Prostate Cancer Screening

PROSTATE CANCER: What are the symptoms and risk factors in prostate cancer?

Although prostate cancer affects 1 in 12 men during their lifetime, as many as 1 in 2 men will develop benign enlargement of their prostate. Consequently, most men who experience associated urinary flow symptoms  will not have cancer.

The main symptoms to look out for include: frequent visits to the toilet, getting up at night to pass urine (and having to rush to get there), a pause before being able to start to pass urine, and a slow flow of urine with dribbling at the end. If you see blood when you pass urine this is also an important thing to speak to your doctor about. 

If you have a family history of prostate cancer then your own risk of having prostate cancer is increased so you should seek medical advice as to whether or not you should be tested. 

These days there are good treatments available for nearly all prostate diseases and prostate cancer is curable if detected early.

What can go wrong with the prostate gland?

The prostate gland is about the size of a walnut and sits at the base of the bladder.  The urethra (urine pipe) passes through it, so when it becomes diseased symptoms are often seen within the urine and urinary flow is affected. 

The most common problems associated with the prostate are:

1. Gland enlargement (the most common problem which increases with age)
2. Inflammation or infection (prostatitis) 
3. Cancer

Not all men with a diseased prostate will have symptoms. Sometimes prostate disease is found “by chance” when a patient is undergoing other tests (blood tests [PSA level] or examination of the back passage for another condition – e.g. piles or rectal bleeding).

Common urinary symptoms include:

• Poor urinary stream
• Dribbling after passing urine 
• Increased frequency of urination
• Urgency (need to rush to  the toilet to pass urine)
• Poor bladder emptying (need to go back to the bathroom after voiding)
• Nocturia (getting up at night to pass urine)
• Haematuria (blood in the urine)

Risk factors associated with prostate cancer:

• Age – prostate cancer is rare in men under the age of 40, however, the disease incidence increases after the age of 45 and it is the commonest cancer in men aged 65 and over.
• Men who have had a close family member (father/brother) diagnosed with prostate cancer at a younger age (under 55) have a 3-fold increased risk due to an inherited genetic risk.

Screening

Men who have an increased family risk of prostate cancer should consider having regular prostate (PSA) screening blood tests once they are over the age of 45.

Sometimes men have symptoms arising from prostate cancer cells that have spread to other parts of the body.  These (metastases) normally lodge in bones and can cause pain that does not improve or go away with simple painkillers.

Prostate Specific Antigen (PSA) Test

PSA is a protein produced by the prostate gland.  Levels are checked using a simple blood test and can be useful in guiding doctors as to what is wrong and which investigations or treatments may be necessary. Levels can also help medical teams to monitor the effect of prostate cancer treatments.

Sometimes a raised PSA can detect prostate cancer at an early stage, before any symptoms develop, but it is important to remember that NOT ALL  men with a raised PSA level will have prostate cancer. 

PSA levels can be elevated secondary to:

• Increasing age
• Excessive benign prostate growth
• Prostate cancer
• Urinary tract infections
• Excessive cycling (more than 10miles/day on a regular basis)
• Sex
• Medical inspection of the bladder (cystoscopy)
• Digital rectal examination

What happens if my PSA test is abnormal?

If your PSA test comes back elevated and/or a digital rectal examination by your doctor reveals an abnormal texture of your prostate gland, you will be advised to undergo additional tests which may include a prostate biopsy.

Currently the gold standard investigation of someone with a raised PSA is an MRI scan.  If this is normal, then normally no additional tests are necessary.  Sometimes the scan identifies areas of concern, and a prostate biopsy is necessary.

Prostate biopsy is a day-case procedure which is performed under local anaesthesia. 

An ultrasound probe is placed into the back passage using a lubricant jelly and moved around to scan the prostate.  The sonographer is able to take various size measurements and inject local anaesthetic into the correct area prior to biopsies (small samples of prostate tissue) being taken. 

After the procedure, it is common to see some blood when passing urine.  Blood may also be seen coming from the back passage. In both cases this usually clears after a day or so. 

The biopsies are sent to a laboratory for analysis. You will be contacted once the results are available to arrange a follow up consultation to explain what they meand and discuss further management should it be necessary.