Prostate Cancer
Prostate cancer develops in the prostate gland when abnormal cells start to grow in an uncontrolled way. It is the most common malignancy in males in the UK, with 1 in 8 males being diagnosed with prostate cancer in their lifetime.
What is prostate cancer?
Prostate cancer is a type of cancer that develops in the prostate gland, a small gland in the male reproductive system that helps produce fluids for semen. It develops when abnormal cells form and start to grow in an uncontrolled way in the prostate gland.
Prostate cancer is the most common malignancy in males in the UK with almost 50,000 new cases diagnosed every year. 1 in 8 UK males will be diagnosed with prostate cancer in their lifetime. This increases to 1 in 4 if you have a first degree relative diagnosed with prostate cancer, or are of black or Afro-Caribbean descent.
In some cases prostate cancer grows too slowly to cause any significant problems. Men with this form of slow growing cancer are likely to never need any treatment.
In other instances prostate cancer can grow quickly and be more likely to spread to other parts of the body. Men diagnosed with this form of more aggressive cancer will require treatment to stop it spreading.
There are three different types of prostate cancer.
- Early prostate cancer (or localised prostate cancer) when the cancer is contained within the prostate gland.
- Locally advanced prostate cancer where the cancer has broken through the capsule surrounding the prostate gland and started to spread into nearby tissue or organs.
- Advanced prostate cancer (or metastatic prostate cancer) where the cancer has spread to other parts of the body, such as the bones.
Survival rates
Understandably the possibility of getting prostate cancer is worrying. But prostate cancer survival rates in the UK have significantly improved in recent decades, with early detection and treatment playing a crucial role.
Overall, survival rates are high, particularly for localised disease, and the likelihood of surviving for at least 10 years after diagnosis is generally high.
Cancer Research UK has published more data on prostate cancer survival rates.
Causes of prostate cancer
Most prostate cancer happens spontaneously, but certain factors can increase a man’s risk.
Age: The main risk factor is age, with the vast majority of cases being diagnosed after the age of 50, although rarely it can be diagnosed prior to this age.
Ethnicity: There is also an increased risk in men of black or Afro-Caribbean descent, which doubles your lifetime risk of being diagnosed with prostate cancer.
Family History: Your lifetime risk of being diagnosed doubles if you have a first degree relative (grandfather, father or brother) who has been diagnosed with the disease. It doubles again if you have two first degree relatives who have been diagnosed.
Genetics: There are genetic conditions that are related to prostate cancer that are related to other cancers such as BRCA. BRCA1 and BRCA2 are associated with ovarian cancer, fallopian tube cancer, primary peritoneal cancer, male breast cancer, prostate cancer, pancreatic cancer, and early-onset breast cancer. At The Urology Partnership we are able to offer you genetic testing, although this is often not covered by standard medical insurance.
Diet: There has also been a link with the consumption of red meat and prostate cancer. Current research suggests that you maintain a healthy diet if you have been diagnosed with prostate cancer or are at risk of prostate cancer. Cancer Research UK offer further advice on diet and prostate cancer.
Symptoms of Prostate Cancer
Most people with prostate cancer do not have any symptoms and diagnosis is usually picked up on a routine PSA test. However, a prostate problem might be indicated by a change in your normal urination.
Signs to look out for are:
- The need to urinate more frequently, especially at night.
- Difficulty starting to urinate.
- Straining or taking a long time to finish urinating.
- A weak urine flow.
- A feeling that your bladder hasn’t emptied properly.
- Getting sudden urges to urinate.
- Leaking urine before you get to the toilet.
- Dribbling urine after you finish peeing
If you notice a change in your normal urinating patterns and are concerned it is advisable to seek medical advice. Urinary problems are often caused by something other than cancer, for which there are treatments that will help.
Diagnosing Prostate Cancer
Prostate cancer is diagnosed through a range of tests and investigative procedures ranging from a simple PSA blood test to a biopsy.
We understand going through diagnosis can be a time of anxiety and worry. Throughout the process we offer advice and support on what each test involves, the pros and cons, and answer any questions or concerns you might have.
a) PSA test
The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. Prostate-specific antigen (PSA) is a small protein that is secreted from the prostate into the blood and can be measured in the blood in nanograms per millilitre (ng/ml).
If you have a raised PSA you will be invited to undertake an MRI scan for the next step in investigation for prostate cancer.
More information about raised PSA.
b) MRI scan
A prostate MRI scan is routinely used as a first-line investigation to create detailed images of the prostate. The specialist images are analysed by a consultant radiologist who can identify the exact size, and location of any abnormality. This enables biopsies of suspected cancer to be precisely targeted, enabling more accurate sampling and an earlier cancer diagnosis.
By having a prostate MRI as a first-line investigation, men may avoid a prostate biopsy altogether. Find out more about a prostate MRI.
c) Transperineal prostate biopsy
At The Urology Partnership we believe that targeted transperineal prostate biopsy based on MRI findings allows us to perform an optimal biopsy while minimising the risk of infection. Our consultants are experts in local anaesthetic transperineal prostate biopsy, being involved in research and teaching the technique.
During a transperineal biopsy ultrasound is used to guide a needle inserted into the prostate (via the perineum) to take samples. These samples are then sent to a laboratory for analysis to see if any cancer cells are present.
We usually perform transperineal biopsy under local anaesthetic, which brings a number of patient benefits:
- It avoids the risks associated with general anaesthetic.
- It might reduce the chance of difficulty passing urine (urine retention) following the procedure.
- The procedure can be done in an outpatient clinic therefore avoiding a hospital visit.
- There are quicker recovery times as no general anaesthetic.
- It’s less expensive with no hospital/anaesthetist fees.
Following a prostate biopsy we will arrange a face-to-face appointment with one of our prostate cancer specialists, to discuss results and make a personalised plan going forward.
Treatments for Prostate Cancer
If you are diagnosed with prostate cancer, your treatment will depend on several factors including your age, general health, cancer stage and risk, your personal preferences and something called the Gleason score.
The Gleason score is made up of the two most common patterns of prostate cancer seen in your prostate. This combined with your PSA and stage (how far the prostate cancer has spread locally) will be used to determine how aggressive your prostate cancer is and how we should treat it.
More recently NICE has recommended using the Cambridge prognostication group to help form treatment decisions.
| Cambridge Prognostication Group | Risk Factors |
|---|---|
| 1 | Gleason score 6 and PSA less than 10 microgram/L and stages T1–T2 |
| 2 | Gleason score 3 + 4 = 7 or PSA 10–20 microgram/L and stages T1–T2 |
| 3 | Gleason score 3 + 4 = 7 and PSA 10–20 microgram/L and stages T1–T2 or Gleason 4 + 3 = 7 and Stages T1–T2 |
| 4 | One of: Gleason score 8, PSA more than 20 microgram/L, Stage T3 |
| 5 | Two or more of: Gleason score 8, PSA more than 20 microgram/L, Stage T3 or Gleason score 9–10 or Stage T4 |
Group 1 is usually offered active surveillance, while groups 2-5 are offered active treatments.
At The Urology Partnership we can offer a full range of treatments, from active surveillance for low risk disease to robotic assisted radical prostatectomy for intermediate or high risk localised prostate cancer.
When deciding on your treatment, we’ll thoroughly explain each option and the factors to consider in making a choice. Helping us to form the most effective treatment plan for you.
Active surveillance
If you are diagnosed with low risk prostate cancer you will be offered Active Surveillance, as most men with low risk prostate cancer will never suffer any effects of their prostate cancer. Active Surveillance involves close monitoring of your PSA levels, regular MRI scans and repeat prostate biopsies if required.
Overall, two thirds of all men that commence active surveillance will continue lifelong. The other third move to active treatment at some point.
At The Urology Partnership you will be offered a consultation after each investigation, giving you a personalised management plan.
Robotic assisted radical prostatectomy
For men with clinically significant localised prostate cancer, surgical removal of the prostate (also known as radical prostatectomy) is one of the gold standard treatments of choice. The aim of a radical prostatectomy is to remove the entire prostate gland with a minimal chance of leaving any cancerous cells behind.
Our specialists Luke Stroman and Adam Jones both regularly perform a high volume of robotic radical prostatectomy ensuring a high quality of surgery, as Mr Luke Stroman explains in the video below.
Find out more about robotic radical prostatectomy.
Prostate brachytherapy
Prostate brachytherapy is a way of using localised radiotherapy to treat prostate cancer that is contained within the prostate gland. During prostate brachytherapy radioactive iodine seeds are placed directly into the prostate gland, with the intended benefit of curing the cancer.
During the procedure, our consultant Mr Adam Jones installs the radioiodine seeds along with a consultant oncologist and a medical physicist.
Find out more about prostate brachytherapy.
Prostate radiotherapy
In high to intermediate risk localised prostate cancer, prostate radiotherapy offers an alternative to robotic radical prostatectomy. Prostate radiotherapy is usually delivered along with hormone treatment, which increases the effectiveness of hormone treatments.
At The Urology Partnership we work closely with oncology doctors who deliver radiotherapy. If you are diagnosed with high or intermediate risk prostate cancer we will refer you on to an oncologist. If you decide to go ahead with radiotherapy you might want to consider a rectal spacer, which can reduce rectal exposure to radiotherapy.
Concerned about prostate cancer?
If you are worried about your PSA levels, or prostate cancer do not hesitate to contact the Urology Partnership and we will make an appointment to see one of our prostate cancer specialists within a week.
Please call us on 0118 920 7040.
Next Steps
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If you would like more information or wish to arrange a consultation with one of our specialist consultant urological surgeons then please either Call 0118 920 7040 or complete the form below.
Insured patients
Contact your GP and ask for a referral to the Urology Partnership.
All consultations, investigations and treatments are covered by major insurance companies (depending on policy).
Funding your own treatment
Self-funding initial consultation fee is £205. Follow up fees are £165.
Consultation charges are exclusive of any tests and other investigations that the consultant may wish to carry out.