Prostate Cancer
Despite prostate cancer being one of the most common cancers in men, representing 25% of all new cancer cases diagnosed in the European region, only 48% of men in Europe are aware of the risk of Prostate Cancer and early detection options. Moreover, the sensitive nature of the disease and associated effects of the treatments may lead some men who are diagnosed with prostate cancer to avoid opening up to those around them, including their family, friends and healthcare professionals.
For the prostate cancer patient community, it’s crucial to raise awareness of its symptoms and make sure more men can seek medical advice and receive a timely diagnosis, which can positively impact the evolution of the disease.
What is Prostate Cancer?
The prostate is a gland roughly the size of a walnut – though often bigger in older men - located between the penis and the bladder. It produces semen which is then transported via the urethra that runs through its centre.
Prostate cancer occurs when normal cells within the prostate mutate and begin to grow in an uncontrolled manner. Sometimes, cancer cells can leave the prostate and spread to other parts of the body. Doctors make the following distinction between different types of prostate cancer:
Localised prostate cancer: the cancer growth is confined to the prostate gland and has not spread to other parts of the body. The speed at which the cancer grows and spreads can vary per person.
Locally advanced prostate cancer: the cancer has just spread beyond the prostate gland to the surrounding area(s).
Metastatic prostate cancer: the cancer has spread to other parts of the body and can no longer be cured.
How common is Prostate Cancer?
Prostate cancer is the most commonly occurring cancer in men, representing 25% of new cancer cases diagnosed among men. Every year, approximately 450,000 men are diagnosed
with prostate cancer in Europe, and more than two million Europeans are living with the disease.
Unfortunately, the cause of prostate cancer is still unclear, but well-established risk factors have been identified:
• Age: the risk of developing prostate cancer increases with age. The average age at the time of diagnosis is 69 years.
• Ethnic origin: prostate cancer is most commonly diagnosed in men of African descent.
• Family history: those with a history of prostate cancer in their family are at a higher risk of developing the condition themselves.
While the link between obesity and the development of prostate cancer remains unclear, well-designed studies have found that obesity can have an important impact on the progression of the disease. Men who are overweight are more likely to experience an aggressive form of the disease.
What are the symptoms of Prostate Cancer?
More often than not, prostate cancer is asymptomatic, a ‘silent disease’ which means that there are no specific symptoms associated with it. Occasional backaches and an increased and often sudden need to urinate are common symptoms of senior age. However, when pain persists and urinating becomes more and more uncomfortable, there might be more than age at play.9
The cause of prostate cancer is largely unknown, and many people show no related symptoms in the early stages of the disease.10
Urinary symptoms, such as a constant and sudden need to urinate, difficulty urinating, a weak flow, and the feeling that your bladder hasn’t emptied properly, are usually early indicators of prostate cancer, though they can also be indicative of non-cancerous prostate diseases, such as an enlarged prostate and prostatitis.10
Other symptoms may occur in more advanced stages of prostate cancer, meaning that the cancer has broken out of the prostate and possibly spread to other parts of the body.10 These can include:10
• Back, hip or pelvis pain
• Blood in the urine or semen
• Difficulty in having an erection
• Unexplained weight loss
It is important to make an appointment with your doctor as soon as you experience any such symptoms.10 Diagnosing prostate cancer earlier will likely have a better prognosis and can be easier to treat.11
What methods are used to diagnose prostate cancer?
There are different tools for diagnosis,12 the most common being:
• Digital Rectal Exam (DRE): the doctor digitally inspects your rectum to check for possible changes to your prostate gland.
• Prostate-Specific Antigen (PSA) test: a blood test that detects the level of PSA, a protein produced by the prostate and may be indicative of the disease being present.
• Gleason Score: a test that indicates how aggressive the prostate cancer is. A higher number means that the cancer is more aggressive and more likely to spread.13
• Prostate biopsy: you will be referred to a health care provider who will sample a small piece of tissue from your prostate gland for examination.
• Other: Magnetic Resonance Imagining (MRI), Computerised Tomography (CT) or Positron Emission Tomography (PET) scan to get a better view of the size of the cancer and the extent of spread.
These are the different stages of prostate cancer:14
Stage I | Stage II | Stage II and III | Stage IV |
|---|---|---|---|
Stage I The cancer is confined to the prostate gland and usually cannot be felt | Stage II The cancer is still within the prostate but can be felt via rectal examination | Stage II and III The cancer has started to spread beyond the prostate to nearby tissues. | Stage IV The cancer has spread to other areas of the body, such as the bladder, rectum, or bones. |
Treatment and Care
There are several treatment options for prostate cancer, and often, it ultimately comes down to the patient to decide which option to pursue. If your cancer is asymptomatic and low risk, treatment may do more harm than good.15 In some cases, active surveillance will be advised, which requires regular check-ups with Prostate-Specific Antigen (PSA) tests, Digital Rectal Exam (DRE), Magnetic Resonance Imagining (MRI) scans, and other exams. Re-biopsies are sometimes needed as well. If tests results change, treatment may be considered.16
When diagnosed with locally advanced prostate cancer, treatment will depend on your individual situation. Your doctor will propose an appropriate plan based on your age, health and stage of the cancer.17
Usually, the standard approaches to treatment18 are:
• Active surveillance: Medications, radiation and surgery aren't used. Periodic tests check for signs the cancer is growing. You might consider active surveillance for prostate cancer if your cancer is small, expected to grow very slowly, confined to one area of your prostate, and isn't causing signs or symptoms. If you have certain health problems that makes certain treatments unsuitable, active surveillance for prostate cancer may also be a reasonable approach.19
• Surgery: eliminating the cancerous cells through the removal of the prostate.
• Radiation therapy: using radiation to kill cancerous cells.
• Hormone therapy: blocks cancer cells form getting the hormones they need to grow.
• Chemotherapy: using special drugs to shrink or kill the cancer. The drugs can be pills or medicines given through your veins, or both.
As with any therapy, cancer treatments can cause side effects, so it is important to discuss your options with your medical team.17 Be as open and honest as possible and address every concern you may have to make a decision that fits your therapeutic needs.18
If diagnosed with metastatic prostate cancer, your doctor will advise treatments to help manage and relieve symptoms.9
Living with Prostate Cancer
Being diagnosed with cancer can be a distressing experience that can have an impact on your everyday life, work, and relationships.20 It’s normal to feel frightened, uncertain, and even angry. Self-care is necessary for both you and the people close to you. Be honest. Share your feelings and let them know what you need to cope with your condition.20
Men diagnosed with prostate cancer can still live their day-to-day life, but often feel worried about the disease progressing. If you have a more progressive form of cancer, you may not feel well enough to go about your normal routine and treatments can make you feel tired and unwell.20
It’s important to focus on your specific situation and what will offer you the best quality of life. Know that you’re not alone and you can ask your doctor about patient associations and social services that can support you and your loved ones. Healthy nutrition and an exercise routine fitted to your personal situation can help manage side effects and offer an emotional outlet as well.21
What to ask your doctor?
The list below includes example questions to help start a conversation with your health care provider. There may be other relevant questions based on your symptoms, stage, and medical history that are not listed here.
- What tests will I need?
- How and when will I get the results? Who will explain the results to me?
- How advanced is my disease, and what can I expect?
- What are the treatment options? How much time do I have to decide?
- What are the possible side effects?
- What happens if the treatment doesn’t work?
- How will this affect my everyday life?
- What symptoms or side effects should I tell you about right away?
- Are there any clinical trials I can join?
- Can I be referred to patient support groups?
- …
Glossary
- Gleason Score: a score used to grade of prostate cancer.22
- Haematuria: the presence of blood in one’s urine.23
- Prostatectomy: partial or complete removal of the prostate and some of the tissue surrounding it.24
- Metastatic: when the cancer has spread from where it originated to other parts of the body and can no longer be cured.
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