Men Ought to Know About Prostate Cancer

Did you know, 1 in 4 black men in the UK could be diagnosed with Prostate Cancer in their lifetime? Studies also show that 1 in 8 white men could also be diagnosed with Prostate Cancer in their lifetime (3). 

Prostate cancer is the most commonly diagnosed cancer in men across the world; it is also the 5th most common cause of cancer-related death in men (1, 2). Some risk factors of prostate cancer include ethnicity, obesity, family history and increasing age. Studies also show that men are more likely to be diagnosed with prostate cancer over the age of 50, but this does not make it impossible to be diagnosed younger than 50 (3). While many risk factors contribute to the possible development of this cancer, there is no real cause linked to the disease.  So many men are aware of prostate cancer, but they don’t understand what it is, how it can affect them or what the possible consequences are of late diagnosis. I hope from this article, you will be able to get a general understanding of what prostate cancer is, and how to take the necessary steps to get yourself checked for it.

Quick anatomy…

The prostate gland is a small glandular organ in the male reproductive system. It sits at the bottom of the bladder, around part of the urethra. The urethra is the small tube which allows us to move urine from the bladder out of the body. It is also important to note that the prostate gland is directly in front of the back passage (rectum) [Figure 1]. 

Figure 1 – Front and side view diagram of the position of the prostate gland in the body. Created by Mojibola Orefuja.

The prostate gland plays a unique role in helping men produce children by secreting special fluids and engaging specific muscles to support the process of child-making. Normally, the prostate grows and functions in response to Testosterone and other male reproductive hormones (2, 4). As men get older, the prostate can get larger and larger because it is constantly growing and developing. This can sometimes cause more problems than benefits. In the case of prostate cancer, some of these cells begin to grow abnormally, leading to the formation of a cancerous mass. As the prostate continues to grow bigger, the cancerous mass also grows bigger. It can even spread beyond the prostate to surrounding organs and the rest of the body, particularly the bones, liver, lungs, and lymph nodes (1, 6). One of the saving graces of this kind of cancer is that it is slow-growing, so when you catch it, there is still time to make informed decisions about how to manage it. This is, however, dependent on what stage of the cancer it is when you catch it.

Signs and symptoms

Normally, early stages of prostate cancer are asymptomatic, which means most men don’t notice there’s a problem until it’s grown bigger or begins to cause uncomfortable effects which can’t be ignored. 

Maybe you struggle to start urinating when you go to the toilet, despite absolutely needing to; or maybe you find that you can never quite get everything out, no matter how many times you go to the toilet; or you find that you are going to the toilet all the time, even during the night. These are all the usual symptoms associated with prostate cancer.

Now, before you jump to conclusions, there are also other prostate and urinary tract-related conditions that can give you these symptoms, so it is important that you get checked if you do have these symptoms. Conditions like Benign Prostatic Hyperplasia (non-cancerous enlargement of the prostate), prostatitis (prostate infection), or simple urinary tract infections can give you these same symptoms.

Other symptoms to watch out for, that could be associated with prostate cancer include:

• blood in your urine
• pain when passing urine
• problems with conceiving/engaging in sexual activity
• infertility
• chronic constipation – this is an associated symptom of prostate cancer because the constipation is caused as a result of an enlarged prostate pushing on the back passage and blocking it from emptying.

If you have any of the above symptoms as well as these symptoms below, speak to a doctor as soon as possible:

• back or bone pain that doesn’t go away
• tiredness
• weight loss

These symptoms could be caused by the cancer spreading to other parts of the body, so it is important that you get tests done straight away.

Investigations

• Digital rectal Exam (DRE)

When you first begin to worry about prostate cancer, the first test your doctor will do is a little unpleasant, but incredibly necessary. It is a physical exam called a Digital Rectal Exam. In this exam, the doctor will ask you to lie on your side on the examination bed in the foetal position. They will then insert a finger into your back passage. This allows them to assess the size and texture of the prostate through the back end. As mentioned above, the prostate is directly in front of the back passage, and therefore, it can be felt through the walls of the back passage. This exam is one of the most beneficial first steps towards diagnosis.

• Blood tests – including Prostate Specific Antigen (PSA)

If your doctor still suspects prostate cancer after doing the DRE, then they will order blood tests for you. The most important blood test is the Prostate Specific Antigen (PSA) test (2). This is a small protein released from the prostate into the fluid it produces; however, PSA can also be found in small amounts in the blood. When the prostate gland is of normal size, PSA levels in the blood are not expected to exceed a specific level. This expected level increases with age, but if your PSA level is above it, it prompts further investigation. Please note – if your PSA is raised, this does not automatically mean you have prostate cancer.

• MRI

MRI is the next step in assessing whether a person has prostate cancer, as it allows us to see the structure in more detail, and specialised doctors can determine if the prostate appears abnormal through MRI. 

• Prostate biopsy

A prostate biopsy is a test where a thin needle is inserted into the prostate directly to collect samples of the cells in the prostate (2). Lots of samples are taken to make sure as much of the prostate is covered, in order to give an accurate diagnosis. The samples that are taken are then inspected under a microscope, and using special scientific techniques, doctors can determine whether the cells in the prostate are cancerous or not. This makes biopsies the main diagnostic factor for prostate cancer. This test also allows doctors to calculate your Gleason score, which is simply a value based on grades indicating how abnormal/cancerous the cells look under the microscope. After prostate cancer is diagnosed, other tests can be carried out to check if the cancer has spread to other parts of the body, but this is done if the grade of cancer suggests this.

Stages of Prostate Cancer

Treatment of prostate cancer isn’t straightforward, as with any other type of cancer. There are lots of considerations, such as age at diagnosis, stage of cancer and available treatment based on the patient’s other medical conditions. Age plays a role because certain methods of treatment aren’t suitable for patients who are much older; methods like radical surgery. The stage of cancer is important because it helps to determine how aggressively to attack the cancer or not. Table 1 shows important information about staging in prostate cancer.

Table 1 – Breakdown of stages of prostate cancer, and the associated spread of the cancer. Adapted from (7).

Management

Watchful waiting or active surveillance

This is a treatment option for older patients who don’t have concerning signs or symptoms or other medical conditions. Watchful waiting differs from active surveillance because, in active surveillance, the patient still has regular tests and check-ups to monitor the clinical picture, whereas in watchful waiting, the patient’s care depends on symptoms.

Surgery

This is an option suggested for younger, healthy patients. This is because they are more able to recover from the surgeries and return to a good quality of life afterwards. There are different types of surgeries which can be suggested to treat prostate cancer, and if surgery is an option for you, your doctor will go over your surgical options very clearly with you. For most people, having the surgery puts them in a really good position to move past the cancer diagnosis and improve their quality of life.

Radiation therapy

This is a form of treatment which uses radiation from X-rays and other types to kill the cancer cells in the prostate or stop them from further growth. This form of treatment can be associated with other complications and other new cancers, so it is important that you understand the risks beforehand.

Hormone Therapy

Sometimes, prostate cancers develop due to stimulation from certain hormones, like testosterone. Hormone therapy is a specialised medical therapy that removes hormones that stimulate cancer growth or blocks their action, thereby preventing cancer cells from growing.

Chemotherapy

This is a general form of medical therapy that uses medications to kill cancer cells or prevent their growth. This form of treatment has more side effects and complications than hormone therapy because chemotherapy medications generally act on rapidly growing cells, including those in your hair and skin.

There are other forms of therapy like immunotherapy and targeted therapy, but these require very advanced conversations with your doctor, so I won’t go into them here. There are also always new therapies coming out frequently, which improve the management of prostate cancer (7).

As far as cancers go, prostate cancer is a cancer with a very good chance of survival due to its slow-growing nature and abundance of treatment options. Don’t let fear stop you from saving your life. Get checked. It’s better to know sooner and treat it than to find out when it’s too late and wish you’d tackled it sooner.

References:

1. Leslie SW, Soon-Sutton TL, Skelton WP. Prostate cancer [Internet]. StatPearls – NCBI Bookshelf. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470550/
2. Sekhoacha M, Riet K, Motloung P, Gumenku L, Adegoke A, Mashele S. Prostate Cancer Review: Genetics, diagnosis, treatment options, and Alternative Approaches. Molecules [Internet]. 2022 Sep 5;27(17):5730. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9457814/#B24-molecules-27-05730
3. Advising men without symptoms of prostate disease who ask about the PSA test [Internet]. GOV.UK. 2024. Available from: https://www.gov.uk/government/publications/prostate-specific-antigen-testing-explanation-and-implementation/advising-well-men-about-the-psa-test-for-prostate-cancer-information-for-gps
4. Murray TBJ. The pathogenesis of prostate cancer. In: Prostate Cancer [Internet]. 2021. p. 29–42. Available from: https://www.ncbi.nlm.nih.gov/books/NBK571321/
5. Cancer Research UK. Symptoms of prostate cancer [Internet]. Cancer Research UK. Available from: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/symptoms
6. Cancer Research UK. Metastatic prostate cancer [Internet]. Cancer Research UK. Available from: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/metastatic-cancer
7. Prostate cancer treatment [Internet]. Cancer.gov. 2024. Available from: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq