Prostate cancer

• Prostate cancer is usually a condition of old age and in men it is the most common cause of cancer deaths in the UK.
• As well as prostate cancer, prostatic conditions, for example, benign prostatic hyperplasia and prostatitis, feature significantly as a cause of ill-health among men.
• These conditions can significantly damage the quality of life for the man and his family.

In order to get prostate cancer, there is a need to have a prostate gland. This cancer mainly affects men; however, trans people who were assigned male at birth and male-assigned non-binary people can also get prostate cancer.

For most men, they will have had symptoms for a number of months before seeking help, which results in delays between presentation and referral.

Prostate cancer (like other cancers) can have devastating effects on the man. Prostate cancer impacts on the daily lives of men, specifically on their physical and emotional health, relationships and social life (Appleton et al, 2015). Each man (and, if appropriate, his family) will cope (or attempt to cope) with the disease and the treatment in various ways, employing a number of strategies to help them manage their diagnosis as they undertake their activities of living.

There are some prostate cancers that can grow and spread quickly; however,

The aetiology of prostate cancer is unknown, with genetic and environmental factors though to play a role in the onset. However, prostate cancer is not thought to be related to benign prostatic hyperplasia.

The genes BRCA 1 and BRCA 2 are important risk factors for breast and ovarian cancers and these have also been implicated in prostate cancer risk. Knowing if a person has the BRCA 1 or BRCA 2 genes will have implications for treatment.

Prostate cancer can be spread by local extension via the lymphatic system or via the bloodstream. The most common sites for metastases are in the bone and lymph nodes.

The main risk factor for prostate cancer is older age. Preventable cases of prostate cancer are not known; this cancer is clearly not related to any preventable risk factors.

The risk factors associated with prostate cancer can be seen in Box 1. Male hormones modify the growth of the prostate, and prostate cancer appears to be related to lifelong levels of testosterone: prostate cancer is testosterone-dependent until late in the course of the disease.

Box 1. Risk factors related with prostate cancer

• Ethnicity is a significant risk factor, with a higher incidence of prostate cancer in North America and Europe, predominantly among Black African or Black Caribbean groups. Low rates of the condition are noted in China and Japan
• Risk increases 2–3 times if a first-degree relative is diagnosed at an early age. There is a greater risk with a family history of breast cancer. Certain genes have been identified

In early prostate cancer, often there are no symptoms at all (asymptomatic). If the man does experience symptoms, these may be similar to those of other prostate conditions. The symptoms of growths in the prostate are similar, regardless of whether they are benign or malignant. Lower urinary tract symptoms, for example, urinary frequency, hesitancy, nocturia and slow stream, do not increase the risk of prostate cancer.

In localised prostatic disease, there may be:

• raised prostate-specific antigen (PSA)
• weak urinary stream
• hesitancy
• a sensation of incomplete emptying of the bladder
• urinary frequency and urgency
• urinary tract infections.

Where there is locally invasive disease, the man may experience:

• haematuria (blood in urine)
• dysuria (painful or difficult urination)
• incontinence
• haematospermia (blood in semen)
• perineal and suprapubic pain
• loin pain
• if the ureters are obstructed, urine output will be affected
• anuria (failure of the kidneys to produce urine)
• symptoms of renal failure
• erectile dysfunction.

A medical history and physical examination will be needed to make a definitive diagnosis along with a range of investigations, non-specific and specific. 

A transrectal ultrasound scan (TRUS) is a scan performed to examine the prostate gland using ultrasound. A small ultrasound probe is gently lubricated and inserted into the rectum (Figure 4).

The treatment options available to the man will depend on location, stage, grade, the man's general health and his own preferences. The various treatment options, with the benefits and potential side effects of each are discussed with the man and the multidisciplinary team.

Depending on the man's condition, the option of not having treatment straight away is available. The patient's cancer is monitored closely through active surveillance and watchful waiting. With active surveillance, the man's condition is monitored and treatment is commenced if the cancer starts to grow. The intention is to avoid uncalled-for treatment and to offer radical treatment to those men who need it. With watchful waiting, the man has fewer tests than with active surveillance. The cancer is monitored and treatment starts as symptoms develop.

Surgical intervention or radiotherapy are equally effective at curing early prostate cancer. It must be remembered, however, that regardless of treatment option,

The author would like to thank Mrs Frances Cohen for her help and support.