Prostate Cancer

What is Prostate Cancer?

Cancer of the prostate gland is relatively common in older males. In the United Kingdom, almost 4000 men die from this each year. When related to the population at risk, this works out at about one for every 1700 men over the age of 50 being in the “at risk” age group. This is a very high rate, although in the upper age group the death rate for all forms of disease is gradually increasing, and this tempers the figure a little.

Prostate Cancer Symptoms

About 80 per cent of cases present with symptoms of general prostatic hypertrophy that has just been discovered. In fact, the symptoms may be identical. As with that condition, the decision to seek medical attention may have been delayed.

The other 20 per cent come with symptoms relating not to the primary cancer, but to symptoms attributable to its spread, so-called metastases. Commonly these affect bones, and pain is a prominent symptom. Those seeking treatment in this group very commonly have widespread dissemination of the disease, probably all through the body, and the original site is not the primary concern, either for symptoms or treatment.

Diagnosis

This may be difficult, as it usually starts with a general examination, followed by a rectal one that may give some indication. A hard indurate area may be felt that is often highly indicative of the disease. X-ray examination, radionuclide scanning, CT and ultrasound can often yield valuable evidence, particularly of the spread of the disease. Besides confirming the diagnosis, these tests will give some indication as to the suitability of the patient for probable surgery.

Various laboratory tests are available. Most important is the PSA (short for prostate specific antigen.) The figure (normally 0.1 to 0.4) often rises significantly with an enlarged prostate and prostate cancer, although low readings do not always exclude cancer. It is the best single biochemical screening test currently available. The serum alkaline phosphatase is another test suggesting prostatic pathology. Unfortunately it is not very specific for early disease.

Digital examination and trans-rectal ultrasound and prostate biopsy have revolutionised early diagnosis. The prostate can be felt and also clearly seen, section by section, on the ultrasound screen. A needle biopsy is taken of suspect areas, and cancer can he quickly and accurately diagnosed.

Prostate Cancer Treatment

This presents a major problem, and a course will be worked out in every case. Often radical prostatectomy (removal of the prostate gland) forms only a small part of the overall therapy. This may remove the primary site, but as metastases may be widespread, and probably are causing the major symptoms, little relief may be gained.

However, if there is obstruction, and problems relating to urination, this may be the first step. Sad to say, the outlook is often a hopeless one. “In the vast majority of cases, by the time symptoms have drawn attention to the primary focus, only palliative relief treatment is practical,” Ferguson says in the British Medical Journal. “Other methods of treatment can often achieve a reasonable period of’ survival in comfort without resort to major operations.”

The use of endocrine therapy plus super voltage radiotherapy can be offered the patient, and “this has now overcome many of the disadvantages of earlier techniques and offers an acceptable alternative for local treatment.” Therefore, endocrine therapy and radiotherapy are at present, the mainstay of treatment.

In younger men, say those under 65 years, “the activity of the disease is likely to be greater and early energetic treatment may he indicated.” Once again, the crux of this lies in the absolute necessity for early assessment by the doctor if any telltale symptoms of urinary obstruction are apparent. They must never be neglected or delayed. Seeing your family doctor is probably the best starting point. From here, referral to a urologist, or a major urological clinic in a large hospital where all facilities are available, is essential.