MEDICAL MATTERS...
“WHILE I’M HERE, DOCTOR, COULD I JUST MENTION SOMETHING ELSE…?”
You may recall – if you’re one of our hun- dreds and thousands of regular PHTM readers - that we have run a couple of Medical Matters columns about prostate cancer in recent times. We thought, especially as March is Prostate Cancer Awareness Month, that it would be appropriate to run an update on this very sensitive but common disease, with a view to raising awareness – and possibly saving a few lives.
Last time we highlighted the fact that prostate cancer had become a bigger killer than breast cancer, and part of the reason for this was lack of focus and lack of funding for the men’s complaint. Cancer UK has announced that another £3 million has been raised in the last 12 months, bringing the total to £50 million over the past 25 years. But people still really do have to put their hands in their pockets for more, as there is so much more to be done.
To remind readers, the prostate is a small gland about the size of a walnut, just below the man’s bladder. It surrounds the first part of the urethra, the tube which carries urine from the bladder to the penis. The same tube also carries semen. The prostate is divided into two lobes: the left and the right.
This gland makes the fluid part of semen; it needs the male sex hormone, testosterone, to grow and function. Therefore some treat- ments for prostate cancer work by reducing the levels of testosterone.
SIGNS AND SYMPTOMS
It is important to stress from the outset that in the early stages of prostate cancer there are absolutely no symptoms whatsoever; this is the tricky part, because the problem can develop over a period of years without the person knowing it. But equally, it is vital to know that the most common symptoms of prostate cancer and non-cancerous (benign) enlarged prostate are the same. They are:-
• Having to rush to the toilet to pass urine • Passing urine more often than usual, espe- cially at night
• Difficulty passing urine, including straining to go, or starting and stopping
• A sense of not being able to completely empty the bladder
• Pain when passing urine • Blood in the urine or semen
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Prostate cancer and non-cancerous enlarge- ment of the prostate both cause symptoms by pressing on the urethra; this pressure blocks the flow of urine. Most enlargements of the prostate are not cancer, and can be easily treated.
Before anyone starts Googling all over the place and self-diagnosing here, you’ll note that some of these symptoms also pertain to many other complaints as well, such as the urgency to pass water and having to go more than usual, especially at night. Those can be classically related to type 2 diabetes, especially late onset diabetes. So this is why if you have any doubts or concerns, you must arrange to see your doctor to discuss them as soon as possible.
RISKS AND CAUSES
Across the UK prostate cancer is now the most common cancer in men. Over 47,000 men are diagnosed with prostate cancer every year. Around 400,000 men are living with and after the disease. Shockingly, more than 11,500 men die from this every year. In simple terms, one man dies every 45 minutes from prostate cancer. One in eight men will get prostate cancer in their lifetime
Some risk factors include age: more than half of all cases of prostate cancer are diagnosed in men over 70. It is quite rare (but not out of the question) in men under 50.
You may also be more at risk if you have a fam- ily history of prostate or breast cancer, or if you are black (of African or Caribbean ancestry), as this type of cancer is more common in black men than white or Asian men. And Asian men have a lower risk than white men.
There is a lot of research going on (and these stats are courtesy of Cancer Research UK); the evidence is not mega-strong, but your diet may affect your risk: you may increase your risk if you eat a diet high in dairy prod- ucts. There is also some evidence that lycopene from tomatoes – especially cooked or processed tomatoes – may lower the risk.
Some studies have shown that having dia- betes may reduce the risk of prostate cancer. (There’s a turnup for the books! – at least one possible complaint off the long list for dia- betic men...). There is also some evidence that regularly taking aspirin or other non- steroidal anti-inflammatory drugs (NSAIDs) could reduce the risk.
SCREENING AND DIAGNOSIS
The aim of screening is to diagnose the dis- ease at an early stage, before symptoms start. Cancers diagnosed early are easier to treat and more likely to be cured; but before it is possible to screen for a disease, there must be an accurate test to use. Unfortunately there is currently no national screening programme for prostate cancer in the UK, because there is no clear evidence from research that screen- ing will reduce deaths from prostate cancer, or will help people to live longer.
If you ask your GP to check you for prostate cancer they will examine your prostate by putting a gloved finger into your back pas- sage and feeling the prostate gland; and take a blood test for a protein produced by the prostate called PSA: prostate specific antigen.
Generally speaking, the higher the PSA level, the more likely there is a cancer. However, the PSA reading can be raised for other reasons, such as a urinary infection (quite common) or an enlarged prostate that is not cancerous. PSA testing alone is not recommended for screening in the UK for many reasons: men with prostate cancer may not have a raised PSA; two out of three men with a raised PSA do not have prostate cancer; many prostate cancers grow very slowly and may never cause any problems.
So you can see that this is one huge grey area! The National Institute for Health and Care Excellence (NICE) has produced guide- lines for GPs to help them decide which patients need to be seen urgently by a spe- cialist urologist. The guidelines say you should get a specialist referral within two weeks if you have:
• Abnormalities in your prostate that your GP can feel during an examination
• A PSA test considered high for your age • A borderline PSA test, followed by a repeat test one to three months later that shows the level is rising
• A raised PSA reading, plus other symp- toms that may be linked to prostate cancer
Once at the hospital, the blood test for PSA levels will be repeated and the examination of the prostate gland. They will also request an ultrasound scan and up to 12 tissue biop- sies taken during the scan, which may result in an MRI scan or different type of biopsy.
If they have to check whether the cancer has spread anywhere else in your body, you may have to have more tests: bone scan, X-rays, a CT scan, further MRI or ultrasound scans. It can take a week or so for the test results to come through, at which point you are called back to see the specialist again.
MARCH 2019
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