Prostate cancer: everything you need to know

Prostate cancer is the most commonly diagnosed cancer in men in the UK, affecting more than 52,000 men every year. However, many men go undiagnosed until the disease is quite advanced and this becomes more difficult to treat. In this article, a consultant urological surgeon explains the signs of prostate cancer, how to get a diagnosis, and treatment options.

What are the signs of prostate cancer?

Prostate cancer tends to develop slowly, and it may not be apparent for many years. The prostate, which is a small gland in the pelvis that produces the fluid that transports sperm from the testicles (semen), can become enlarged, and eventually big enough to obstruct the urinary tract, which will typically be accompanied by symptoms such as:

Increased frequency of urination
Difficulty starting urination
Painful urination
Painful ejaculation, or inability to ejaculate
Blood in the urine (haematuria)

However, it is important to note that an enlarged prostate can happen for benign reasons, and it is not uncommon for men over the age of 50. This is why healthcare specialists and doctors stress that patients undergo regular examinations in order to catch the cancer in its earliest stages.

How is prostate cancer diagnosed?

Often, prostate cancer is discovered in a patient when they seek treatment for the aforementioned symptoms. The first likely step in the process is the prostate-specific antigen (PSA) blood test, which will look at PSA levels in the blood. PSA levels spike when the prostate enlarges, so while it does not prove that the patient has cancer, it will signify that, for whatever reason, the prostate is behaving abnormally, and this opens the door for further testing and examinations such as:

Digital rectal exams
issue biopsy
Transrectal ultrasounds
Imaging scans like MRIs or CT scans

What are the stages of prostate cancer?

Once prostate cancer is diagnosed, it will be assigned a grade, which is based on how likely it is to spread and grow. This is determined by how the cancer cells (obtained with a biopsy) look under a microscope. Higher-stage prostate cancer is more likely to grow and spread quickly.

Stage 1: the cancer is localised in a small area of the prostate, and the cancer cells are not too abnormal.
Stage 2: the cancer remains in one area of the prostate but has indeed spread slightly.
Stage 3: the cancer has taken over the entire prostate and may spread to other tissues at an accelerated pace.
Stage 4: the cancer has spread to the bladder, lymph nodes, bones, or other organs in the body.

What are the treatment options for prostate cancer?

Once the prostate cancer has metastasised, treatment is aimed at prolonging life expectancy and controlling symptoms.

For patients with an earlier stage of prostate cancer, there are a variety of options available, including:

External beam radiotherapy, a non-invasive, well-tolerated and rapid treatment that can be conducted over two to four weeks
Surgery, like a prostatectomy, in which the prostate is removed entirely
Hormonal therapy, where testosterone levels are manipulated to slow growth
Focal treatments like HiFU/cryotherapy, which are used to ablate the cancerous tissue
Active surveillance

For patients with advanced prostate cancer, there have been many innovations in treatments over the last decade, with a doubling of the expected survival rate. Treatments include:

Brachytherapy (internal radiotherapy), which uses a permanent seed implant
Chemotherapy
Stereotactic ablative radiotherapy (SABR)