The prostate is a small gland, walnut-shaped and is part of the male reproductive system. Production of prostate fluid is its primary function. This fluid adds to the semen volume and is crucial to fertility as it nourishes and transports sperm.
The prostate gland is located below the bladder. The water pipe (urethra) passes through the prostate and carries urine from the bladder or, during orgasm, carries the ejaculate.
The last part of the large bowel is called the rectum, which lies behind the prostate gland.
The prostate gland has a role in hormone production. It changes testosterone into a biologically active form called dihydrotestosterone (DHT) which is ten times more potent.
It is the most common cancer in men; 1 in 8 men is affected.
143 men are newly diagnosed every day.
There is one death from prostate cancer every 45 minutes.
Prostate cancer is responsible for the death of 12,000 men every year
The European Health Union 2022 has updated their position and recommends testing men up to 70 years with a prostate specific antigen (PSA). Those needing further investigations will be referred for a magnetic resonance imaging (MRI scan) of the prostate.
In the United Kingdom, there is no national screening programme, although data for this common cancer has shown solidly that screening for prostate cancer has a role. Instead, there is an informed choice programme, referred to as prostate cancer risk management, for healthy men aged 50 years or over who ask their general practitioner (GP), NHS consultant, or private urologist about the pros and cons of doing a PSA test.
Prostate Specific Antigen (PSA) is a blood test showing your prostate’s activity.
One needs to interpret it with caution as it can be high due to different reasons;
Historically, a PSA cut-off of 4 ng/ml was considered the threshold. The argument is more complicated; the thresholds have been lowered throughout the years.
There is no such ‘normal’ PSA.
A PSA of 4 ng/ml means a 27% per cent risk of having prostate cancer, and a PSA of 3 ng/ml means 24%.
This means that a PSA as a standalone test is not suitable. One needs to look at the trajectory of the PSA levels and combine the information with other essential elements like the medical, family history and digital rectal examination.
If you have any of the following;
it is best to visit your doctor and kick-start your investigations.
If your PSA is high or the prostate examination is abnormal, doctors can order an MRI scan of your prostate. You will be asked to undergo a prostate biopsy if this is suspicious.
Most men with early stages prostate cancer don’t feel anything.
Typically prostate cancer starts growing in the outer part of the gland, so at the early stage, there is no pressure on the urethra that leads to waterwork changes experienced by men with advanced prostate cancer.
Difficulty emptying your bladder is more likely to be an issue from the prostate that has grown (medically, this is called benign prostatic hyperplasia – BPH). If you are experiencing the following, you still need to go to your NHS or private urologist;
If prostate cancer progresses and breaches the capsule (the covering of the prostate gland) or spreads to different areas of the body, it can cause a person to complain of:
The National Institute for Health and Care Excellence (NICE) now recommends the CPG system over the traditional three-group system, classifying prostate cancer into low, intermediate or high risk.
The CPG helps men to form informed decisions about the management of prostate cancer.
CPG consists of five groups.
You have one of the following
You have two or more of the following
Your CPG is a risk checker and guides your NHS consultant or private urologist on the way forward. Treatment choice depends on other factors like:
Your doctor may recommend close monitoring for CPG 1, 2 or 3. Depending on the situation, this can be either:
Your doctor might recommend treatment if you are in the CPG 2, 3, 4 or 5 groups. This can be;
The following can be explored depending on your level of fitness;
Prostate cancer care has evolved with encouraging results both for early stage and late stage as a result of continuous research.
More men are seeking to check themselves and get an earlier diagnosis. More treatments are available, which means that doctors and patients have to honestly discuss when to avoid unnecessary treatment and when not to delay treatment. Yet more needs to be done to provide the necessary support and address concerns as more men are living longer.
Charities like prostate cancer UK, Movember and others are raising more awareness, empowering men and support research.
Men with an increased risk for prostate cancer through age, race, or genetic factors seek natural ways to prevent prostate cancer by following a healthy diet and a regular exercise regimen. Studies show mixed results however many men explore these lifestyle changes.
For more precise prostate cancer survival data, the stage of the disease at diagnosis is the most critical factor.
Early prostate cancer carries a better prognosis than metastatic prostate cancer. Ask your NHS consultant, private urologist or cancer nurse specialist what stage you are in.
One-year net survival of prostate cancer by stage
Five-year net survival of prostate cancer by stage
Written by Mr E Calleja
NHS Consultant, Private urologist, Robotic Surgery