Prostate cancer is often in the media spotlight, but the recent news has been positive. Fergus Bescoby explains.
Diagnosing prostate cancer
There are several methods to check for the presence of prostate cancer. The simplest is the digital rectal examination, in which a gloved finger is inserted into the rectum, through which an enlarged prostate can be felt. Nowadays, however, a prostate-specific antigen (PSA) blood test is often preferred. Other, more accurate tests, including urine tests, will hopefully soon be available to replace the less accurate PSA test. More sophisticated tests include the use of ultrasound scans and X-rays.
How prostate cancer spreads
Prostate cancer tends to spread to the bones rather than any other organs. With prostate cancer, it is sometimes possible for there to be metastases (cancer spread) present even when the prostate tumour is still very small.
Treatment
If diagnosed early, treatment can be quite successful. The key decision in prostate cancer is whether or not to treat it at all. In many older men, the cancer progresses so slowly that surgery and other treatments may cause more harm than good.
However, for those whose cancer is more aggressive – either already spreading or liable to spread beyond the prostate – surgery is usually the first option.
A specialist may then arrange a biopsy of the prostate. This should indicate whether prostate cancer is present and whether it is aggressive. Other tests, such as X-rays or scans, may be necessary to assess the extent of the cancer. These results will also influence the types of treatment available.
A prostatectomy means the prostate gland is removed, normally along with small parts of the lymphatic system near the gland. Unfortunately, the operation often causes nerve damage, which can make it impossible for men to achieve an erection afterwards or maintain complete control over urination.
However, modern ‘nerve sparing’ surgical techniques – combined with drugs such as Viagra – mean the effects on both sexual function and quality of life
can be minimised.
The main advances in prostate cancer treatment are being made in surgery and radiotherapy. Surgeons are learning how to remove the prostate without causing the problematic nerve damage that was inevitable in the past.
And radiotherapy technology advances mean that far higher doses can be targeted more precisely on the prostate, killing more cancer cells with fewer treatments.
Recent advances include the use of a technique called brachytherapy. There are two major methods of prostate brachytherapy: permanent seed implantation and high dose rate (HDR) temporary brachytherapy.
Permanent seed implants involve injecting approximately 100 radioactive seeds into the prostate gland. They give off their cancer-killing radiation at a low dose rate over several weeks or months, and the seeds remain in the prostate gland permanently.
HDR temporary brachytherapy instead involves placing very tiny plastic catheters into the prostate gland, and then giving a series of radiation treatments through
these catheters.
Another option is high-intensity focused ultrasound, which uses sound waves to ‘melt away’ the cancer.
Prognosis
The prognosis for this type of cancer depends on how quickly doctors discover the disease. The earlier prostate cancer is detected, the better the prognosis. With early diagnosis it has become curable, and even patients with cancer that has spread outside the prostate have many treatment options with a high chance of responses that should be durable.
More than three-quarters of men diagnosed with prostate cancer now survive their disease beyond five years. In the 1970s less than a third of sufferers reached this point.
Fergus Bescoby is underwriting development manager at VitalityLife (formerly PruProtect)
