Prostate cancer is the most common cancer amongst men in the UK, with around 48,500 new cases every year (that’s more than 130 a day), projected to rise by 12% by 2035. Of those cases, around four in 10 are diagnosed at a late stage in England. However, if it is caught early, the chances of survival are generally good, making awareness exceptionally important – as always.
Types of prostate cancer
There are in fact several different types of prostate cancer, dependent on the type of cell the cancer started in, as well as its size and spread. The most common type is called acinar adenocarcinoma, which develops in the gland cells that line the prostate gland and accounts for nearly all cases of prostate cancer.
However, there is also ductal adenocarcinoma, which starts in the cells that line the ducts (tubes) of the prostate gland and tends to grow and spread more quickly. Transitional cell (or urothelial) cancer starts in the cells that line the tube carrying urine to the outside of the body and usually starts in the bladder. Meanwhile, squamous cell cancer develops from flat cells that cover the prostate, and small cell prostate cancer is very unusual and grows more quickly than other types.
Spotting the signs and symptoms
One of the challenges with prostate cancer is that it doesn’t usually cause symptoms until it has grown large enough to put pressure on the urethra. When this happens, symptoms tend to include the following, although these can also be signs of something else and do not always mean you have cancer:
- Needing to urinate more often
- A sudden need to rush to the loo
- Difficulty starting to urinate
- Straining to urinate
- A weak flow
- A feeling that your bladder hasn’t fully emptied
- Blood in your urine or semen
If the cancer has spread then you may also experience bone and back pain, loss of appetite, testicular pain and/or unexplained weight loss.
Who is at risk of getting prostate cancer?
While all men can develop prostate cancer at any age and should therefore take care to be aware of the symptoms, it is more prevalent amongst certain demographics. Statistics show that it’s most common amongst black men, followed by white men and it’s least common in Asian men. It’s most prevalent amongst men over the age of 50, with the majority of cases diagnosed between the ages of 65 and 69.
A family history can also be a factor. Prostate Cancer UK states that you are two and a half times more likely to get prostate cancer if your father or brother has had it, compared to a man who has no relatives with prostate cancer. The risk may be greater if your father or brother was under 60 when they were diagnosed, or if your mother or sister has had breast cancer.
Treatments for prostate cancer
Diagnosis is based on a prostate examination, a biopsy and scans. As with all things, treatment for prostate cancer varies depending on your personal circumstances. In some cases, no treatment is necessary. In some cases, the aim is to cure or control the disease and in cases where it has already spread the goal is generally to prolong life and delay symptoms.
Watchful waiting: If the cancer is unlikely to affect your life expectancy, watchful waiting is often recommended as an approach. If the cancer is in its early stages and not causing symptoms, you may decide to delay treatment and wait to see if any symptoms of progressive cancer develop. However, hormone medication is often used to control it.
Active surveillance: This approach aims to avoid unnecessary treatment and only use it when needed. It means having regular tests, scans and sometimes biopsies to ensure any signs of progression are found as early as possible. If it does progress, then you can make a choice about further treatment down the line.
Radical prostatectomy: This involves the surgical removal of the prostate gland and is an option for curing prostate cancer that has not spread. It is still possible for the cancer to return after surgery, although radiotherapy follow up treatment can help decrease that risk.
Radiotherapy: This is sometimes an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far. It is usually an outpatient treatment done in short sessions, frequently and over a concentrated period of time. You may also have hormone therapy before and /or after treatment to reduce the chances of cancerous cells returning.
There are other treatments in development as well, which are sometimes available as part of a clinical trial of other options fail and may be more readily available in the future.
Side effects of cancer treatments
As with all surgeries, a radical prostatectomy carries some risks. For example, it can cause long-term issues such as erectile dysfunction and urinary incontinence, although this isn’t the case for everyone and often it improves with time. It should also be remembered, that after a radical prostatectomy, you'll no longer ejaculate during sex, so if you are at a stage where you may still want to have children, it’s worth talking to your doctor about storing a sperm sample.
Radiotherapy can also have side effects, especially in the short-term, but most disappear once treatment has finished. Short-term you may experience discomfort, diarrhoea, pubic hair loss, tiredness and inflammation of the bladder lining which can cause cystitis. We have discussed many of the side effects of radiotherapy, especially relating to the skin on our blog before – information which you may find helpful.
While any cancer diagnosis is daunting, there is lots of support available from self-care options to help support your mental and physical health to support groups to talk to. Meanwhile, your doctor will be able to advise you on the treatment options that are right for you, and there are lots of communities and groups who welcome the opportunity to help you and your loved ones on your cancer journey.