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What are the facts about prostate cancer and how common is it?

Prostate cancer is the second commonest cancer in men. The reasons causing some men to have it are not clearly understood at the moment. Hence we don’t know the exact reasons why some men develop prostate cancer. It is usually seen in older men and is rarely seen in men under 50. Unlike other cancers it grows very slowly and may not cause any problems during a man’s life. It is especially true in men in their 70s and 80s. However there are some types of prostate cancers that do grow fast, spreading to bones and become the cause of death.

What are the risks of having prostate cancer?

The risks of having prostate cancer increase with increasing age. But it is known to cause fewer problems in older men. It is also more common in people who have close relatives with prostate cancer. It is more commonly seen in Afro-Caribbean or African-American decent.

What are the symptoms of prostate cancer?

Early prostate cancer may not have many symptoms. But when it grows it may present with these symptoms which may be seen in other medical problems as well. They are:

•Difficulty in passing water.

•Increased frequency in passing water, which can be more prominent in the night.

•Occasionally blood may be seen in the urine.

What is the PSA (Prostate Specific Antigen) Test?

The PSA test is a blood test. PSA is one of the chemical substances manufactured by the prostate gland which is found in the bloodstream. Hence the purpose of the test is to find out the amount of PSA in the blood.

What is the need for having a PSA test?

It is always better to find a prostate cancer in its early stages. Hence even before any symptoms arise or your doctor detects changes in your prostate the PSA test may help in detecting a prostate cancer if present. If prostate cancer is detected in its early stages then it can be surgically removed or treated by radiotherapy.

How reliable is the test?

It is not a very specific test for diagnosing prostate cancer. A raised PSA level may point to prostate cancer but it could be raised due to other prostate problems like infection or enlargement of the prostate that is normally seen due to ageing. At the moment only 30% of men with a high PSA level will have prostate cancer. Some times the PSA level may be normal even in the presence of prostate cancer.

How is the PSA test interpreted?

There are three main ways of interpreting a PSA test. They are:

•PSA not raised: Usually no further action is needed as there are very few chances of having a prostate cancer.

•PSA slightly raised: There might be a need to repeat the PSA test, probably not cancer.

•PSA definitely raised: Now a definitive investigation like a biopsy is needed to confirm prostate cancer.

What is a biopsy?

During a prostate biopsy a sample of the prostate cells are taken and seen under a microscope after special tests. The biopsy is done using an ultrasound scan and a probe which is passed through the back passage. It can be uncomfortable and can cause a few complications like blood in the urine, infection of the prostate or blood.

A normal biopsy result again does not rule out cancer of the prostate fully. There might be further repetitions of the PSA test and the biopsy after some time.

What is the Trans-Rectal Ultrasound Scan. (TRUSS)?

This is a test to take biopsy of the prostate gland. It takes about 15 minutes to do and you can eat and drink 15 minutes after the procedure. You will need to lie on your left side with your knees tucked into your tummy to help in passing the lubricated probe into the back passage. An image of the prostate gland is seen on a monitor by the doctor and helps in accurate assessment of the size and shape and in accurately taking biopsies from different areas. Local anaesthetic is injected into the prostate and small samples of the prostate tissue are taken using a biopsy gun. (biopsy). Before you leave the department it is important that you pass water. It may take up to 14 days for the results of the tests to come back.

Possible complications are:

•Discomfort

•Risk of infection. Antibiotics will be given before and after the procedure to prevent germs from the bowel to cause infection of the prostate. If you develop fever, burning while passing water, or heavy bleeding please visit your specialist.

•There may be bleeding into the urine, semen or stools for a few days afterwards. Blood with sperms may take up to six weeks to go away fully.

•Occasionally blood clots may get stuck in the urethra making it difficult to pass water.

•You need to inform your specialist if you are on blood thinning medicines like aspirin or warfarin prior to the test.

 What are the treatment options for early prostate cancer?

There is no clear consensus on the best way of treating it and the results post treatment. There are four main treatment options:

•Radical Prostatectomy: (This is an operation which removes the whole prostate gland.) Risks: 5 men out of 1000 may die, up to 200 could have problems with leakage of urine, between 200 to 800 can develop problems with erection.

•Radiotherapy (These are high energy rays to kill cancer cells): For every 1000 men up to 300 have bleeding or discomfort in the rectum, and 500 may develop erection problems.

•Brachytherapy (similar to radiotherapy in which radioactive substances are inserted into the prostate.) It may cause more bladder side effects than radiotherapy and fewer problems with impotence and bowel.

•Wait and Watch: This option depends on regular check ups and advocates treatment only if the cancer is growing in size.

What other conditions can increase the PSA?

PSA is prostate NOT tumour specific and is elevated in benign prostatic hypertrophy (BPH), prostatitis etc. PSA samples should not be taken from men who have:

   an active UTI.  ejaculated in the previous 48 hours.  exercised vigorously in the previous 48 hours.  had a prostate biopsy in the previous 6 weeks.