Prostate cancer is the most commonly diagnosed cancer in men in most developed countries, including the UK. The lifetime risk of prostate cancer in men in Europe and North America is about 30%.
While prostate cancer is distressing and potentially fatal if left untreated, it's important to know that many men die with, rather than from, prostate cancer. The risk of dying from prostate cancer is only around 3% - and many cases do not warrant treatment.
Please note: the information below does not constitute medical advice. If you have any concerns at all about prostate cancer symptoms, speak to your GP.
Early detection is critical: about 98 % of men with low-grade cancers live for more than 5 years. But, about 70% of men with advanced (metastatic) prostate cancer will die within 5 years.
Age is the single greatest risk factor for prostate cancer. The older you are, the higher your chance of developing the disease. Other risk factors include close relatives with the condition, and a diet high in saturated fats such as those from cheese and red meat. It also occurs more frequently in Afro-Caribbean populations and less in men of Asian origin.
Men with prostate cancer may have no symptoms at all or they might experience a variety of different symptoms, including:
Prostate cancer may be diagnosed due to symptoms, or as a result of regular tests and check-ups.
Anyone with suspected prostate cancer should have three specific tests.
A pathologist will study the biopsy results. If cancer is present, it is given a “Gleason Score”. This is a number that describes the cancer's aggressiveness, ranging from 1 to 10, with 1 being the least aggressive.
Patients with prostate cancer have access to several treatment options, and some promising new therapies. The right treatment depends on the exact type and aggressiveness of the cancer. A urologist will discuss your options before making a decision.
This option is appropriate for:
Careful follow-up with regular DRE and PSA monitoring is essential. However, the patient needs to be offered counselling and active treatment if the cancer progresses.
With locally advanced prostate cancer, the cancerous cells have spread to the seminal vesicles or the bladder, but not to the lymph nodes or bones. The PSA is normally more than 10ng/ml. In this case, surgery is often avoided, and radiotherapy and hormone therapy are preferred.
Treatment of locally advanced disease is unlikely to cure the cancer. The aims are to slow progression of the cancer and to improve quality of life.
Metastatic prostate cancer is where the cancer has spread to other parts of the body.
The PSA level will often be highly elevated and scans will show how the cancer has spread. Lymph nodes may also be enlarged.
This form of prostate cancer has the worst outlook: about 70% of men with metastatic cancer will die within 5 years. Fortunately, there are options that can delay the progression for several years.
All men with prostate cancer have regular PSA checks. After radical prostatectomy the PSA should remain at zero if all of the cancer has been removed. With locally advanced and metastatic disease treated with hormones, the PSA should initially fall to very low levels. However, the cancers eventually become insensitive to hormone therapy and the PSA begins to rise.
This PSA rise often brings clinical symptoms, especially bone pain. Quite often a bone scan will need to be repeated to see whether there has been any spread of the cancer. If the PSA does rise there are other therapeutic options, but none of them will offer a cure. Options include:
If you're worried about prostate cancer symptoms and treatment, speak to your GP.
Another useful resource is the Your Prostate website (www.yourprostate.eu) from the European Men's Health Forum. You can send an email - anonymously if you prefer - and a urologist or prostate nurse will get back to you with free advice.
The Gleason Score, or Gleason Grading System, helps doctors to assess the stage of prostate cancer in men. Alongside other factors, such as your age and general health, the score helps urologists choose the best therapy option.
The higher the Gleason Score, the more aggressive the cancer.
The score is calculated from the sum of the two cancer patterns, each with a number from 1 to 5, giving a total possible score of 10.
The score shows the degree that tissue differs from normal healthy prostatic tissue. (1=well differentiated, and 5=poorly differentiated, i.e. tissue unrecognisable as glandular).
A Gleason score of 2 out of 10 represents a 'latent' cancer whereas a Gleason score of 10 is seen as an aggressive cancer.
Depending on the PSA value, DRE and the TRUS biopsy findings, further staging studies may be required. These will tell the doctor how advanced the cancer is and help in deciding what treatment is required.