Prostate cancer detection and treatment: what are my options?

Prostate cancer is a disease which affects thousands of men across the UK each year. Respected consultant urologist Mr Andrew Ballaro discusses the various methods of prostate cancer detection and treatment, explaining how they are carried out and how effective they are.

What are the signs and symptoms of prostate cancer, and when should patients be evaluated for possible prostate cancer?

Early prostate cancer which is confined to the prostate gland commonly has no symptoms, particularly when it is small.

Statistics demonstrate that a significant proportion of men have small volume undetected prostate cancer. If the tumour grows, it can cause the prostate gland to restrict the flow of urine from the bladder. This results in reduced urine flow, having to strain to empty the bladder and the sensation of being unable to empty the bladder. These symptoms, however, are more commonly caused by non-cancerous enlargement of the prostate.

More advanced disease can provoke more significant urinary symptoms and pelvic pain, while widespread prostate cancer can lead to weight loss, bone pain, tiredness and in some cases, problems due to spinal nerve compression such as leg weakness.

What are the main procedures used to diagnose prostate cancer?

The mainstay of prostate cancer diagnosis is a prostate MRI scan followed by a needle biopsy. The MRI is highly accurate at detecting abnormal or suspicious areas of the prostate and these can be targeted directly using highly sophisticated software which enables a very slim needle to take small samples of prostate tissue from just that suspicious area. This is a short procedure which is most comfortably done under a short general anaesthetic.

The MRI- fusion Transperineal template prostate biopsy is the most targeted and therefore minimally invasive method of obtaining a tissue diagnosis of prostate cancer.

What are the different stages of prostate cancer, and how do they impact treatment decisions?

Early prostate cancer confined to the prostate gland can be cured by a number of treatments and most normally is treated by surgery to remove the whole prostate gland or targeted radiotherapy.

A significant proportion of patients with early prostate cancer have low risk disease which may not cause problems or affect life expectancy. For these men, a specific surveillance protocol can be applied, which is aimed at monitoring the condition, thereby sparing the patient from the side effects of treatment. Intervention is only required when there is evidence that the cancer is developing further.

More advanced prostate cancer in the pelvis can be treated by radiotherapy and hormone therapy, while widespread or metastatic prostate cancer is treated by hormone therapy and a number of second-line oncological treatments.

How do doctors determine the stage of prostate cancer, and what impact does it have on treatment decisions?

The stage (how advanced and aggressive) of the disease is determined by MDI scan, biopsy, and PET scans. The stage of the disease affects how it is managed.

Are there any genetic or familial risk factors for prostate cancer, and how are they evaluated?

Yes, genetic or familial factors can contribute to the risk of developing prostate cancer. Men with a family history of prostate cancer have a greater risk of developing it themselves and we detect this during the initial assessment.

Additionally, Afro-Caribbean men have a greater risk of developing prostate cancer than white men. Due to increasing advances in technology, in the future, genotyping will be used to assess risk within certain men. It is also thought that cancer vaccines may be given to those at risk.

If you would like to book an appointment with Mr Ballaro, do not hesitate to do so by visiting his Top Doctors profile today.