Prostate Cancer - Symptoms, risks and treatment

In 2012 an estimated 1.1 million men worldwide were diagnosed with prostate cancer, accounting for 15% of all cancer diagnosis in men. Two thirds of prostate cancer cases are diagnosed in more developed regions of the world.

Prostate cancer occurs when normal cells in the prostate gland alter to form a mass of cancer cells, creating a tumour. How these cells react and affect the operation of the prostate, will differ for each individual. In some men the cells may grow very slowly and they may not develop symptoms from their prostate cancer.

For others the cancer cells will grow quickly, requiring treatment to kill the cells and prevent spread to other areas. The risk of developing prostate cancer rises with age.

It is most often diagnosed in the early stages, before it has begun to spread beyond the prostate gland.

In many cases prostate cancer can be cured or kept under control.

The cause of prostate cancer is unknown. But there are some factors that might increase your risk of developing it.

• Age: Your risk increases as you get older. 60% of prostate cancer diagnosed in men over 65.
  
  
• Family history: Men whose brother or father developed prostate cancer at a young age have an increased risk.
  
  
• Race: African-American and African-Caribbean men are 70% more likely to develop prostate cancer than other ethnic groups.
  
  
• Diet: Men who eat a diet high in saturated fat and not enough green vegetables may have a raised risk of getting prostate cancer.
  
  
• A previous cancer: Men who have had other cancers in the past may have an increased risk of getting prostate cancer.

There are three stages of prostate cancer, determined by how large the tumour is and how far it has spread. By determining the stage the cancer is at doctors decide which treatment is most appropriate.

Tests and scans used to diagnose cancer give some information about the stage. Sometimes it’s not possible to determine the stage until after surgery.

In the early prostate cancer or localised prostate cancer stage, cancer is confined to the prostate gland only. The tumour may be very small and no symptoms may be experienced. A doctor may suspect prostate cancer after doing a PSA blood test.

The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate.

The PSA test can only indicate a prostate problem - it doesn’t specifically diagnose prostate cancer.

Several treatment options are available to treat early prostate cancer, most aim to cure the cancer.

Prostate cancer is most often diagnosed in the early stages, before it has begun to spread beyond the prostate gland.

Locally advanced prostate cancer is where the prostate cancer has spread through the prostate gland and into the surrounding tissues but has not yet spread to other parts of the body.

It may have spread into the:

• tissue around the prostate
• the tubes that carry semen (seminal vesicles)
• body organs nearby such as the back passage (rectum) or neck of the bladder
• lymph nodes close to the prostate gland

Treatment options will depend on how far the prostate cancer has spread.  Treatment may focus on eradicating the cancer or keeping it under control.

In the advanced prostate cancer stage, the cancer has spread from the prostate to other parts of the body, most commonly the lymph nodes or to the bones. In some cases it can also spread to other organs.

The cancer cells spread to other parts of the body through the bloodstream or lymphatic system.

It is not possible to cure advanced prostate cancer but there are treatments that can help control it.

Prostate cancer usually only causes symptoms when it has grown large enough to disturb the bladder or press on the urethra, causing problems passing urine. These symptoms are called prostate urinary symptoms.

Problems passing urine is a common complaint for men as they grow older.

It is also important to understand that early prostate cancer may not cause urinary symptoms, or any symptoms at all. It is not safe for you to assume that because you have no prostate urinary symptoms that you do not have prostate cancer.

Visit your doctor if you are worried, or if you have any of these symptoms so that they can be discussed and assessed.

Symptoms may include the following:

• Prostate urinary problems
• A slow flow of urine
• Trouble starting or stopping the flow
• Passing urine more often
• Getting up in the night several times to pass urine
• Pain when passing urine
• Blood in the urine or semen – less common symptom
• Urgency – sudden strong urge to pass urine
• Feeling of not emptying your bladder fully
• Leaking urine
• Erection problems – less common symptom

Because early prostate cancer does not usually cause any symptoms, it is often identified through prostate cancer screening. This involves a doctor checking for the possibility of prostate cancer even when no symptoms are displayed.

Men experiencing prostate urinary symptoms attending their doctor will initially undergo a general health exam and screening, where the doctor will enquire about the man’s general health, any symptoms and any family history of prostate cancer.

The first tests for assessing the prostate gland are the PSA blood test and a digital rectal examination.

In the early prostate cancer stage a prostate tumour may be so small it cannot be felt by the doctor during a digital rectal examination.

A raised PSA indicates that a man may have a problem with his prostate gland which merits investigation.  A high proportion of  men with a raised PSA who do proceed to prostate biopsy do not have prostate cancer.

Treatment for prostate cancer depends on:

• where your cancer is
• how far it has grown or spread (the stage)
  
• the type of cancer
  
• how abnormal the cells look under a microscope (the grade)
• your general health and level of fitness
  

A doctor will discuss the best treatment options with a patient, explaining the benefits and the possible side effects. Many men may find it stressful having to choose between treatment options, and worry they will choose the wrong one. Often there is no single best option, it’s important time is taken to think through each treatment option and decide with a doctor which one is right.
 

Generally recommended for men whose prostate cancer may be caught early, contained or not causing symptoms. Men are monitored for changes in their cancer and tested regularly.

Uses high-energy X-rays aimed at a cancer to cure or control it.

There are two primary types of radiotherapy. External beam radiation and internal radiation (brachytherapy).

Prostate cancer depends on the male hormone testosterone to grow. By reducing the amount of testosterone via hormone therapy, the growth of cancer cells can be slowed or stopped.

Some men with advanced prostate cancer may be given chemotherapy in combination with hormone therapy.

Anti-cancer drugs designed to stop the growth of cancer cells are administered.

Radical Prostatectomy is the other option of definitive therapy next to Radiation therapy -- the choice is largely a matter of patient preference.

The options include open abdominal surgery and minimally invasive laparoscopic surgery (both performed “nerve sparing”) which is associated with a significantly lower rate of complications that would impact the patient’s quality of life.

The above techniques can also be performed as Robotic surgery.

Both Radiation therapy and Prostate surgery can have the undesired complications of urinary incontinence and erectile dysfunction.

Receiving a diagnosis of prostate cancer is shocking. It can be difficult to remember and understand all the information given by the doctor, or to know what questions to ask. Many men find it useful to ask the doctor to write down the information and record the details of biopsy results and treatment options for referring to another time.

At Allianz Worldwide Care our core plans cover in-patient, day patient and out-patient oncology treatment. Insured members are not only covered for preventative check-ups but can avail of all cutting edge therapy options including the Da Vinci Robotic surgery device. In case of after surgery problems they are fully covered for the necessary therapeutic options ranging drugs for erectile dysfunction up to a penile implant.

“I recommend that men attend a Urologist at age 50 – even without having any symptoms – to get a base assessment and discuss further preventative measures. This is not a “one size fits all” preventative strategy – it needs to be tailored to the individual patient very much taking family history, lab results and personal preference into account.” Dr Ulrike Sucher, Medical Director, Allianz Worldwide Care.