Management of Prostate Cancer

What is Prostate Cancer?

Prostate cancer happens when abnormal cells form and grow in the prostate gland. Most prostate cancers start in the outer gland cells of the prostate and are known as acinar adenocarcinomas. Many of these cancers grow extremely slowly and are not likely to spread but some can grow more quickly.1

Research published on April 5th, 2024 by the International Agency for Research on Cancer (IARC) together with partners in a new Lancet Commission predict that the global burden of prostate cancer is set to more than double to almost three million new cases by 2040, compared with the estimated number of cases today.2

The Prostate Gland

The prostate gland is part of the male reproductive system. It is situated at the base of the bladder and is about the size of a walnut but gets bigger as men get older. It surrounds the first part of the tube that carries urine from the bladder to the penis. This tube is called the urethra, also known as the pipework’s. The prostate gland produces a fluid that mixes with sperm (from the testicles) to make semen. It also produces a protein called the prostate specific antigen (PSA) which can be measured in the blood. Male hormones, such as testosterone, control its growth and function.3

Prostate cancer in Ireland

After non-melanoma skin cancer, prostate cancer is the most common cancer in men in Ireland. It accounts for almost one-third of all invasive cancers in men. According to the 2023 National Cancer Registry of Ireland (NCRI), an average of 3,980 people are diagnosed annually with a mortality rate of 623. Prostate cancer has a high survival rate if caught in time.

The five-year survival rate currently stands at 93%.4

Risk Factors for Prostate Cancer

In most cases cause is unknown. Factors that may increase the risk of developing prostate cancer include:

• Age – Prostate cancer is more common in older men. Most prostate cancers occur in men aged 50 or over.
• Ethnicity – Prostate cancer is more common in black-African men than white men. It is least common in Asian men.
• Family history – Prostate cancer is more common in men who have a father, son or brother with prostate cancer.
• Genetics – Prostate cancer is more common in men with certain genetic alteration (e.g. BRCA1 and BRCA 2 alterations) and syndromes (e.g. Lynch syndrome)
• Obesity and weight – Obesity and overweight is the second biggest preventable cause of cancer after smoking. Being overweight or obese increases your risk of metastatic or advanced prostate cancer.

Maintaining a healthy body weight, being physically active and eating a balanced diet is good for your health and may help to reduce your risk of prostate cancer.5,6,7

Symptoms of prostate cancer

Prostate cancer does not usually cause symptoms in the early stages. Most prostate cancers start in the outer part of the prostate gland. This means that to cause symptoms, the cancer needs to be big enough to press on the urethra (pipeworks) that carries urine from the bladder to the penis.

While not common, symptoms of early prostate cancer might include the following:

• Passing urine more frequently
• Getting up at night to pass urine (nocturia)
• Difficulty passing urine –this includes:

– A weaker flow

– Straining when starting to urinate

– Needing to rush to the toilet urgency

Less common symptoms include:

• Blood in the urine or semen
• Feeling of not emptying your bladder fully8

Along with the symptoms above, more advanced prostate cancer can sometimes cause other symptoms, such as:

• Trouble getting an erection (erectile dysfunction or ED)
• Pain in the hips, back (spine), chest (ribs), or other areas, from cancer that has spread to the bones
• Weakness or numbness in the legs or feet, or even loss of bladder or bowel control, from cancer in the spine pressing on the spinal cord
• Weight loss
• Feeling very tired

Most of these symptoms are more likely to be caused by something other than prostate cancer. For example, benign prostatic hyperplasia (BPH), a non-cancerous growth of the prostate.9,10

Diagnosing prostate cancer

If you have any of the symptoms above, you should contact your GP without delay to find out what is causing your symptoms:

Tests your G.P. may do include the following:

• Medical history and examination
• A blood test called a PSA test
• Digital Rectal Examination (DRE)

Prostate-specific antigen (PSA) is a protein made by cells in the prostate gland (both normal cells and cancer cells). The PSA level alone is not a reliable test to check whether a man has prostate cancer or not. Some men have prostate cancer but have a PSA level that is normal for their age while other men have a higher PSA level but do not have prostate cancer. Urinary infection or a prostate infection can also raise the PSA. If you’re due to have a PSA test don’t ejaculate or exercise heavily for 48 hours beforehand as it also affects the results.

Depending on the results of your tests, your GP may repeat your PSA in 6–12 weeks or may refer you to one of the National Cancer Control Programme (NCCP) Rapid Access Prostate Clinics where your prostate can be assessed further by a Urologist. The urologist may repeat the above tests and may take a biopsy of your prostate gland – TRUS biopsy/Trans perineal biopsy. Further tests may also be required and may include one or more of the following: MRI/ Multiparametric MRI (mpMRI)/CT Scan/Pet-CT Scan.

These tests and scans provide information about:

• the type of cell the cancer started in and where it began
• how abnormal the cells look under the microscope (the grade – known as the Gleason’s score for prostate cancer)
• the size of the cancer and whether it has spread (the stage)11

Treatment for prostate cancer

Treatment depends on the stage and grade of your cancer, size of your prostate gland and your general health.

A team of experts called the MultiDisciplinary Team (MDT) will decide on the most appropriate treatment. Sometimes no active treatment may be required, and the patient may be monitored through ‘Active surveillance’ or ‘Watchful waiting’.

If active treatment is required, it may include one or combination of the following:

• Surgery
• Chemotherapy
• Radiation therapy (External/ Internal – brachytherapy)
• Hormone therapy – blocks testosterone12

Types of prostate cancer

There are different types of prostate cancer. The most common type is adenocarcinoma of the prostate. Two types of adenocarcinomas of the prostate are Acinar adenocarcinoma and Ductal adenocarcinoma.

Other types of prostate cancer include Transitional cell carcinoma, Squamous cell carcinoma and Small cell prostate cancer.13

References available on request

Written by Bernie Carter, Assistant Director of Nursing, Marie Keating Foundation

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