For such a seemingly innocuous organ, the prostate gland can cause a lot of trouble in older men. About the size of a walnut, the prostate is situated at the base of the bladder. It’s not high on the list of vital organs, not being essential for life, but its function is to produce the ejaculate fluid in which sperm bathes.
In men over the age of 50, the prostate makes its presence felt because it gets bigger. This enlargement can obstruct the passage of urine, causing problems with urination like difficulty in getting started, dribbling or slowness in passing urine, and sometimes pain, blood or incomplete emptying of the bladder. Prostate cancer can cause these symptoms. Although it is less common than BPH, as cancers go, it is very common.
Not much is known about why cancer develops in the prostate in some men. It’s a disease of older men – it is rare under the age of 50. But when it does occur in men under 50 it is more likely in a man with a family history of prostate cancer. It has been found to be associated with certain diets, including diets high in animal fats, low in plant food, and possibly low in certain elements, anti-oxidants and vitamins, as well as occupational exposure to certain substances including cadmium and rubber.
If the doctor suspects there could be a problem with the prostate, he or she will do a rectal examination. If its larger, lumpy or harder than normal it could be cancerous. The only certain way of diagnosing prostate cancer is with a biopsy of the prostate. So if the symptoms and a rectal examination and a positive PSA test (discussed below) suggest the possibility of prostate cancer, the GP will send the patient to an urologist for an opinion. If the urologist believes it could be prostate cancer, a prostate biopsy will be arranged. If the biopsy shows cancer is present, then other tests such as a bone scan will be done to determine if and where the cancer has spread.
The PSA test is a blood test that can help detect some prostate cancers. The prostate produces a substance called Prostate Specific Antigen (PSA) which is thought to aid sperm movement. This is released into the bloodstream. A prostate cancer usually releases PSA in abnormally high amounts. The PSA test measures the level of PSA in the blood. If it is abnormally high, it may indicate the man has prostate cancer.
PSA level is also abnormally elevated in some other conditions, including infections of prostate and BPH. The ratio of free PSA to total PSA can help distinguish these borderline cases. Only about one in three men with a raised PSA will be found to have prostate cancer, although the higher the level of PSA, the more likely it is due to cancer.
Conventional Treatment
There are various options for treating prostate cancer, depending on the extent of the cancer, in particular whether it is localized to the prostate gland only or has spread into surrounding tissues or to other parts of the body.
Other important considerations are the age and general health of the man, and how aggressive and rapidly growing the cancer cells are. The pathologist can usually give an indication of this from examination of the cancer cells in the biopsy specimen.
If prostate cancer is diagnosed at an early stage and confined to the prostate gland, the prostate with the cancer may be surgically removed. After the operation, known as radical prostatectomy, more than 75% of men will remain free of disease for 10 years or longer, but most men will be left with at least some degree of impotence and about half will have some degree of urinary incontinence.
Radiotherapy can be an effective alternative and is followed by lower rates of impotence and incontinence, but radiation colitis is a common side effect, often leaving the patient with poor bowel control.
An alternative is not to have an operation but to wait and see what happens. This is sometimes called ‘watchful waiting’. Prostate cancer is the most common form of internal cancer in men, but it usually grows quite slowly. After diagnosis, the majority of men will survive for at least five years, or even as much as 10 years or more. If the man is elderly, and at the age of diagnosis his life expectancy is not so great anyway, he may die of something else. In other words, he will die not from prostate cancer, but with prostate cancer.
Each person needs to make their own decision regarding what to do, using the help of their doctor, based on their own circumstances and life priorities. If the disease is advanced locally into surrounding tissues or if it has spread to other areas of the body, a cure is difficult and treatment is aimed at slowing the growth of the cancer and improving and maintaining quality of life for as long as possible. Radiotherapy will usually achieve good control of a locally advanced cancer, possibly for several years, and may also be helpful in controlling a painful secondary spread of prostate cancer in a bone; but for more widespread cancer, hormone treatment, or even chemotherapy, may be needed to achieve relief for a greater or lesser period of time.
Prostate cancer, like the normal prostate, is influenced by male hormones (androgens). Treatments aimed at reducing male hormones in the blood will slow the growth of the prostate cancer.