Prostate Cancer Awareness by Dr Angela Rai

Prostate cancer is the most common cancer in men in the UK and accounts for 26% of all male cancer diagnoses in the UK.. Recently there has been an increase in awareness of symptoms of prostate cancer, however more awareness is needed as early detection is vital in improving treatment outcomes and survival rates.

What is the prostate?

The prostate is a small gland in men in the pelvic area. It is at the base of the bladder and in front of the rectum, surrounding part of the urethra. It’s part of the male reproductive system and helps make some of the fluid in semen.

This gland can grow and be a normal part of ageing. The prostate surrounds the urethra, therefore prostate enlargement can cause difficulty in passing urine. A benign enlargement is known as Benign Prostatic Hyperplasia (BPH).

Risk factors for prostate cancer

  1.     Age. Increasing age is a risk factor. Prostate cancer mainly affects men over 50. The average age of men being diagnosed with prostate cancer is between 65 and 69 years.
  2.     Ethnicity. Men from Afro-Caribbean origin have a higher risk of developing prostate cancer.
  3.     Family history. Men with a first degree relative (father or brother) who have had prostate cancer have a higher risk of developing prostate cancer, especially if the relative was diagnosed before the age of 60.
  4.     BRCA gene. The risk of prostate cancer increases in men with BRCA 1/BRCA 2 gene mutation. BRCA gene also increases the risk of breast and ovarian cancer in women.
  5.     Obesity. There are links with obesity and prostate cancer.  Staying a healthy weight and exercising regularly may be important.

What are the symptoms?

The symptoms of prostate cancer can be similar to other prostate conditions such as BPH, but you should seek medical advice if you have any of the following symptoms:

  • Frequency- having to pass urine more often than usual
  • Nocturia- waking up in the night several times to pass urine
  • Hesitancy- difficulty in starting to pass urine and difficult emptying your bladder
  • Weak flow of urine
  • Urgency- a sudden strong urge to empty your bladder
  • Blood in urine or sperm
  • Other symptoms that can occur if the cancer has spread include back pain, bone pain, unexplained weight loss and loss of appetite.

Having these symptoms does not mean you have prostate cancer, however further investigations may be necessary and you should speak to your GP if you have concerns.

Testing

There is currently no screening programme on the NHS for prostate cancer. However an individual’s risk is assessed by their doctor and further tests are initiated.

PSA test– This is a blood test.  Prostate specific antigen (PSA) is a protein that is produced by both normal and malignant cancer cells. It is normal for men to have some PSA in their blood, but high levels can also indicate prostate disease, both cancerous and benign. A raised PSA can be due to BPH, urinary tract infection and other benign conditions as well as cancer.

There are age related reference ranges for PSA results, however these may vary with individual risk factors:

Age 40-49 years < 2.5     Age 50-59 years < 3.0     Age 60-69 years < 4.0      age 70-79 years < 5.0

Testing Free and Bound PSA

There is also a test available that calculates the ratio of ‘free’ and ‘protein bound’ PSA in the blood. Free PSA is associated with benign conditions whilst bound PSA is associated with malignancy. Research has shown that the proportions of free and bound PSA are different in men with prostate cancer compared to those that have benign disease.  If more than 25% of the total PSA is free then there is less chance of having prostate cancer.  However PSA testing is not diagnostic and further investigations would be required to diagnose prostate cancer.

In addition to the PSA blood test, further investigations include a rectal examination, trans-rectal ultrasound scan, MRIs and biopsy.

If you have any questions or concerns about these issues then please speak to your GP who can advise on the best form of examination and testing.

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