Prostate Cancer

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oneineightProstate cancer is the most common male cancer in Ireland. One in eight men in Ireland will be affected by the disease and about 3,474 men are diagnosed with prostate cancer here every year. However, prostate cancer also has one of the best survival rates of all cancers. Over 90% of men who are diagnosed with the disease survive.

What is the prostate?

Many men are not even aware of their prostate until later in their life. It is a gland that is sometimes referred to a ‘the sex organ you didn't know you had.’ Its role is to help nourish sperm and aid fertility.

In a grown man, a normal, healthy prostate is about the size and shape of a walnut. It is found below your bladder and above the base of your penis, between your pubic bone and your rectum (back passage). It surrounds the urethra, which is the tube through which urine passes from the bladder through your penis.

The growth of the prostate

  • prostate-imageWhen a boy is born, his prostate is about the size of a pea. It grows very slowly until puberty.
  • When he is going through puberty, his prostate doubles in size during a dramatic growth spurt.
  • When a man reaches his 40s, his prostate begins to increase in size again and can become as large as a grapefruit.
  • Various hormones control its growth and function. The most important is the male sex hormone, testosterone

What are signs or symptoms of prostate cancer?

The most common sign of a prostate problem is difficulty in passing urine. This does not mean you have prostate cancer. If your prostate starts to change and grow, it will cause the tube which carries urine to the bladder, the urethra, to narrow. As a result, you might experience:

  • a weak flow
  • intermittency — a flow which stops and starts
  • hesitancy — having to wait before you start to go
  • frequency — having to pee more often than previously
  • urgency — finding it difficult to postpone having to pee
  • nocturia — having to get up at night to pee

If you have any of the above symptoms, you should visit your GP as you may have a problem with your prostate other than prostate cancer. A blood test or a physical exam may help to tell your doctor more.

Risk factors of prostate cancer

  • Age

Age is the most significant risk factor for prostate cancer. Your risk increases as you get older. Most men diagnosed with prostate cancer are over 50 years of age. If you are over the age of 50, talk to your GP about the PSA blood test which can indicate if your prostate is healthy or not.

  • A family history of cancer

A family history means that you have someone in your family who has cancer. Generally, if you have a father or brother diagnosed with prostate cancer, you are 2 to 3 times more likely to get prostate cancer yourself, compared to the average man.

The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found. It is always worth knowing about your family history.

  • Genes

Several inherited gene changes seem to raise prostate cancer risk, but they probably account for only a small percentage of cases overall. For example, inherited mutations of the BRCA1 or BRCA2 genes raise the risk of breast and ovarian cancers in some families. Mutations in these genes (especially in BRCA2) may also increase prostate cancer risk in some men.

  • Ethnicity

Prostate cancer is more common in black Caribbean and black African men than in white or Asian men. Asian men have half the risk of white men.

  • A previous cancer

Men who have had certain cancers in the past may have a slightly increased risk of getting prostate cancer. Studies have shown an increase in risk for men who have had kidney cancer, bladder cancer, lung cancer, thyroid cancer and melanoma skin cancer.

What should I do if I think I have a prostate problem?

If you notice any of the above symptoms or you think you might have a problem with your prostate, talk to your GP. Prostate cancer can be treated and over 90% of men with the disease survive but the first step is to talk to your GP.

Your GP may want to do a blood test called a PSA blood test and then examine your prostate. This involves inserting a gloved finger into your back passage to feel the size and shape of your prostate.

What is the PSA blood test?

Men over 50 should talk to their GP every year about the PSA blood test.

The PSA blood test measures Prostate Specific Antigen (PSA). A PSA blood test does not test for prostate cancer but can help the GP decide if there is a problem with your prostate or not.

PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells.  It is normal for all men to have a small amount of PSA in their blood. A raised PSA level does not necessarily mean that you have prostate cancer but may indicate that you have a problem with your prostate such as an enlarged prostate or inflammation of the prostate.

What can go wrong with my prostate?

There are generally three conditions that affect the prostate.

  • prostate enlargement
  • inflammation of the prostate gland (prostatitis)
  • prostate cancer

Prostate enlargement is a common condition that is associated with ageing. About a third of all men over 50 years of age will have symptoms of prostate enlargement. If the prostate becomes enlarged it can place pressure on the urethra, the tube which carries your pee and semen from the bladder to the penis, making it more difficult for the bladder to empty.

A simple treatment for prostate enlargement is to reduce the amount you drink before you go to bed, it is usually recommended that you stop drinking after 7pm.

If that does not help, your doctor can prescribe medication to relax the prostate gland muscles or reduce its size so that it is easier for you to urinate.

In more severe cases, where the medication does not work, the inner part of the prostate gland which is blocking the urethra can be surgically removed using laser surgery. There is currently research going on where surgeons use implants which prevent the prostate pressing against the urethra and making urinating difficult.

Prostatitis is a condition where the prostate gland becomes inflamed (red and swollen). The inflammation may happen because of an infection, but in most cases of prostatitis no evidence of infection can be found. Prostatitis can be painful particularly in the perineum, the area between your scrotum and back passage. Prostatitis is thought to affect up to 3 in 20 men (15%) at some point in their lives. Although it can affect men of any age, it is more common in men between 30-50 years of age. Prostatitis can be treated using a combination of painkillers and a type of medication known as an alpha-blocker, which can help relieve the symptoms. A longer course of antibiotics can also be prescribed.

Prostate cancer is the most common male cancer in Ireland, with over 3,300 new cases diagnosed every year. Your chances of developing prostate cancer increase with age. Most cases occur in men who are 50 years of age or older. The causes of prostate cancer are unknown, but risk factors include age, ethnic origin and family history.

The outlook for prostate cancer is generally good because, unlike many other types of cancer, it usually progresses very slowly. Over 90% of men who are diagnosed with prostate cancer survive. Many men die with prostate cancer, rather than as a result of having it.

Prostate cancer treatment and survival rate

If treated early, prostate cancer can often be cured. The survival rate for prostate cancer is over 90%. Treatments include:

  • Active Surveillance: Having regular PSA levels and a biopsy if PSA levels change or 18 months has passed.
  • Surgery to remove the prostate gland. There are few types of surgery that might be recommended- open prostatectomy, keyhole surgery or robotic surgery
  • Radiotherapy - using radiation to kill the cancerous cells. Common types of radiotherapy used for prostate cancer is external beam radiotherapy or brachytherapy where small pellets that are full of radiation are placed directly inside the prostate via ultrasound guidance  to kill the cancer cells
  • Hormone therapy - using medication to block the effects of testosterone (the hormone that stimulates prostate cancer)
  • Watchful waiting- because prostate cancer can grow very slowly, doctors may decide to monitor a man in his 80’s  to see if it gets bigger but not treat him at the moment if his health is otherwise good.

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