Things to Know About Prostate Cancer: Symptoms, Diagnosis, and Treatment
In males in the UK, prostate cancer is the most common cancer, with around 52,300 new cases every year, that's more than 140 every day (Cancer Research UK 2016-2018 Statistics). Prostate cancer accounts for 27% of all new cancer cases in males in the UK. Incidence rates for prostate cancer are projected to rise by 12% in the UK between 2014 and 2035, to 233 cases per 100,000 males by 2035.
Prostate cancer is one of the most curable cancers with early diagnosis. However, 1 in 7 men will experience this disease at some point in their life.
The prostate, which is part of the male reproductive system and responsible for semen production, is just below the bladder and in front of the last part of the large intestine called the rectum.
Two important terms about prostate cancer
- PSA (Prostate-Specific Antigen): It is a protein made by the prostate gland. Measurement of this protein in the blood is used in diagnosis, staging, treatment plan, and evaluation of treatment response.
- DRE (digital rectal examination): It is the examination of the prostate from the anus with a finger. Since the prostate gland is adjacent to the rectum, the last part of the large intestine, the doctor can detect prostate tissue problems with a finger from the anus.
Should I Have Prostate Cancer Screening?
A PSA blood test is recommended for all men over the age of 50. However, before having prostate cancer screening with PSA or any other method, a person should discuss this with their doctor. Because a biomarker with high sensitivity and specificity for prostate cancer has not yet been found. Many other urological problems increase the blood PSA level. Only 20-40% of patients with positive PSA or rectal examination have prostate cancer. Therefore, men aged 50 years and older with normal risk who do not have a family history or hereditary risk factors should discuss the pros and cons of prostate cancer screening tests in detail with a specialist.
What are Prostate Cancer Risk Factors?
- Heredity: 10% of prostate cancers are caused by mutations of BRCA1 and especially BRCA2 genes.
- Age: 60% of prostate cancers occur in men aged 65 and over.
- Family history: Those with a first-degree relative, such as a father and sibling, with a history of prostate cancer have twice the risk.
- Nutrition: Excessive consumption of saturated fat in the diet increases the risk of both obesity and prostate cancer.
What are the Symptoms of Prostate Cancer?
Urinary complaints may be caused by prostate cancer because the prostate is adjacent to the bladder and urethra.
- Burning, pain, or difficult urination when urinating
- Initiating and/or ending urination
- Decreased urine flow, thickness
- Frequent urination at night
- Urinary incontinence, blood in the urine
- Erectile dysfunction, erectile dysfunction
- Bone pain, especially in the lower back and hip area
- Swelling in the groin area or legs
- Blood in semen, painful ejaculation
Should I Get Prostate Biopsy?
- Digital rectal examination findings and/or suspicious increases in PSA levels measured in the blood are sufficient for a biopsy decision.
- Most of the prostate cancer diagnosis, treatment, and follow-up guidelines accept a serum total PSA value above 3.0 ng/ml as high and recommend biopsy at PSA levels higher than this value.
- In men with an increase in total PSA level, the presence or absence of a change in PSA level with antibiotic treatment does not affect the biopsy decision.
The Most Important Determinants of Treatment in Prostate Cancer: Stage and Risk Groups
Prostate cancer stages are defined as:
The cancer is confined to the prostate and has spread to part of the prostate. Gleason score and PSA are quite low.
At this stage prostate cancer may not be detected by rectal examination or imaging methods.
The tumour is larger, maybe in both lobes of the prostate, but still has not spread beyond the prostate.
At this stage, the tumour may still not be detected by examination and radiological methods, but the Gleason score is higher.
Cancer has spread outside the prostate, mostly to the seminal vesicles (sperm sac) and nearby lymph nodes.
Cancer has metastasized to bones, near-distant lymph nodes, and other organs in the liver.
Prostate Cancer risk groups are determined by Gleason Score, Tumour Size, and PSA Value
The tissue taken by prostate biopsy is examined with a microscope by the pathologist to find a Gleason score of 1 to 5.
In the 1st pattern, cancerous prostate cells appear as normal prostate glands, while in the 5th pattern, the normal glandular image is either rarely or not observed. The pathologist then identifies the dominant patterns in the tumour sample, and the sum of the 2 dominant patterns forms the Gleason score. For example, 3+4=7 might be the final Gleason score.
T staging: It is staging based on the size of the tumour:
- T1-T2a: Tumour in less than half of one side of the prostate
- T2b: Tumour in more than half of one side of the prostate
- T2c: Tumour in both lobes of the prostate
- T3 and above: The tumour has exceeded the prostate capsule
Prostate Cancer Risk Groups Calculated Based on Gleason Score, T stage, and PSA Values
- Low Risk: T1-T2a stage and Gleason score ≤6 and PSA ≤10
- Moderate Risk: T2b stage and/or Gleason =7 and/or 10<PSA≤20
- High Risk: ≥T2c stage or Gleason 8–10 or PSA>20
Prostate Cancer Treatment – General Approach
It is important to know that there are many different treatment options for prostate cancer, specific to this disease. The main goal is to get rid of the disease completely, and while doing this, a method that the patient can tolerate easily and that will not cause problems in the rest of his life should be applied. Nearly 90% of patients diagnosed with prostate cancer are in the early stages.
In the early stages, treatment approaches "according to the patient's risk group" are radiotherapy (internal or external), hormone suppression, surgery, HIFU, cryoablation, and active surveillance without treatment.
In the advanced stage, chemotherapy and hormone suppression are the main treatments. It should be noted that some patients may benefit from immunotherapy or BRCA-targeted genomic therapies.
Multidisciplinary Decision Making
Today, prostate cancer treatment should be applied by multidisciplinary teams composed of physicians who have advanced expertise in this field and know prostate cancer is a complex and systemic disease.
At Oncotrust our 7-Day Diagnosis Pathway can help patients exclude a diagnosis of lung cancer quickly and safely. Please visit our contact page today to submit your questionnaire or book your Private GP Appointment