, it has the potential to grow and spread. Some variants can be more aggressive and spread quickly.
What are the associated risk factors?
Several risk factors contribute to the likelihood of developing prostate cancer. Age is a primary factor, with the risk increasing as one gets older. There are two other risk factors. Firstly, family history. Family history plays a significant role; having a father or brother with prostate cancer doubles a man's risk.
Additionally, genetic factors such as inherited mutations in the BRCA1 or BRCA2 genes can increase the risk. African American men are at a higher risk of developing prostate cancer compared to men of other races.
What are the symptoms of prostate cancer?
Early-stage prostate cancer often does not present symptoms, making regular screening crucial for early detection. When symptoms do appear, they may include difficulty urinating, a weak or interrupted urine flow, frequent urination (especially at night), pain or burning during urination, and blood in the urine or semen. erectile dysfunction.
It is very important to appreciate that having urinary symptoms does not necessarily mean that one has prostate cancer - a significant proportion of men with these symptoms have them due to a benign and non-cancerous growth of the prostate. However, amongst these men there may be some with prostate cancer. Advanced prostate cancer can also spread to bones and cause pain in the back, hips, or pelvis, and may lead to general deterioration and even erectile dysfunction.
What does screening for prostate cancer involve?
There is currently no formal screening programme for prostate cancer in this country and the topic remains somewhat controversial for a number of reasons. Having said that, the reality is that if diagnosed early, most prostate cancers can be managed safely.
Men who are worried about the possibility of prostate cancer or have urinary symptoms or those who are at a higher risk should seek medical attention and see their GP or a specialist. Their consultation should involve a discussion about the merits of a PSA (Prostate Specific Antigen) test and a digital rectal examination (DRE).
Elevated PSA levels can indicate the presence of prostate cancer, but they can also be caused by other conditions such as benign prostatic hyperplasia (BPH), infection or prostatitis. If either of these tests is abnormal then one may require further investigations such as scans and even a prostate biopsy. Some men may simply be monitored initially rather than being put through invasive tests and scans. This typically applies to some older men in whom the disease may pose less of a threat.
How is prostate cancer normally treated?
Treatment options for prostate cancer depend on a number of factors including the PSA, stage of the disease, aggressiveness, as well as patient factors (age, overall health, and personal preferences). Some low-risk cases may be recommended to have monitoring (Active surveillance) while some patients would be put on ‘watchful waiting’.
Patients with more significant disease may be recommended ‘Active Treatment’ including surgery (Robotic Radical Prostatectomy) and Radical Radiotherapy (in combination with hormones). Patients with more advanced disease may require hormone therapy, chemotherapy, and even some of the newer options like immunotherapy and targeted therapy.
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