Prostate cancer: Risk factors, screening and treatment

Prostate cancer is the most common cancer among UK men, diagnosed over 50,000 times annually. Its early stages often progress without symptoms, complicating early detection. When symptoms appear, they can mimic benign conditions. Advanced stages may show more distinct signs like blood in urine or semen, and bone pain. Advanced diagnostic tools, including MRI scans and PSA tests, have significantly improved detection accuracy while minimising invasive procedures. Understanding risk factors like ethnicity and family history is crucial for targeted screening and treatment planning. In his latest online article, renowned consultant urologist Mr Taimur Shah. gives us his insights.

What are the symptoms of prostate cancer?

Prostate cancer stands as the most common cancer affecting men in the UK, with over 50,000 new cases diagnosed annually. Despite its prevalence, the disease often progresses silently in its early stages, presenting no discernible symptoms. This characteristic poses a significant challenge in timely detection and treatment initiation.

In clinical practice, symptoms that do emerge often mirror those of benign prostatic hyperplasia (BPH), such as difficulties with urination. It's common for men to seek medical attention due to these urinary issues, which may prompt further investigation.

As prostate cancer advances, symptoms become more apparent, typically indicating metastasis or the spread of cancer beyond the prostate gland. These advanced symptoms can include blood in the urine or semen, significant urinary problems, bone or joint pain, and, in severe cases, kidney issues. However, it's important to note that these symptoms usually manifest in later stages of the disease when treatment options may be more limited.

How is prostate cancer diagnosed?

Recent years have witnessed substantial advancements in the diagnostic approach to prostate cancer, revolutionising how healthcare providers identify and manage the disease.

Contemporary practices have integrated magnetic resonance imaging (MRI) scans as a pivotal component of the diagnostic pathway. This non-invasive imaging technique offers high precision in assessing the prostate gland and identifying suspicious areas that may indicate cancerous growth.

Following a PSA test, an MRI scan provides detailed images that guide subsequent medical decisions. If the scan reveals abnormalities, trans-perineal targeted biopsies using MRI-Fusion are conducted through the perineum, minimising infection risks associated with traditional transrectal biopsies.

Risk factors for prostate cancer

Several factors influence an individual's susceptibility to prostate cancer, including ethnicity and family history. Black men, for instance, face a notably higher risk compared to other ethnic groups, while those with a family history of the disease also exhibit increased susceptibility.

Understanding these risk factors is crucial in guiding healthcare providers toward recommending appropriate screening protocols and preventive measures for at-risk individuals.

Treatment innovations

Innovations in prostate cancer treatment have significantly improved outcomes and patient experiences. Robotic-assisted surgery, such as robotic prostatectomy, has become the standard for surgical interventions, offering minimally invasive procedures that reduce recovery times and minimise complications compared to traditional open surgery.

Similarly, advancements in radiotherapy techniques have enabled more precise targeting of cancerous tissues, thereby minimising damage to surrounding healthy organs and tissues.

Moreover, the advent of focal therapy represents a significant leap forward in treatment options. This approach allows physicians to target and treat specific cancerous areas within the prostate gland while sparing healthy tissue. Techniques like high-intensity focused ultrasound (HIFU) and cryotherapy (freezing therapy) are among the focal therapy methods employed, providing effective treatment with reduced side effects compared to whole-gland treatments.

Screening effectiveness

The effectiveness of prostate cancer screening has evolved alongside diagnostic and treatment innovations. Historically, concerns over the risk of over-diagnosis and unnecessary treatments tempered the enthusiasm for widespread screening.

However, with the integration of MRI scans into screening protocols, healthcare providers can now better distinguish between aggressive cancers requiring immediate intervention and indolent ones that may warrant active surveillance. This refined approach to screening aims to enhance the balance between the benefits of early detection and the potential harms associated with overtreatment.

Mr Taimur Shah is an esteemed consultant urologist. You can schedule an appointment with Mr Shah on his Top Doctors profile.