Prostate cancer — a doctor’s guide
Men are less likely than women to see a GP over worrying symptoms. But here’s why prostate cancer shouldn’t be ignored
- Prostate cancer is the second most common cancer in men
- Most cases are diagnosed in men over 50
- It might not show symptoms, and may require little or no treatment
It’s that time of year again, when men grow moustaches — ranging from flattering to funny — in support of Movember.
The campaign raises awareness and funds in three areas: male suicide — which claims 60 men every hour globally — as well as testicular cancer and prostate cancer.
Here we talk to Dr Rhianna McClymont, a Livi GP, about the facts on prostate cancer.
What is the prostate?
Around the size of a walnut, the prostate is located just below the bladder and in front of the rectum. It’s a gland only men have.
Its main function is to produce the thick, white fluid that creates semen when mixed with sperm produced by the testicles.
Prostate cancer — common among older men
The Movember campaign has made many of us more aware of prostate cancer. Thankfully so, as it’s the second most common cancer in men, and the fourth most common cancer overall.
In fact, more than 1.2 million new cases of prostate cancer were recorded globally in 2018 and in excess of 350,000 deaths.
The UK is in the top 18 countries with the highest rate of prostate cancer.
What increases the risk of prostate cancer?
Age – Most prostate cancer cases are diagnosed in men over 50. ‘Age is an important risk factor, with the risk of getting prostate cancer rising as you get older,’ says Dr McClymont.
Ethnicity – ‘Research has shown that men from an African-Caribbean or African descent are more likely to get prostate cancer’.
Family history – ‘If you have a dad or brother who has developed prostate cancer, particularly if this developed earlier in life before the age of 60, then the risk is higher,’ Dr McClymont says.
Obesity – According to the NHS, recent research suggests obesity increases the risk of prostate cancer.
What are the symptoms?
Prostate cancer often shows no symptoms in its early stages and, in fact, may require no or minimal treatment.
However, as the disease progresses common symptoms can include:
- Passing urine more frequently (particularly at night)
- Difficulty in starting to pee, or a weak flow of urine
- Feeling like your bladder hasn’t emptied completely
- Feeling like you need to pee urgently
How is prostate cancer tested?
‘If you have any of the above symptoms, you may be offered a Prostate-Specific Antigen (PSA) test (taken as a blood test) and an examination of your prostate by your GP,’ says Dr McClymont. The latter will include a rectal exam.
‘A PSA test can indicate a problem such as prostate cancer, but your PSA level can also be raised for a number of other reasons, so it’s not conclusive,’ she points out.
‘Usually, an MRI scan will also be used to assess the prostate if a PSA level is raised, and prostate cancer is then diagnosed with a biopsy.’
How is it treated?
Treatment for prostate cancer depends on the severity of the cancer, whether it has spread outside the prostate to other areas of the body, your general medical fitness, and other health conditions you may have.
‘There are numerous treatment options, including surgery, radiotherapy, hormone therapy or “watchful-waiting”. This is where the cancer is unlikely to affect your natural lifespan, so symptoms are controlled while the cancer is monitored, to make sure it’s not progressing,’ says Dr McClymont.
‘Any form of treatment involves potential side effects,’ she points out. ‘If surgery to remove the prostate gland is recommended to treat the cancer then these are important considerations.
‘Following a prostatectomy (removal of the prostate), for example, many men subsequently suffer with difficulties getting or sustaining an erection, and also with urinary incontinence.’
It's worth remembering that while prostate cancer may be a serious disease, most men who are diagnosed with it do not actually die from it.
Watchful waiting has advantages and disadvantages. You won’t have side effects from any treatment or need regular scans or biopsies, and if you begin to suffer from symptoms such as pain or swelling, there is treatment to help manage them. But most men never need treatment.
Disadvantages can include the possibility of the cancer growing and spreading, and the man and his loved ones having the psychological worry that he’s not being treated.
‘Usually, the watchful waiting approach is for men with mild cancers that are not causing significant problems — and are unlikely to develop them throughout their lifetime. Or for men with other health problems who may not benefit from more invasive treatments like surgery or radiotherapy,’ Dr McClymont points out.
Talk to a doctor if you have any symptoms or concerns.
This article has been medically approved by Dr Rhianna McClymont, Lead GP at Livi
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