PROSTATE CANCER


PROsTATe CANCeR:


W


ith around 270 men dying from the disease in Northern Ireland every


year, prostate cancer is the second most common cause of cancer death in men. Fortunately, thanks to innovative treatments, more men are likely to experience positive outcomes.


What is prostate cancer? Prostate cancer is a generally slow- growing cancer which usually affects men over the age of 40. More than 70 per cent of cases occur in men aged over 65.


Prostate cancer usually develops when one cell in the prostate – a small gland that lies just below the bladder – starts to multiply out of control and forms a tumour. In many cases, the cancer is slow growing and may not cause major problems. In other cases, however, it can be faster growing and requires prompt treatment.


At present, no one knows exactly what causes prostate cancer, but certain things have been shown to increase a man’s risk of developing the disease, such as age, family history, ethnicity and lifestyle.


Symptoms Men who are in the early stages of prostate cancer are unlikely to have any symptoms. When they do appear, however, they are likely to include: • Poor urine flow • Blood in semen • Blood in urine • Difficulty passing urine • Passing urine more frequently, especially at night


• Dribbling/leaking • Back/bone pain


14 - PHARMACY IN FOCus


new hope for many


IN NORTHeRN IReLAND, MORe THAN 1100 MeN ARe DIAGNOseD WITH PROsTATe CANCeR eVeRY YeAR, MAKING IT THe MOsT COMMON FORM OF MALe CANCeR.


Diagnosis Prostate cancer is diagnosed by a number of tests.


Prostate Specific Antigen (PSA) test: The PsA test measures the level of a protein called Prostate specific Antigen (PsA) in the blood. Prostate cancer increases the level of PsA, although other factors, such as infection, can also increase its level. It is for that reason that the PsA test is not considered in isolation as a diagnostic tool.


Digital rectal examination (DRE): The DRe involves a doctor or nurse feeling the prostate gland through the wall of the back passage using a finger. This enables them to identify any hard or irregular areas which could indicate a sign of prostate cancer.


Treatment Radiotherapy: The most common treatment for prostate cancer is radiotherapy, which is delivered directly to the prostate. unfortunately, the prostate’s proximity to the rectum means that many men experience side effects of current treatments, primarily when healthy tissues near the prostate are damaged by radiotherapy.


These side effects can include: rectal bleeding, pain, frequency/urgency of bowel motion, frequency/urgency of urination and loss of sexual function, but now, new technology has been created to reduce these side effects.


The new procedure involves the injection of a biodegradable substance (examples include polyethylene glycol hydrogel, hyaluronic acid and human collagen), or the insertion and inflation of a biodegradable balloon spacer in the


space between the rectum and prostate. This temporarily increases the distance between them and consequently reduces the amount of radiation and toxicity delivered to the rectum. The procedure is usually done with the patient under general anaesthesia. However, it may be done using local or spinal anaesthesia, depending on local protocols. The spacer degrades slowly over several months.


Prostatectomy: A prostatectomy is a surgical procedure for the partial or complete removal of the prostate. The procedure involves a surgical incision and the removal of the prostate gland or part of it. This can be achieved by either a retropubic or suprapubic incision in the lower abdomen or a perineum incision through the skin between the scrotum and the rectum. Nerve- sparing surgical removal is important to preserve as much function as possible.


sometimes laparoscopic surgery is done using a robotic system. This involves the surgeon moving a robotic arm while sitting at a computer monitor near the operating table. Not every hospital is capable of carrying out robotic surgery but, since 2016, more than 100 men a year are operated on in Belfast City Hospital thanks to a £1.5 million robot. The arrival of the robot meant that men no longer had to travel to england for this procedure.


Transurethral resection of the prostate (TURP): TuRP involves removal of part of the prostate gland and is performed through the penis with an endoscope, a small, flexible tube with a light and a lens on the end. This procedure doesn’t cure prostate cancer, but can remove the


obstruction while the doctors plan for definitive treatment.


Focal therapy: Focal therapy is particularly suitable for men with localised, but clinically significant prostate cancer. Focal therapy involves treating just the cancer, while leaving the rest of the prostate and surrounding tissue intact. There are many types of focal therapy, but all have the same basic principle: they use a high dose of energy to kill cancerous cells while avoiding side effect-inducing collateral damage. These include:


Cryotherapy: In cryotherapy, the cancerous tissues is cooled to around -40°C, triggering a kind of extreme hypothermia in the cancer cells, which subsequently kills them. The area is slowly warmed up and then given a second blast of cold, ensuring that the treatment has been effective.


High intensity focused ultrasound (HIFU): At the other end of the temperature scale is HIFu, which uses high temperatures of over 60°C to kill cancer cells. Heat is generated by high energy sound waves, which are focused by a transducer. This procedure means that the sound waves are precisely targeted to burn only the cancerous areas of the prostate, and leave the healthy tissue untouched.


Irreversible electroporation (IRE): With IRe, pulses of electricity, which can be very finely pinpointed, create tiny holes in cancer cells, causing them to die.


Photodynamic therapy: This therapy involves laser beams, which are used to activate a light-sensitive drug in the precise area where it is needed to kill prostate cancer cells.


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