The prostate is an organ that is unique to men rather than women. We’re born with a
prostate gland that is actually small and as one gets older, the prostate gland gets
bigger. As it gets bigger, it can restrict your urinary flow and that can cause problems
in men as they get older. It can also be the site or development of a prostate cancer which
requires treatment in men as they get older. The first issue with the prostate gland is
that because it gets bigger, it may restrict the urinary flow between the bladder and the
urethra so men may complain of hesitancy, poor flow, and incomplete emptying. These are
usually signs of prostate enlargement and in people who’ve got enlarged prostate with
a significant cancer, this may be how they present.
However, most men will present with no symptoms. They may simply have an elevated PSA blood
test. This blood test stands for prostate specific antigen. It is prostate specific.
It is not prostate cancer specific. But it can give an indication that somebody’s at
risk of developing prostate cancer. We usually recommend that this is tested from the age
of 50 or from the age of 40 in men who have a family history of prostate cancer. It’s
important to know what your own baseline PSA is. If the PSA in the 40-year-old man is above
2, that could certainly be suspicious for early prostate cancer; above 3 in a 50-year-old
man and above 4 in a 60-year-old man. Men may present because they have urinary
symptoms or because they have the elevated PSA blood test. We can sometimes identify
prostate cancer on a physical examination of the prostate which is done through the
back passage with a finger. However, that is not the most accurate way to diagnose prostate
cancer. The most modern technique is to use an MRI
scan of the prostate which allows us to visualize the shape of the prostate and identify if
there’s any area within the prostate gland that we might say that does not look right,
that looks like it may be a cancer. In those situations, we can then do prostate biopsies
which we can take some samples from the prostate to see if we can find the cancer visualized
by the MRI scan or if the MRI scan is normal, but the blood test, the PSA blood test remains
elevated, we may still want to do biopsies around the prostate gland. The important thing
to understand is that prostate gland can harbour prostate cancer silently and therefore biopsies
are necessary to identify whether there is any cancer in the prostate.
Once a prostate cancer diagnosis has been made, we have some information from the biopsy that gives us
an idea about the grade of the cancer. That tells us something about how potentially aggressive
it may be. Some prostate cancers are low grade, non-aggressive, and they may grow very, very
slowly for many, many years and they may require no treatment. In that situation, we will monitor
the PSA over time and that is called active surveillance.
In patients who have a higher grade of tumour, we may offer them either some form of radiotherapy
treatment or some form of surgery. The radiotherapy treatments lie between brachytherapy where
we put radioactive seeds individually into the prostate to kill a prostate cancer
in situ or external beam radiotherapy where the radiation is beamed in from outside the
body. In both of these treatments, the prostate
gland remains in place in the body. Surgery requires removal of the prostate gland.
From 10 years ago, this surgery was routinely done by open surgery. Nowadays, we can actually
do the surgery less invasively using keyhole surgery and robotics. This allows us to remove
the prostate gland much more safely with less morbidity particularly with regards to urinary
incontinence or erectile dysfunction. Although prostate cancer the commonest form
of malignancy in men, most men will not die from prostate cancer. If it can be caught
early and adequately treated, most people will have a normal life expectancy. The critical
thing with diagnosing and treating prostate cancer is to identify significant disease
early and to offer an appropriate treatment early so that the long term effects of prostate
cancer spreading outside the prostate gland itself are avoided. In that way, most patients
will have a normal life expectancy.