What is prostate cancer?
Prostate cancer is a malignant tumour in the prostate. There are several stages of prostate cancer. Your treatment and experience depend on the specific characteristics of the tumour and the expertise of your medical team.
Most prostate cancers develop slowly and do not cause any symptoms. Fast-growing prostate cancer is less common. The risk of getting prostate cancer increases with age. The average age for diagnosis of prostate cancer is 69.
Prostate cancer is the most common cancer in elderly men in Europe. The survival rate for prostate cancer in Europe is relatively high and is still going up.
What is the prostate?
The prostate is a gland located in the lower urinary tract, under the bladder and around the urethra. Only men have a prostate. It produces part of the fluid which carries semen. The prostate contains smooth muscles which help to push out the semen during ejaculation.
A healthy prostate is about the size of a large walnut and has a volume of 15-25 millilitres. The prostate slowly grows as men grow older.
What are the symptoms of prostate cancer?
Prostate cancer is generally asymptomatic, which means that there are no clear symptoms to indicate it. In most cases, symptoms are caused by benign prostatic enlargement (BPE), or an infection. If prostate cancer does cause symptoms it is usually a sign that the disease has advanced. Because of this it is important that you see a doctor to understand what causes the symptoms. The symptoms may include:
- Urinary symptoms such as urinary frequency or a weak stream of urine
- Blood in the urine
- Erection problems
- Urinary incontinence
- Loss of bowel control
- Pain in the hips, back, chest, or legs
- Weak legs
Bone pain could be a sign that the cancer has spread through the body. This is known as metastatic disease.
Which tests are done to diagnose prostate cancer?
The most common tool to detect prostate cancer is a test to check the level of prostate-specific antigen (PSA) in your blood. If the PSA level in your blood is too high, this suggests that the cells in the prostate are behaving unusually. This could be because of a tumour in the prostate, but also because of an infection or a benign enlargement of the prostate.
Your doctor will use the test results, together with your age and your family history, to estimate the risk of you having prostate cancer. If the risk is high, you may need a biopsy of prostate tissue. This test is done to confirm if you have a tumour or not. During a prostate biopsy, between 8 and 12 samples of prostate tissue are taken. The tissue samples are analysed by the pathologist in order to help with the diagnosis and determine future treatment.
What is PSA testing?
Prostate cancer is generally asymptomatic but there are several known risk factors. These are increasing age, family history of prostate cancer, and your ethnicity. If you are at increased risk of having prostate cancer your doctor can recommend a test to measure the level of prostate-specific antigen (PSA) in your blood. This is known as PSA testing.
The main advantage of PSA testing is that men who are at higher risk of developing prostate cancer are tested regularly. This means that tumours may be found earlier, and there is a better chance of curing them.
The main setback of PSA testing is that tumours that would not have caused major health problems are also found. Treating these tumours can lead to unpleasant physical side effects. A cancer diagnosis may also lead to anxiety and stress. To prevent what is called over-treatment, some urologists oppose screening for prostate cancer with regular PSA testing.
Discuss with your doctor the pros and cons of PSA testing, and if it is right for you.
How are prostate tumours classified?
Prostate tumours are classified according to the tumour stage and the grade of aggressiveness of the tumour cells. The tumour stage tells how advanced the tumour is, and whether or not the cancer has spread to the lymph nodesor other organs.
The other element of classification is the Gleason score. The Gleason score gives information about the aggressiveness of the cells, and how fast the tumour grows. Tumours with a higher score are more aggressive and more difficult to cure.
How should I prepare for a consultation?
Preparing for a consultation can be very useful. It will help you and your doctor to better address your questions and concerns. Here are some things you can try:
- Write down the questions you would like to ask the doctor. This will help you remember things that you want to ask. Writing down questions can also help you organize your thoughts
- If you can, take someone with you to the visit. It is good to have someone to discuss what the doctor said and you probably remember different things
- Ask for information about your specific type of cancer and possible treatment options
- If the doctor uses words you do not understand, ask for an explanation