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All you need to know about ... prostate cancer

Martin Ledwick
Head Information Nurse, Cancer Research UK

Prostate Cancer affects over 250,000 men and their families in the UK, and with Prostate Cancer Awareness Month taking place in March, it is vitally important for primary care professionals to be well informed about the disease

Prostate cancer is the most common form of the disease in men in the UK and almost a quarter of all cases of cancer in men are found in the prostate. However, this type of cancer is often difficult to detect because most men with early stage prostate cancer don't tend to have any symptoms.

Despite this, men should be alert to some signs that may mean something is wrong. Needing to pass urine more often than usual - especially at night - and having little warning before needing to go may be linked to prostate cancer. Other symptoms can include the appearance of blood or semen in urine or difficulty in passing it.

Men with these symptoms should be checked out by a doctor
to be on the safe side. The need to urinate frequently is common in older men and is unlikely to mean they have prostate cancer. But men need to know this can be a symptom of the disease.

As men get older their prostate gland enlarges and the symptoms of this growth are similar to prostate cancer. Symptoms like pain and bleeding are actually very rare in prostate cancer and tend to be a sign of non-cancerous conditions. Men must be reassured that most of the time an enlarged prostate is not cancer and can be easily treated.
In some cases of prostate cancer, symptoms can be mild when they first start to appear and occur over many years. Sometimes, the initial symptoms may only appear once the prostate cancer has spread to the bones causing pain in the back, hips, pelvis or other bony area.

But more often there are no symptoms, especially if a tumour is not yet large enough to put much pressure on the tube that carries urine. In these cases, some men may wish to have a prostate specific antigen (PSA) test.

It's important for patients to understand the uncertainties around the PSA test and be informed about the potential risks and benefits of having one. While some studies suggest screening for prostate cancer may save lives, you would need to screen a high number of men to save one life.

In many men, the cancer can grow very slowly and if they are older they may be unlikely to die from it. Radical treatments may not be the most beneficial option for these men, especially since most of these treatments have side-effects like impotence and incontinence, which could cause more problems than the cancer.

Some prostate cancers are aggressive and grow quickly. Others grow slowly and can be safely left alone as they aren't life-threatening. The difficulty comes in that, to date, there is no reliable way to distinguish which is which when detected at an early stage.

A PSA test measures the chemical made by prostate gland cells, which is then secreted into the blood. When the prostate gets bigger, the level of this chemical in the blood goes up because there are more prostate cells making PSA.

PSA levels can go up for a number of reasons - the prostate growing as men get older, inflammation of the prostate (known as prostatitis) due to an infection, or because of cancerous cells in the prostate. Urine infections can also affect PSA levels and lead to inaccurate readings.

There are further limitations with the test in that the 'normal' level of PSA varies from one person to another - doctors usually take a level under four as normal.

Two out of every three men who have a raised PSA don't have cancer. And some men with prostate cancer don't have a raised PSA.

For these reasons, measuring PSA levels is not an infallible stand-alone test for prostate cancer. Patients interested in the screening for prostate cancer should know that the PSA test is usually combined with a digital rectal examination and in some cases an ultrasound scan. But you can only really get a definite diagnosis by taking a biopsy to see if the growth in the prostate is cancerous.
 
Sometimes the biopsy can miss the area of the prostate where the cancer cells are and sometimes cancer is present in men with a low PSA.

But some men may benefit from early treatment if the cancer is picked up early through a test. Cancer Research UK believes it is important that men are aware of the opportunity to take the test and it's important that health professionals can provide information about the benefits and risks.

This is why we welcome the Prostate Cancer Risk Management programme. This will give all GP surgeries information packs, which include a decision-making tool for health professionals to discuss with their patients and a fact sheet about the pros and cons of having a PSA test.

Prostate cancer tends to be more common in older men - more than half of all cases are diagnosed in men over 70. It's also important to be more aware of symptoms in men with a family history of prostate cancer. Men with a father or brother with prostate cancer are four times more likely to get the disease.
Equally, if there is a strong history of breast cancer in his family a man may also face a higher risk of prostate cancer. This is because the BRCA1 and BRCA2 genes associated with higher breast cancer risk are also linked to a higher risk of prostate cancer.

Men from black Caribbean, black African and mixed race backgrounds face a higher risk of prostate cancer than white men.

One of the main hurdles in early diagnosis is ensuring men go to see their doctors if they have symptoms which are not normal for them.

In general, men do have the reputation of being reluctant to visit the doctor and they are likely to be far less familiar with GP surgeries than women. Men seem more prone than women to use excuses like "It's probably nothing" or "I'm too busy" or "I'm embarrassed" to delay getting checked.

But it's important to make men aware of what is normal for them and to see a GP if there are any worrying symptoms. The chances are that if there is anything wrong it probably won't be cancer. But, if it is, the earlier cancer is diagnosed the more effective treatment is likely to be.

Cancer Research UK runs a cancer information helpline, staffed
by specialist nurses, which can offer men worried about symptoms up-to-date information. Or they can visit CancerHelp UK, an award-winning website specially written and designed for a lay audience at www.cancerhelp.org.uk
Nurses can also sign up to receive Cancer Research UK's Practice Nurse newsletter, CancerInsight, which includes the latest news and developments in cancer.

Email cancerinsightnurse@cancer.org.uk to receive copies of the CancerInsight newsletter