Prostate Cancer

Prostate Cancer

What is prostate cancer

What is the prostate gland?

Only men have a prostate gland. The prostate is usually the size of a walnut. It lies underneath the bladder and surrounds the tube that you pass urine and semen through (urethra). The gland’s main job is to make some of the fluid that carries sperm (semen).

What is prostate cancer?

Prostate cancer is the most common cancer in men. Normally the growth of all cells in the body is carefully controlled. As cells die, they are replaced by new ones. Prostate cancer can develop when cells in the prostate gland start to grow in an uncontrolled way.

In most cases prostate cancer is a slow growing cancer and it may stay undiagnosed because it never causes any symptoms.Helpline 0800 074 8383 prostatecanceruk.org 5

However, in some men, the cancer may grow more quickly. It sometimes causes symptoms such as problems passing urine. Sometimes the cancer spreads outside the prostate to other parts of the body. The bones are a common place for prostate cancer to spread to, and it may cause symptoms such as bone pain.

About one in nine men (11 per cent) will get prostate cancer at some point in their lives. The following factors may increase your risk of prostate cancer.

  • _ _Age

Prostate cancer mainly affects men over the age of 50 and your risk increases with age.

  • _ _Family history

You are two and a half times more likely to get prostate

cancer if your father or brother has been diagnosed with it. You are more at risk if your relative was under the age of 60 when they were diagnosed, or if more than one close relative has prostate cancer.

  • _ _Ethnicity

In the UK, men of black Caribbean or black African descent are three times more likely to get prostate cancer than white men.

  • _ _Lifestyle

We do not know how to prevent prostate cancer but a healthy diet and lifestyle may be important in protecting against it.

For more information about prostate cancer risk, please read our booklet Know your prostate.

How is prostate cancer diagnosed?

Prostate cancer is diagnosed by a number of tests, which are described on the following pages. You may have already had some of these but you may need further tests to find out whether the cancer has spread and how aggressive it is. You may not need to have all of the tests described here, and you may not necessarily have them in this order.

You can read more about the tests for prostate cancer in our Tool Kit fact sheet, How prostate cancer is diagnosed.

PSA test

The PSA test is a blood test that measures the amount of a protein called prostate specific antigen (PSA) which is produced by the prostate. All men have some PSA in their blood. The level of PSA

can be affected by a number of things, including age, an enlarged prostate, infection, vigorous exercise, ejaculation, and prostate cancer.

Digital rectal examination (DRE)

A digital rectal examination (DRE) involves a doctor or nurse feeling the prostate gland through the wall of the back passage (rectum). They will wear gloves and put some gel on their finger to make it more comfortable. They are feeling for any hard or irregular areas that may be a sign of cancer.

Prostate biopsy

During a prostate biopsy, small amounts of tissue are removed from different areas of the prostate gland. These samples of tissue are sent to the laboratory to be checked by a doctor who specialises in looking at cells under the microscope (a pathologist).

A report, called a pathology report, is sent to your doctor explaining what the pathologist has found. Some men also receive a copy

of their pathology report. If cancer has been found, the pathology report will provide details, including:

•_ _ how many samples contain cancer

•_ _ how much cancer is in each sample, and •_ _ your Gleason score (see page 11).

You may have the following tests to find out whether the cancer is likely to have spread outside the prostate.

CT scan

A computerised tomography (CT) scan uses X-rays to take pictures of the body from different angles. This helps the specialist to see whether the cancer could have spread to the surrounding tissues.

MRI scan

Magnetic resonance imaging (MRI) uses magnets rather than X-rays to create an image of your prostate and other tissues to see whether the cancer has spread.

Bone scan

A bone scan may show whether any cancer cells have spread from the prostate to the bone. A small amount of a safe radioactive dye is injected into a vein in your arm. After two to three hours, you will have a scan to find any areas where the dye has collected. This can show if prostate cancer cells have spread to your bones.

What do my test results mean?

Your doctor will use the results of all the tests you have had to build up a picture of your cancer. This allows them to measure how far the cancer has spread and how quickly it may be growing.

What are my treatment options?

The results of your tests will give you and your doctor a good idea of how your cancer is behaving. A number of things such as

the stage of your cancer, your Gleason score and PSA level will affect which treatments you can have. If you have been diagnosed with localised prostate cancer, there may be several treatments available to you. If you have locally advanced or advanced prostate cancer, there may be fewer suitable treatments.

Localised prostate cancer

Prostate cancer that has not spread outside the prostate gland (localised cancer) can behave in different ways. Many localised cancers are not aggressive and grow so slowly that they do not cause any problems during your lifetime. However, some cancers may be aggressive and spread to other parts of the body. The results of the tests described on pages 7-8 may give some clue as to how your cancer will behave.

There is not an overall best treatment for localised prostate cancer, and each treatment has its own advantages and disadvantages. You will need to think about these when deciding on a treatment.

Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that has spread to the area just outside the prostate gland. Your treatment options will depend on how far the cancer has spread.

Advanced prostate cancer

Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body. It is also called metastatic prostate cancer. Prostate cancer can spread to any part of the body, but most commonly to the bones. Advanced prostate cancer can cause symptoms, such as bone pain and problems passing urine. It is not possible to cure advanced prostate cancer, but treatments can often keep it under control for several years.

Choosing a treatment

Your doctor or specialist nurse will explain all your treatment options and help you choose the right treatment for you. We have provided a summary of the different treatments on the following pages. Ask your doctor or nurse to tick the options that may be suitable for you. You may not be able to have all of the treatments listed here.

You can read more about each treatment, including how it works and its advantages and disadvantages, in our Tool Kit fact sheets. You can download these from our website or order them by calling our helpline or emailing literature@prostatecanceruk.org. If you would like to discuss your treatment options, you can also call our Specialist Nurses on our confidential helpline.

Your personal preference will be an important factor in deciding which treatment to have. Hearing about your different treatment options can be a lot to take in, especially when you have just been diagnosed. Your doctor may suggest you take time to think things through before coming to a decision.

Make sure you have all the information you need. It can be a good idea to write down any questions you might want to ask at your next appointment. You might find it useful to have someone with you at the consultation, or to make notes that you can read in your own time.

Each treatment has side effects, and will affect each man differently. You may not get all of the side effects. It is important that you think about the side effects and how you would cope with them when deciding on a treatment. We have included some information about side effects here. The first treatment you have may affect which treatments you can have in the future, if you need further treatment. Speak to your doctor or nurse about this.

The following information describes treatments for men who have just been diagnosed with prostate cancer. Men who have had prostate cancer for some time may have different treatments and combinations of treatment.

 Treatment options

Active surveillance

Localised •_ prostate cancer

  • _Watchful waiting
  • _Surgery (radical prostatectomy)
  • _External beam radiotherapy
  • _Brachytherapy (either permanent seed

or high dose rate)

  • _Cryotherapy (as part of a clinical trial)
  • _High intensity focused ultrasound (as part of a clinical trial)

Locally •_Hormone therapy advanced •_ Watchful waiting

prostate

cancer •__External beam radiotherapy with hormone therapy

(and sometimes with high dose rate brachytherapy)

  • __Surgery (radical prostatectomy) with hormone therapy and/or external beam radiotherapy. This is less common and you may be offered it as part of a clinical trial.

Advanced •__Hormone therapy

prostate cancer

  • __Pain-relieving drugs to treat pain•__Palliative radiotherapy to treat symptoms•__Bisphosphonates to treat symptoms •__Chemotherapy to treat symptoms

Active surveillance

Prostate cancer may be slow growing and, for many men, may never progress or cause any symptoms. Active surveillance is a way of monitoring prostate cancer. It aims to avoid or delay unnecessary treatment for localised prostate cancer and so avoid the side effects that can be caused by treatment.

Active surveillance involves monitoring your cancer with regular tests, rather than treating it straight away. The aim is to find any changes which suggest that the cancer may grow. If tests show that your cancer may be growing, you will be offered treatment

with surgery (radical prostatectomy), radiotherapy or brachytherapy, with the aim of getting rid of the cancer completely.

Watchful waiting

Watchful waiting is a different way of monitoring prostate cancer that is not causing any symptoms or problems. The aim is to monitor the cancer over the long term. It is generally suitable for men who have other health problems so may not be fit enough for treatments such as surgery or radiotherapy. It may also be suitable for older men whose cancer is unlikely to cause problems during their lifetime or shorten their lifespan.

If you choose watchful waiting, you will not start treatment unless you get symptoms, such as problems passing urine or bone pain. You may then be offered hormone therapy to manage these symptoms. Watchful waiting involves fewer tests than active surveillance.

If you are offered active surveillance or watchful waiting, make sure you are clear which approach you are being offered. These terms are not always used in the same way. Other terms that

you may hear to describe either active surveillance or watchful waiting include ‘active monitoring’ and ‘wait and see’. Because active surveillance and watchful waiting are two quite different approaches to treatment, ask your doctor to explain exactly what they mean.

Surgery (radical prostatectomy)

This is an operation to remove the whole prostate and the cancer contained in it. There are several types of operation: traditional open surgery, laparoscopic (keyhole) surgery and robot-assisted keyhole surgery. Surgery is usually only suitable for men with localised prostate cancer.

However, surgery may be an option for some men with locally advanced prostate cancer. This is not very common as it may not be possible to remove all the cancer cells that have spread outside the prostate. You may be offered surgery as part of a clinical trial. You may have hormone therapy or a course of radiotherapy following surgery.

The main side effects of surgery are problems controlling when you pass urine (urinary problems) and difficulty getting and keeping an erection (erectile dysfunction). Symptoms may improve over time, and there are treatments available to help manage these

side effects.

External beam radiotherapy (EBRT)

This treatment uses high energy X-rays to destroy the cancer cells. EBRT is often used together with hormone therapy and is suitable for men with localised prostate cancer. It is also suitable for some men with locally advanced prostate cancer.

Side effects of EBRT include urinary problems, bowel problems such as passing loose watery stools (diarrhoea), problems getting an erection, and tiredness. Symptoms may develop during treatment and improve over time. However, some men may get side effects later on which may develop several months or years after treatment. There are treatments available to help manage

side effects.

Brachytherapy

This is an internal radiotherapy treatment, which involves putting

a source of radiation into the prostate. There are two types of brachytherapy – permanent seed brachytherapy and high dose rate brachytherapy.

Permanent seed brachytherapy involves implanting tiny radioactive seeds into the prostate. This is an option for men with localised prostate cancer.

High dose rate brachytherapy, also called temporary brachytherapy, involves putting a source of radiation into the prostate gland for a few minutes at a time. This treatment is less common and may be used to treat localised prostate cancer. It may also be an option for some men with locally advanced prostate cancer.

Brachytherapy may be used together with external beam radiotherapy to give higher doses of radiation to the whole gland as well as to the area just outside the prostate.

You may have hormone therapy to shrink the prostate for a few months before starting either type of brachytherapy.

Side effects of brachytherapy include problems passing urine, problems getting and keeping an erection, and tiredness. Men who have permanent seed brachytherapy may also get bowel problems, although these tend to be mild. Side effects may improve over time, and there are treatments available to manage them.

You can read more about brachytherapy, including the side effects, in our Tool Kit fact sheets, Permanent seed brachytherapy and High dose rate brachytherapy.

High intensity focused ultrasound (HIFU)

HIFU uses ultrasound to heat and destroy cancer cells in the prostate. It is not widely available in the UK, but may be available as part of a clinical trial. We do not know very much about how effective it is in the long term compared to other treatments.

It may be a suitable option if you have localised prostate cancer. It may also be used to treat cancer that has started to grow again after radiotherapy.

The side effects of HIFU include problems passing urine and sexual problems including difficulty getting an erection. Side effects may improve over time, and there are treatments available to manage them.

Cryotherapy

Cryotherapy uses freezing and thawing to destroy the prostate cancer cells. We do not yet know very much about how effective this treatment is in the long term. It is not widely available in the UK but may be available as part of a clinical trial.

Cryotherapy may be suitable for men with localised prostate cancer. It may occasionally be suitable for some men with locally advanced prostate cancer. However, it is more commonly used to treat men whose cancer has started to grow again after radiotherapy or brachytherapy.

The most common side effect of cryotherapy is problems getting or keeping an erection. Some men also get urinary problems after cryotherapy. These side effects may improve over time. There are treatments available to manage them.

Hormone therapy

Prostate cancer needs the male hormone testosterone to grow. Hormone therapy stops testosterone from reaching the cancer or reduces the production of testosterone, causing the cancer

to shrink.

Hormone therapy will treat all prostate cancer cells, wherever they are in the body. It will not cure prostate cancer but it can usually keep the cancer under control for several years. It is the standard treatment for locally advanced and advanced prostate cancer.

There are three main types of hormone therapy for prostate cancer. These are:

  • _injections to stop the production of testosterone

(LHRH agonists and antagonists)

  • _tablets to stop the testosterone reaching the cancer cells

(anti-androgens)

  • _surgery to remove the testicles (orchidectomy).

The side effects of hormone therapy are caused by lowered testosterone levels. They can include:

  • _loss of sex drive and problems getting and keeping an erection•_ hot flushes
  • _tiredness (fatigue)
  • _swelling and tenderness in the breast area (gynaecomastia)
  • _weight gain.

You may not get all of these side effects, and there are ways to manage them. The risk of getting each side effect depends on a number of factors, including which hormone therapy you are taking and how long you take it for.

Treatments to relieve the symptoms of advanced prostate cancer

If you have been diagnosed with advanced prostate cancer and are having problems with symptoms such as bone pain, there are treatments to manage these.

  • _Palliative radiotherapy uses a low dose of radiotherapy to shrink the cancer and relieve symptoms.
  • _Bisphosphonates are drugs that treat pain caused by cancer that has spread to the bones.
  • _Chemotherapy uses anti-cancer drugs to kill the cancer cells. This slows the growth of the cancer and can help control symptoms.
  • _Pain-relieving drugs can help relieve pain such as bone pain.

You can read more about these in our Tool Kit fact sheets, Treating prostate cancer after hormone therapy, Radiotherapy for advanced prostate cancer, Bisphosphonates, Chemotherapy and Pain and advanced prostate cancer.

Where can I get support?

A diagnosis of cancer can be a frightening and overwhelming experience, and men respond in all kinds of ways. You might feel shocked or angry. You may be concerned about the future and how a diagnosis of prostate cancer will affect your life and your loved ones. It can be difficult and stressful trying to make a decision about your treatment. There is no right or wrong way to feel, and you may find that your feelings change over time. Your family may also find this a difficult time and may need some support. This section may be helpful for them.

Talking about it

Many men find that talking about their cancer can help them to cope. Some men find that talking to a partner, friend or relative can help. However, some men find it difficult to share their feelings with someone close to them and prefer to talk to someone else.

You and those close to you can speak to one of our Specialist Nurses by calling our confidential helpline. They can help you to understand your diagnosis and the emotional effects of cancer. You may also find it helpful to talk to your nurse, doctor or GP about how you are feeling. If you would like some more support, they may be able to put you in touch with a counsellor.

Asking questions can help you understand what is happening, and may help you feel more in control. You may find it useful to write down any questions you have to take along to your appointments.

Talking to someone affected by prostate cancer

You and your family may find that talking to someone with similar experiences helps. Our support volunteers are all men and women personally affected by prostate cancer. They are trained to listen and offer support over the telephone. Call our Specialist Nurses on our confidential helpline to arrange to speak to a volunteer.

If you have access to the internet, you and your family can join our online community on our website at prostatecanceruk.org

You can share your experiences with other men and their families. There are also prostate cancer support groups across the country, where you and your family can meet other people affected by prostate cancer. You can find details on our website or ask your nurse.

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Practical support

You may find that making changes to your diet gives you more control over your body and is something that you can do for yourself. Eating a healthy, balanced diet and being physically active will benefit your overall health and may be helpful in slowing down the growth of the cancer. Diet and physical activity may also help you cope with the side effects of treatment and any feelings of anxiety. If you live in England and are having treatment for cancer, including treatment for the symptoms of cancer or treatment for the side effects of a cancer treatment, you are entitled to free prescriptions. You will need to apply for a medical exemption certificate.

Ask your doctor for a FP92A form. Once you have filled out the form, your doctor will need to sign it, and you will be sent the certificate. You can find out more about free prescriptions at NHS Choices. If you live in Scotland, Wales or Northern Ireland, all prescriptions are free.

Details of your local support group:

Helpful Information

UK Prostate – guide to reliable sources of prostate cancer information – www.prostae-link.org.uk

Contact Numbers

Macmillan cancer Support: www.macmillan.org.uk

Freephone:   0808 808 00 00 (9am-8pm, Mon-Fri)

National Institute for Health and Clinical Excellence (NICE) www.nice.org.uk

TEL: 0845 003 7780

NHS Choices: www.nhs.uk

UK Prostate Link: www.prostate-link.org.uk

TONY DAVIS EMPLOYEE SUPPORT

Tel: 07813 596505 Or 01482 870577

Will offer support and advice on how to deal with anxiety and utilising Cognitive Behaviour Therapy to overcome any problems or difficulties you may have.

Email: tonydavis@tonydavis.karoo.co.uk