A B C D E F G H I J K L M N O P R S T U V W

CANCER OF THE PROSTATE

What is Cancer of the Prostate ?

Cancerous changes within the prostate are very common with increasing age. Information from routine autopsies shows that about 80% of apparently normal men over the age of 80 years have small cancerous areas in their prostate. Many of these cancers never cause trouble and lie dormant over a lifetime. An area of malignancy can also be found by chance when a benign prostate is removed. Many of these patients will have no further problems even if no specific treatment is directed against the tumour. All urologists will treat a cancer of the prostate which is causing symptoms. Most urologists will tend to treat larger areas of malignancy which have been found incidentally during a prostate operation. The symptoms which may occur are loosely termed prostatism . Lower urine tract symptoms consist of a poor urinary flow and an inability to empty the bladder fully, and a need to wait for the urinary flow to commence. Because the bladder never empties fully, urine may need to be passed very frequently. This can interfere with a good night's rest. Sometimes there is an increasingly strong desire to pass urine and rarely leakage of urine (incontinence). If the cancer has spread, it usually affects the bones of the spine causing back pain. The diagnosis may be suggested by the findings on rectal (back passage) examination. This may actually be a chance finding when the rectal examination is being performed for a different reason.

Why does Cancer of the Prostate occur ?

There seems to be no particular factor which predisposes to cancer of the prostate. Because the disease can be treated by hormones, some kind of hormone change with age may be the cause.

Treatment Involved for Cancer of the Prostate

When the diagnosis is suspected following clinical examination, the urologist will arrange blood tests and x-rays. If there has been bleeding, an x-ray of the kidney will be necessary. The diagnosis can only be accurately confirmed by taking a tissue specimen from the prostate itself. This specimen can be very small and can be withdrawn through a needle. The procedure usually can be performed as an outpatient. In most hospitals an ultrasound scanner (transrectal ultrasound) is used to guide the needle into the prostate. The transrectal ultrasound probe is about the size of a large index finger. Although this examination is uncomfortable, it should not be painful. This scan should also give extra information about the extent of the tumour. Since cancer of the prostate can spread to other parts of the body, especially bones, a bone scan and certain blood tests are usually taken to identify the extent of any spread as accurately as possible. Treatment can be aimed at the prostate and at any spread of the growth which may be present. If the prostate itself, due to its enlargement, is causing symptoms a transurethral resection may be indicated. This will not cure the disease but by reducing the size of the prostate will relieve some of the symptoms. Most patients will require additional treatment to control the disease process. In the United Kingdom there are two principal forms of treatment: radiotherapy and hormone therapy. Radiotherapy is directed both to the prostate and to the painful areas of spread to the bones. Most prostate cancers require the male hormone testosterone for their continued growth. Since testosterone is produced mainly by the testicles, operative removal of the testicles (bilateral orchidectomy) starves the tumour of testosterone, and will make the tumour stop growing and even shrink. A similar effect can be achieved by turning off the production of testosterone using special injections. Other drugs are sometimes used which can literally block the effects of testosterone. Female hormones (oestrogens) can also be used: they work by opposing the effect of testosterone. Both the tumour within the prostate as well as any areas of spread in the bones will usually shrink, causing pain relief. Some urologists prefer to use radiotherapy to the prostate as the main approach to treatment. The effects on the tumour are similar to the other forms of treatment. Radiotherapy in shorter courses is also very useful to control the painful symptoms of prostate cancer which has spread to bone. This can be used if hormone treatments have failed. Chemotherapy by cancer-killing drugs (cytotoxic drugs) given directly into veins can also be used for widespread prostate cancer. Trials of various drugs are still in progress. As yet, these drugs are not being used as a first line treatment. Operation to remove the whole prostate and its coverings is called a radical prostatectomy. This operation is increasingly popular in the UK, and is widely practised in North America. It is only suitable for younger patients with very small areas of malignancy, but is becoming accepted as the best treatment in certain cases.

During Treatment of Cancer of the Prostate

Some of the hormone treatments, including hormone injection, anti-hormone tablets and the operation to remove the testicles, produce unacceptable side-effects in some patients. All forms of treatment which prevent the production of the male hormone testosterone have the same side-effects. Sexual libido is reduced and penile erection is reduced; beard growth becomes sparse and weight gain is common; hot flushes similar to menopausal symptoms may occur. Use of female-type hormones often results in some swelling of the breasts. These side-effects sometimes diminish with time and may be treated by other tablets. Side-effects of radiotherapy are different. The ability to sustain an erection is usually maintained and the hormone effects are absent. However, in a small percentage of patients, there are side-effects due to the radiotherapy which may inflame the back passage or rectum. This produces diarrhoea which is usually relieved when the course of treatment, usually 6 weeks, is finished. Radical prostatectomy also causes impotence in a proportion of patients.

After Treatment of Cancer of the Prostate

Lifelong follow-up is necessary. Clinic attendances at 6 monthly intervals are usual. If monthly injection therapy is chosen, this may be given by your general practitioner.

If Cancer of the Prostate is Left Untreated

As has been mentioned, some cases would lie dormant, would not progress and would give no symptoms. However, many cancers, particularly those which have already spread from the prostate, would continue to progress. Pain would increase in these aggressive tumours and without treatment would prove fatal.

Effects on Family of Cancer of the Prostate

The partner will need to be understanding about any changes in sexual interest and activity resulting from hormone treatment. She will also need to be sympathetic to the emotional changes which may particularly follow removal of the testicles.