Prostate cancer - a growing problem

Posted 18 April 2018 in Men's Health

A worried manA recent review of prostate cancer diagnoses in the UK has led to the discovery that almost 40% of cases are diagnosed in the later stages of the disease. Furthermore, in February this year, the number of deaths from prostate cancer in men surpassed the number of deaths from breast cancer in women, which had never happened before in the UK. What is causing this startling rise in prostate cancer deaths and why isn’t the disease being picked up sooner? (1)

What is the prostate?

The prostate gland is a crucial part of the male reproductive system. It is responsible for the production of the white fluid, which along with sperm, makes up semen. It is found within the pelvis, enveloping the upper part of the urethra, which is the tube through which urine from the bladder flows out of the body. Prostate cancer develops when mutations (changes) in the DNA of cells in the prostate cause cells to proliferate uncontrollably. It is unclear why this happens, but a genetic link has been found, with men whose father or brother has/has had prostate cancer more likely to be affected by it themselves. (2)

Why the increase in prostate cancer, and why the late diagnoses?

The main reason for the increase in cases and deaths is thought to be our aging population. Prostate cancer is more likely to develop in men over 50, and the risk increases further with age. With life expectancy continually rising in the UK, this means more chance for prostate cancer cases to arise, and consequently more related deaths. (1, 2)

Also, prostate cancer symptoms can be difficult to recognise. In the earlier stages, people with prostate cancer may show few or no symptoms. This may last for decades, until the prostate enlarges to such an extent that it puts pressure on the urethra. Once this has occurred, changes in the pattern and ease of urination may become apparent. You may find it difficult to begin urinating, and you may need to forcefully push to achieve a normal urinary flow. It might also feel as if you can’t get the last drops of urine out of your bladder. Prostate cancer can also cause sudden urges to urinate, and waking up to urinate several times in the night. Erectile dysfunction is another symptom that can occur as a result of prostate cancer. (1, 2)

It is important to note that the above symptoms are not always caused by prostate cancer - other conditions such as benign prostatic hyperplasia (BPH) also cause these symptoms. But any men experiencing such changes in urination must see their GP to rule it out. (2)

How can prostate cancer be identified in the early stages?

There are a number of tests that can be carried out to assess prostate health. The most common is the prostate-specific antigen (PSA) blood test. PSA levels are increased in men with prostate cancer at any stage, but also in other conditions such as BPH, so raised PSA does not necessarily indicate presence of prostate cancer. Nevertheless, the PSA test is available free of charge on the NHS to men over the age of 50 if they ask their doctor for it. (1, 2)

A digital rectal examination (DRE) involves a doctor or nurse inserting a gloved, lubricated finger into the back passage to feel the shape and size of the prostate. It is not reliable enough to be used as a diagnostic test alone, but can be combined with a PSA test or biopsy. (3)

A biopsy involves taking a small sample of tissue from the prostate which is examined for any abnormalities. However, approximately 20% of cancerous samples are not identified, and the procedure can cause problems such as bleeding and infection of the prostate. (3)

What if I am diagnosed with prostate cancer?

Quite often, there is no urgent action required after a diagnosis, other than looking out for the aforementioned symptoms, sometimes called ‘watchful waiting’. If treatment is started in the early stages, it usually comprises hormone therapy, radiotherapy and possible surgery. In the latter stages, when the cancer has often spread to other areas of the body, treatment is supportive (prolonging life and easing pain and discomfort). (2)

Since the symptoms of urinary incontinence and erectile dysfunction can be embarrassing and debilitating, men with prostate cancer may develop depression or anxiety. Prostate Cancer UK has a wealth of information on living with prostate cancer as well as links to support groups, a helpline and advice from nurses specialising in the condition. (2)

References

  1. BBC News. Prostate cancer: Four in 10 cases diagnosed late, charity says [cited 12 April 2018]. Available at: http://www.bbc.co.uk/news/health-43669439

  2. NHS Choices. Prostate cancer [cited 12 April 2018]. Available at: https://www.nhs.uk/conditions/prostate-cancer/

  3. NHS Choices. Should I have a PSA test? [cited 12 April 2018]. Available at: https://www.nhs.uk/Livewell/Prostatehealth/Pages/psa-test.aspx

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