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Prostate Cancer

Prostate Cancer

The prostate gland is situated beneath the bladder in men and is involved in the production of fluid which makes up the semen.

Prostate cancer is the commonest form of cancer in men in the UK, with over 30,000 new cases being diagnosed a year. Prostate cancer is the second leading cause of cancer death after lung cancer in the UK, causing in excess of 10,000 deaths a year.

In the early stages there are rarely symptoms but as the cancer grows and spreads there may be problems with urination and pain.

The quandary with prostate cancer is knowing which cancers are life threatening and which are not.

This can only be answered by inspection of a piece of prostate tissue, obtained from a biopsy of the prostate, under the microscope.

Diagnosis

One of the most useful measures in prostate cancer diagnosis is an annual prostate specific antigen (PSA) test. There is good evidence to suggest that if the PSA value does not rise beyond a certain threshold over time, the presence of prostate cancer is highly unlikely.

In addition to this, a clinical examination of the prostate should be performed by insertion of a gloved finger into the rectum. This is called a digital rectal examination (DRE) and is important as it enables the doctor to gauge the size, shape and consistency of the prostate. It will also help the doctor to decide whether cancer, infection or an enlarged prostate is present.

Should the PSA test result or the digital rectal examination cause concern, further tests are undertaken including an ultrasound of the prostate which allows visualization of the prostate gland. At the same time a biopsy can be acquired if necessary. The biopsy is studied under the microscope for the presence of abnormal tissue or cancer.

Further diagnostic information can be gained from imaging techniques such as MRI.

Screening

There are controversies around prostate cancer screening, specifically to do with PSA tests. Some cancers may be missed (known as false negative results) and sometimes the PSA test may suggest a cancer is there when in fact it is not (known as a false positive result). This confirms the importance of also performing a DRE because there have been cases when a PSA level has been "normal" but the DRE is suspicious for cancer.

Other issues around detecting prostate cancer have centered around the "tiger and pussycat" debate.

Many cancers will be of low risk if detected early and therefore not pose a serious risk to the patient. If the patient has an aggressive "tiger" cancer then radical treatment using surgery or radiotherapy can be curative if the condition is caught early.

Therefore if a PSA and DRE investigation indicates there may be a risk of prostate cancer, the only definitive way of knowing whether the cancer is a "tiger" or a "pussycat" is to undertake a biopsy to analyse the cells.

Treatment

Treatment will depend upon a number of factors including the age and general health of the patient and whether the cancer is small and confined to the prostate or has spread to other parts of the body. Some cancers are made of cancer cells that are more aggressive than others and this may also have a bearing upon the most suitable treatment options.

Management can vary from just monitoring the condition over many years for the less aggressive and smaller tumours to radical surgery or various types of radiotherapy. Medicines taken in the form of tablets or injections (referred to as hormone therapy) may also be used to slow down the progression of the cancer and for more advanced cancers, chemotherapy and other interventions may be employed.

The Princess Grace hospital is one of a very few centres which possesses a da Vinci surgical robot which enables minimally invasive surgery to be carried out on the prostate

Cryotherapy

Radiotherapy

High intensity focused ultrasound (HIFU)

Brachytherapy

Robotic assisted prostatectomy

Open Radical Prostatectomy