Many people are confused about the prostate and its importance for men's health. Where is it situated? What are the symptoms of prostate cancer? What treatments are available and what research has been done into prostate cancer? To help better understand this important issue, we have compiled these Frequently Asked Questions.
We hope you find these FAQs helpful. As we receive no government or other statutory funding, a small donation would assist AICR in supporting further male cancer research and education - please consider donating here.
You can also listen to the Prostate Cancer Edition of the AICR podcast.
A. The prostate is a small gland located underneath the bladder in men. It is about the size of a walnut and fits around the tube (called the urethra) which carries urine out of the bladder. The prostate produces some of the fluid that mixes with sperm when a man ejaculates.
Q. What is prostate cancer?
A. Prostate cancer is caused when cells in the prostate multiply and grow out of control to form a mass or tumour. It is a very variable disease. Some tumours remain small and grow so slowly that they cause no problems for the rest of a man's life; others are aggressive, grow quickly and become life-threatening. Many of these aggressive cases will eventually spread to the bones, where they can cause severe pain.
Q. How common is prostate cancer?
A. Prostate cancer is now the most commonly diagnosed male cancer in many western countries. Currently there are 37,000 new cases a year in the UK; 218,000 in the USA; 25,000 in Canada and 17,000 new cases a year in Australia. The number of recorded cases has increased a lot in recent years. This is partly due to the increased use of the PSA test, which has resulted in more cases being detected, and partly due to the fact that men are living longer. Like most cancers, prostate cancer is more common in those over 60.
Q. What are the symptoms of prostate cancer?
A. The main symptoms are: difficulty passing urine, inability to urinate, passing urine often (particularly at night), weak or interrupted urine flow, pain when urinating, blood in the urine and pain in the lower back, hips and upper thighs. However, all of these symptoms can also be caused by other conditions such as benign prostate enlargement. Men with any of these symptoms should consult their doctor.
Q. What causes prostate cancer?
A. There are no known causes for prostate cancer. However, between 5% and 10% of cases run in families, where the patient inherits a high risk of this type of cancer.
Q. Which men are at risk?
A. Prostate cancer is very rare in men under 50. The risk increases after the age of 50 with half of all cases occurring in men over 70. Men from families with a history of prostate cancer are at higher risk than normal. Race also has an effect: men of Afro-Caribbean descent are about twice as likely to get it whereas men of Asian descent have a lower risk of prostate cancer.
Q. Is diet linked to prostate cancer?
A. Some evidence suggests that a diet high in tomatoes, Vitamin E, cruciform vegetables (such as broccoli, cabbage, cauliflower and brussels sprouts) and selenium may reduce the risk of prostate cancer. However, other studies have failed to confirm these effects, so the findings of this prostate cancer research have not been confirmed.
Q. Will a vasectomy increase the risk of prostate cancer?
A. It used to be thought that a vasectomy increased the risk of getting this cancer, but more recent research has suggested that there is no real difference in risk between men who have had a vasectomy and those who have not.
Q. Can prostate cancer be prevented?
A. There is no known way of preventing prostate cancer, and research has not found any reliable evidence that any particular diet or change in lifestyle can reduce the risk of getting it.
Q. Does prostate cancer run in families?
A. Some families have a higher risk of prostate cancer than others. The normal risk of getting prostate cancer some time in your life is 1 in 9. Having a close relative (father, brother or son) who was diagnosed with prostate cancer increases your risk by two or three times (ie your lifetime risk is between 1 in 4 and 1 in 3). The risk goes up further (ie a lifetime risk of about 1 in 2) if that relative was under 60 when diagnosed or if you have more than one close relative diagnosed with prostate cancer. The highest risk group (with a lifetime risk of about 1 in 1.5) are those men with more than one close relative diagnosed under the age of 60.
Testing / Screening
Q. Is early diagnosis important?
A. If prostate cancer is diagnosed early, it can be treated very successfully. However, when the cancer is advanced, it becomes very difficult to cure. All men over 50 should be aware of the warning signs and take themselves to their doctor.
Q. What tests can be used to detect prostate cancer?
A. A number of different tests are used to help diagnose prostate cancer:
- Digital rectal examination - by inserting a gloved finger into the back passage your doctor can actually feel the prostate gland, to find out whether it has any lumps or is larger than it should be. An enlarged prostate is very common in older men and this does not usually mean that it is cancerous.
- PSA blood test - if the level of Prostate Specific Antigen (PSA) in your blood is too high, this indicates that something is wrong with the prostate. There are several conditions which can raise the PSA levels. Only about one in three men with a raised PSA are found to have prostate cancer.
- Ultrasound - a small probe is inserted into the back passage and used to do an ultrasound scan, showing the exact size of the prostate.
- Biopsy - the definitive test is done by taking a tiny sample of tissue (a biopsy) from the prostate. A probe is inserted into the back passage and a small hollow needle jabbed into the prostate itself. Studying the tissue sample taken by the needle can determine whether there is a tumour and how aggressive it is.
- X-rays - If a tumour is found, an x-ray can reveal whether the cancer has spread to the bones.
Q. Who should have a PSA test?
A. We recommend that men over 50 should request a PSA test every 2 years and also be told about what the result may mean. It is important to understand that a raised PSA level does not specifically indicate prostate cancer because there are several more common conditions that cause an increased PSA level. Overall, 2 out of every 3 men found to have a raised PSA will not have prostate cancer. Also, about one third of men with prostate cancer do not have elevated PSA levels. However, regular PSA testing can give an indication of whether further testing is advisable.
Q. Is there prostate cancer screening?
A. At the moment, routine screening for prostate cancer is not carried out in any country, because there is no firm evidence that it would save lives. However, two large prostate cancer research studies were recently carried out in Europe and the USA to find out if routine screening of men over 50 with the PSA test results in a reduction in the death rate from this cancer. Confusingly, one study reduction and the other study found no reduction. This means that, at present, one cannot be confident about the case for PSA screening.
Q. Can prostate cancer be cured?
A. If the cancer is diagnosed early (before it has spread outside the prostate gland), treatment provides a long-term cure for at least nine out of ten cases. However, if the cancer has spread outside the gland when diagnosed the prospects are worse. Even a small amount of spread reduces the chance of a cure quite a lot. More distant spread makes a cure very unlikely indeed. Treatment can give these patients extra years of life and stop the pain of the disease, but is only able to cure a minority of them. Overall, only about one in three of patients with spread outside the prostate survive for five or more years after diagnosis.
Q. What treatments are available for prostate cancer?
A. Sometimes prostate cancers are so slow growing that no treatment is needed. ‘Watchful waiting’ is used in these cases, with regular monitoring of the patient, by regular PSA tests, to find out if the cancer changes. However, when treatment is necessary, there are four main types used:
- Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.
- Radiotherapy - in radiation treatment, high energy rays kill the cancer cells. This can be used in early prostate cancer, to destroy the tumour, and in advanced tumours, to reduce the pain caused by tumour cells which have spread to the bones.
- Brachytherapy - this is a newer type of radiotherapy in which small radioactive pellets or wires are inserted directly into the tumour, killing it from the inside.
- Hormone therapy - since the growth and division of the prostate cancer cells depends on androgens (the male hormones), drugs can be used to either reduce the level of androgens produced by the body or block the effect of androgens on the cancer cells. These stop the growth of the tumour, but do not kill it, so they have to be taken for a long time. However, after a while (anything between 3 and 20 years), most prostate cancers develop the ability to grow without androgens and the hormone therapy stops working.
Q. What newer treatments are available?
A. Cryotherapy (inserting a metal probe into the prostate tumour which freezes the tissue and kills the cells) and High Intensity Focused Ultrasound of HIFU (which causes localised heating inside the tumour that kills the cells) are available in some cancer hospitals. Although both of these treatments appear to be as effective in the short term as surgery or radiotherapy, their long-term effectiveness is not yet known.
Q. What are the side-effects of prostate cancer treatment?
A. The treatments for prostate cancer carry a significant risk of side-effects, both long-term and short-term. All these treatments carry a high risk of infertility. Most men being treated are well past the age when they want to start a family, but there is a small but significant group of younger patients for whom this may be important. These patients may be able to freeze sperm to make it possible to father children after treatment. After a prostatectomy operation there is a high risk of impotence and a small risk of urinary incontinence. Radiotherapy carries a similar risk of impotence but has a smaller risk of incontinence. Brachytherapy appears to have a lower risk of impotence. Almost all patients receiving hormone therapy experience impotence during the course of the treatment. Hot flushes, tiredness and weight gain are also common. The levels of side-effects reported for cryotherapy and HIFU vary a lot, but appear to be similar to radiotherapy or surgery.
The good news is prostate cancer need not be a death sentence. Early diagnosis is very important and there is a great deal all men can do to safeguard their health.
Learn about the Spotlight Fund for prostate cancer research grants
If you found these FAQs helpful and would like to assist AICR in funding further male cancer research and education to help protect men's health, please consider donating here.
Sources of Information