What do I know about prostate cancer?
I knew it was bad, of course. All cancer is bad, right? I also knew that, along with testicular cancer, mental health and suicide prevention, prostate cancer is one of the causes highlighted when men around the world allow their facial hair to grow beneath their nose during Movember.
Oh, and I knew that it affects mostly men above a certain age and that doctors can check for it by inserting a gloved finger where the sun don’t shine. Family Guy taught me that.
As it turns out, there’s a reason Movember and several other organisations look to raise awareness of prostate cancer. According to Cancer Research UK, ‘Prostate cancer is the most common cancer in UK males, accounting for more than a quarter (27%) of male cases (2016-2018)’. We should probably be treating it a little more seriously.
As it turns out, a finger poke isn’t the only – or definitive – way to tell whether you might have prostate cancer. Here are five things that dads – and all men – should know about:
The alarming truth about prostate cancer is that there are no signs or symptoms that typically present themselves before it’s too late. According to the NHS website, the first alarm bell to sound will be when ‘the cancer has grown large enough to put pressure on the tube that carries urine from the bladder out of the penis’.
The symptoms to look out for, if you have prostate cancer at an advanced, aggressive stage, are:
- Needing to urinate more frequently, often at night
- Needing to go to the toilet quickly, with little warning
- Struggling to begin when urinating
- Straining or taking a long time while urinating
- Weak flow
- The feeling that your bladder is not completely empty afterwards
- Blood in either urine or semen
Of course, presenting with any of these symptoms doesn’t necessarily mean you will have prostate cancer. In fact, it should also be noted that these can also be caused by a common condition in men over 50 called Benign Prostate Enlargement, which is usually not a serious threat to health.
However, if prostate cancer is present, further signs may appear should it begin to spread, including back pain, bone pain, testicular pain, loss of appetite, and weight loss.
Many a gentleman has grimaced – or cracked jokes – at the thought of a doctor checking your prostate. As mentioned in the introduction, Family Guy even produced an entire episode devoted to the finger-probing act.
While the digital rectal examination, to give it its proper name, is one way in which a doctor can attempt to identify it, there is actually no definitive test to say that you have prostate cancer or not. In addition to ‘inserting a gloved finger into your bottom’ (The National Health Service’s words, not mine), your GP may also request a urine sample to test for infection, or take a blood sample to run a Prostate-Specific Antigen (PSA) test.
A raised PSA level will likely result in referral for an MRI scan to identify any potential problems with your prostate. If a possible problem is shown, the next step would be a biopsy, of which there are two types the NHS might opt for, to determine whether it is indeed prostate cancer.
There’s the transrectal biopsy, which the NHS confesses is ‘uncomfortable and sometimes painful’. A needle is inserted into the prostate through the rectum. An ultrasound probe allows the medical professional performing the procedure to see exactly where to pass the needle so as to take small tissue samples from the prostate.
Alternatively, there’s the transperineal biopsy, usually performed with the patient under general anaesthetic, in which a needle is inserted (either way, a needle’s going in, it seems) behind the scrotum and into the prostate. Not only are you asleep for this procedure, but the NHS notes that it has the added benefit of posing a reduced risk of infection.
Also noted is that although biopsies are more reliable than even PSA tests, the cancer can still be missed.
3. Who’s at risk?
There’s no sure-fire cause of prostate cancer. As with any cancer, it can appear seemingly at random. However, there are several factors that can increase the chance of developing it.
Age is a huge factor! The reason that men over the age of 50 are able to request a PSA test from their GP is because most diagnosed gentlemen have surpassed half a century. Although men are able to request a PSA screening, there’s no routine screening programme currently running in the UK, so the NHS won’t ask you first. This is because there is no proof that the benefits outweigh the risks and because PSA levels increase with other, non-cancerous conditions. PSA blood tests are not exclusive to prostate cancer.
Ethnicity also seems to play a role in determining the risk of prostate cancer. The NHS says that it is ‘more common among men of African-Caribbean and African descent than in Asian men’. Prostate Cancer UK, which is currently funding research in order to discover just why black men are at higher risk of it than others, states that one in four black men will get it in their lifetime. Men from other ethnic groups, by comparison, are reportedly half as likely to get prostate cancer with a one in eight chance.
Your family’s history with cancer is something to be aware of, as not only are you at higher risk if your father or brother developed prostate cancer before they reached the age of 60, but research suggests that your risk also rises if a close female relative has had breast cancer.
More recent research, meanwhile, has linked diet with prostate cancer. Evidence points to a high-calcium diet increasing the possibility of developing it, while obesity also adds to the risk. As with many general health matters, a balanced diet and regular exercise reduces risk.
Treatment for prostate cancer varies case-by-case. The NHS even comments that, ‘for many men with prostate cancer, no treatment will be necessary’. The aim of treatment, ultimately, is to cure or control the disease. Should the cancer have spread beyond the chance to cure it, the goal is to delay symptoms and prolong life.
Cancer patients are cared for on the NHS by a multidisciplinary team (MDT). This may comprise cancer surgeons, radiotherapy and chemotherapy specialists, radiologists, pathologists, radiographers and specialist nurses. Also, it includes physiotherapists, dietitians, occupational therapists and, at times, psychological support.
Prostate Cancer UK lists the various treatment options available. It says that ‘you may have a choice of treatments and this will depend on the stage of your cancer’. The list includes radical prostatectomy (prostate removal surgery), as well as chemotherapy, cryotherapy, and several types of radiotherapy.
When it comes to selecting a treatment plan, doctors will consider many variables E.g. the size of the cancer, as well as its type, its grade and whether it has spread elsewhere, and your general health. Although your MDT will make their suggestions, the decision is ultimately yours. You will get the chance to speak with a specialist nurse to discuss the options, including any possible side effects. Any side effects experienced from treatment will be managed – and hopefully stopped – by specialist services.
Terms you may become familiar with will include:
- ‘staging’, as doctors look to identify the ‘stage’ of prostate cancer – or how far it has spread
- ‘watchful waiting’, which is essentially delaying potentially invasive treatment to see if the cancer or symptoms actually develop
- ‘active surveillance’, to find any signs of progression as early as possible via undergoing regular PSA tests, MRI scans and biopsies
Should you find yourself with a diagnosis, support can be found down many avenues. Not only can you turn to your own network of friends and family. There are several organisations, including charities and the NHS, that offer help you may not even realise you need. Here are just a few of the places you can turn to:
Prostate Cancer UK
Prostate Cancer UK offers a wide variety of support to those managing a prostate cancer diagnosis. They offer help with fatigue and sexual issues that may arise. Also the provide emotional support and help with diet and exercise. In addition, Prostate Cancer UK can help you find support local to you and support groups. It also offers an online community to join.
Macmillan recognises that patients may become anxious between appointments. It runs a support phoneline (0808 808 0000), an online chat function, and prostate cancer forum.
Tackle Prostate Cancer
Tackle Prostate Cancer offers a helpline (0800 035 5302) and email (firstname.lastname@example.org), and can also help you track down your nearest local support group.
Cancer Research UK
Cancer Research UK is arguably one of the UK’s most widely recognised charities. Its website includes a ton of information. Additionally, it has tools to find clinical trials, a cancer chat forum, and nurse helpline (0808 800 40 40).
There will of course be other support systems out there. As with anything else, should you or someone you know be diagnosed with prostate cancer, speak to a GP or a member of the MDT assigned.
Written by James Cooke