Written 23th Nov 2015
Prostate cancer usually affects men over 50 years of age. It is the commonest cancer among men.
Compared to other cancers it is usually slow growing with no symptoms for 10-20 years.
What is the prostate?
The prostate is often called the prostate gland. It is the size and shape of a walnut, and sits at the opening of the bladder. A tube from the bladder passes through the prostate to the penis, allowing urine to flow. A good example of another gland is the lymph gland or lymph node which release substances into the blood to help us fight infection. As a gland, the prostate also releases a substance which mixes with sperm from the testicles during ejaculation, to produce semen. Although the prostate acts as a gland, it is also important to think of it as a muscle. During ejaculation it contracts to force the semen from the prostate outwards through the penis.
Is there anything that makes me more likely to get prostate cancer?
Age over 50
Genetic i.e someone in your family has or had prostate cancer
Sexually transmitted infections like chlamydia or syphilis
Geographic- often related to soil deficient in selenium or genetic factors
Diet low in tomatoes or oily fish
*(2 to 3 times increased risk compared to non African-Caribbean man)
Unclear risk factors
Diet-some studies have associated a western style diet high in sugars, processed carbohydrates, processed meats, and low in vegetables with increased rates of prostate cancer. In countries where selenium ( an essential nutrient) is low in the soil, such as New Zealand, more men have prostate cancer. There are hundreds of studies on Selenium. In 2014 a review of the best studies, stated that there was no clear evidence that selenium supplements can reduce the risk of prostate cancer. If you decide to take a supplement it is important to remember that too much selenium in the blood has also been associated with prostate cancer. There are lots of foods rich in selenium so it may be better to look at what you are eating and improve your diet.
Obesity and metabolic syndrome- both of these conditions increase the risk of heart disease. Men who have heart disease are at increased risk of prostate cancer. See advice on lifestyle to help reduce this risk.
Low vitamin D and not enough safe sunlight exposure. There is a geographical relationship between low exposure to sunlight and increase rates of prostate cancer. Patients with Prostate cancer have been found to have low vitamin D levels, but there is no evidence that taking a vitamin D supplement helps treat prostate cancer.
Animal fats-There are mixed results from observational studies that associate animal fats in milk and red meat with higher rates of prostate cancer. These results are controversial.
What are the symptoms of prostate Cancer?
Problems passing urine (see below)
Infection in urine
Difficulty having an erection
Blood in the urine or sperm
Unable to pass urine
Pain in testicles or around the anus
These symptoms could of course mean you have an enlarged prostate, a urine infection, a sexually transmitted infection, low testosterone level in the case of loss of morning ejaculation or something going in the bowels. The list could go on.
So always visit your doctor and let them help you work out what is going on.
Examples of problems passing urine:
You need to get up during the night to pass urine (This can be normal-but get it checked out with your doctor)
You have difficulty or pain starting the stream
Urine stops mid stream
There is dribbling at the end of passing urine
You have to urgently pass urine
You are incontinent of urine
Other symptoms sometimes associated with spread of the cancer:
Persistent pain in the bones-lower back or pelvis
Bleeding from the rectum/anus
What will my doctor do?
Your doctor will ask you about your 'water-works' to see if you have any difficulty passing urine or an infection. He or she will ask you about your bowels to know if you are constipated. The doctor will want to know if you have any of the risk factors mentioned earlier e.g has someone in your family had prostate cancer?
He or she will also about how you are feeling: if you are tired, feeling sick and if you any prolonged pain in the bones that cannot be explained by arthritis.
If you have any of the symptoms above the doctor will
Ask you for a urine sample
Examine the prostate
Arrange an appointment for blood tests
The urine sample
You can bring this with you. It should be taken that morning and collected in the middle of the stream i.e. not at the start of the start or end of passing urine
It’s worth remembering that urine infections in men are rare, compared to women. So if you have an infection you doctor will want to do further tests. Don’t treat this yourself and don’t start an antibiotic unless your doctor has prescribed it.
The prostate examination
The prostate can be felt through the rectum. It is sometimes called a “PR’ examination which means ‘per rectum’ (via the rectum) or DRE which stands for Digital Rectal Examination, because the finger (digit) is used to feel the gland.
This is an important examination as your doctor will be able to feel if the prostate has any lumps on it or if it is hard or enlarged.
The prostate examination can pick up some cancers but not all. It is only performed if you have any of the symptoms above.
PSA Blood test
A lot of men have heard about a test called PSA (Prostate Specific Antigen). In the united Kingdom your doctor will check the PSA test if:
You have any of the symptoms above: difficulty passing urine, urine infection, blood in the urine, new constipation or a lump on the prostate felt during rectal examination.
If you are concerned that you are at risk of prostate cancer and over 50 years of age.
There are special requirements for doing the test. It must be done:
greater than 48 hours after vigorous exercise e.g Cycling can increase PSA
greater than 7 days after digital rectal examination
greater than 48hours after last ejaculation
greater than 4-8 weeks after urine infection has cleared
greater than 6 weeks after prostate biopsy.
So, your doctor will usually ask you to come back after at least one week for the PSA blood test, or after 8 weeks if you have a urine infection.
What if you are under 50 years of age with no symptoms of prostate cancer but want to have the PSA blood test?
Your doctor will ask you questions to see if you have any risk factors for prostate cancer. He or she will also ask you if the worry of not doing the blood test is causing you a lot of anxiety.
If you are at increased risk of prostate cancer and have associated anxiety your GP will perform the test.
If you have no risk factors and no symptoms then you may have to pay for the blood test- discuss this with your doctor.
Remember that a slightly raised PSA test cannot make the diagnosis of prostate cancer and you will have to be referred to a Urology doctor. The urology doctor will discuss with you whether you need a scan and biopsy of the prostate gland which is preformed via the rectum.More information on when to do the PSA test can be found at the Department of Public Health England.
In the UK PSA test is not routinely used to screen for prostate cancer in men under 50 years of age- why is that?
This remains a controversial area. But there are good reasons why we do not screen all men for prostate cancer.
The PSA test can be positive in men who do not have prostate cancer. This positive result usually leads to a needle biopsy of the prostate gland to see if there really are cancer cells. There is 2% chance that the biopsy will cause side-effects such as blood in the urine or sperm, and in some cases pain that can persist for a week. Having a positive PSA result cause undue worry in a lot of men who turn out to have a normal biopsy.
The PSA test can also be normal in a man with early prostate cancer. So a negative result can mean that there are some cancer cells present
So the PSA test is not always correct at predicting prostate cancer, which means at present, it is not a cost-effective means for screening for this disease in the UK. More information on PSA can be found at from the Department of Public Health England.
If your PSA test is positive or if your doctor has felt a lump on the prostate or if you have problems with your 'urinary track', your doctor will refer you to see a urology doctor. He or she will examine the prostate again by PR examination and decide if you need an ultra sound scan and biopsy. There are two new blood tests now available called 'PCA3 assay and the Prostate Health Index (PHI)' which can be used in men who have a normal or uncertain biopsy result but in whom prostate cancer is suspected.
Sometimes the urologist will order a more detailed scan called an MRI. You will also have some other blood tests taken either with your own doctor or in the hospital. All of these results will be used to decide if you have prostate cancer and what stage it is at. More information on all investigations can found here.
Treatment depends on:
The stage of the cancer, which means how big it is and whether it has spread to other parts of the body.
Past and current medical history i.e fit for surgery
Your understanding of the complications or side side-effects of surgery
Your own personal preference
If you have a partner it is important to discuss your options and side-effects with them. You will also see an oncology doctor to discuss your options and will have time to discuss any concerns.
Treatment may involve:
Watch and wait surveillance. You will have regular PSA tests, rectal examination and repeat biopsy.
Surgery to remove the prostate
Alpha blockers ( Also used to treat enlarged prostate)
Lifestyle changes i.e. your diet, exercise and weight loss.
Detailed information on treatments can be found on the Prostate Cancer UK website.
Stop smoking. Smoking is linked to a lot of cancers, so if possible see you doctor or practice nurse about help with stopping, or speak to someone you know who has already given up smoking.
Drink 2-3 litres of water a day. This will help keep you hydrated and, as you get older, reduce the chance of infection in the bladder.
Decrease alcohol and sugar intake.
Eat cooked tomatoes and a variety of fresh vegetables every day.
Eat sustainable oily fish such as line caught mackerel, salmon, anchovies, and arctic char twice a week to increase your omega-3 intake.( These recommendations will change, so it's important to check which fish are safe to eat)
Eat 1-2 Brazil nuts every day. This will provide your daily amount of selenium.
Try drinking a cup of green tea each day. Like red wine, it contains polyphenols. There is also some evidence for pomegranate polphenols.
Exercise- keep your heart, body and mind healthy. Try a ten minute walk and build it up to 30 minutes a day.
Reduce infections transmitted by sexual intercourse. The use of barrier contraception such as condoms can reduce the chance of getting an infection. Remember all sexually transmitted infection can have lasting effects for both men and women.
If you're overweight have a look at my suggestions on finding motivation to get fit. You can also try out my ten-minute exercise work-out to get started at home. It's a good idea to seek personal professional help if you're struggling on your own.
Sleep well. There are some studies that associate good sleep patterns with a decrease risk of getting prostate cancer.
Eating more cruciferous vegetables (cauliflower, broccoli), drinking soy milk and eating pomegranates may reduce prostate cancer.
If you are over 50 years of age and have any symptoms of urine infection, blood in the urine, problems passing urine, getting up at night to pass urine, or difficulty with erections see your doctor to have a rectal examination to feel the prostate (PR), and a PSA blood test.
Remember the biggest threat to a man's life is heart disease, so if you smoke ask your doctor for some help to give up. If you have a poor diet or don't exercise read my prostate newsletter on how to change these habits. Guidelines on exercise can be found on NHS choices website. More information about the PSA test can also be found here.
If you are over 50 with no symptoms and no risk factors then now is the time to keep your body healthy with a good diet high in omega-3 and exercise. More information on prostate cancer can be found at the NHS choices website.
Remember, If you're not sure if you have any of the symptoms above or think you might be at risk, always speak to your doctor.
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