The truth about prostate cancer diagnosis

Mr John Donohue Consultant Urological Surgeon More by this author
It’s never easy to tell someone they've got cancer. But for Consultant Urologists like Mr John Donohue, the burden might be lightened if men knew that when prostate cancer is diagnosed early, any treatment is designed to prevent trouble many years later. In most cases, there’s plenty of time to decide what your next step will be.

I deal with cancer every day. I think about it often and I know the paths that others might take if they ever hear the words: ‘You’ve got cancer’. A man’s already been through a lot of investigations before we can say for sure, but no matter what’s already happened – few men find they’re ready to hear it. Here’s my advice for when you do.

Prostate cancer is typically slow growing

If they live long enough, most men will develop some degree of prostate cancer. If you discover a small amount of cancer at age 50, chances are it won’t present a problem for a while yet. When we do take steps, it’s so you won’t have an issue to deal with in 10 to 15 years’ time. If you’re closer to 80 years old and the cancer is still in its early stages – there may be no need to give it another thought, depending on the state of your health.

Investigations to diagnose prostate cancer are usually initiated when someone has a blood test to measure PSA (prostate specific antigen). PSA is found only in the prostate and is present in the seminal fluid. Damage to the prostate allows more PSA to leak into the blood stream. Prostate cancer can be the cause of this but urinary tract infections can also result in a high PSA. Some men will simply have a higher PSA than others.

Symptoms of prostate cancer

Early prostate cancer usually has no symptoms. Having the PSA test identifies these men. Other men present for a PSA because they have waterworks issues caused by a benign enlargement of the prostate – reduction in flow and increased urination. However, the majority of men with urinary symptoms do not have cancer. Conversely, the absence of symptoms doesn’t mean one does not have cancer, so it’s useful to have the PSA test and a rectal examination. Men should ask their GP about when it’s appropriate for them to have these tests. In most cases, you’ll have plenty of time to decide what to do next.

Prostate cancer treatment is not for everyone

Sometimes that decision is to do nothing. In many cases men have a few cancer cells but we don’t expect them to make trouble. We’ll monitor cancer using ‘active surveillance’. That means you’ll have regular blood tests to check your PSA levels, MRI scans to monitor any growth in the tumour, and biopsies to see if the cancer is spreading within the prostate. Your Consultant will keep you up to date every step of the way, and often there’ll be no real change in your day to day life. However, the on-going checks and tests can lead to anxiety, so it’s important you make your Consultant aware of how you’re feeling throughout the process.

Surgery

One treatment to deal with cancer contained within the prostate is to remove the entire prostate gland under general anaesthetic, often via keyhole surgery. The advantage of this approach is that the patient can usually go home the following day. This operation can result in incontinence and erectile dysfunction. The effects on continence are usually short-term with the vast majority of men recovering full continence or requiring a small pad for occasional leaks. The recovery of erections takes longer and depends on whether the location and size of the tumour allows patients to have a nerve sparing procedure.

Radiotherapy

External radiotherapy treatment usually consists of 37 separate radiotherapy sessions. The radiation dose can’t be given in one session and requires multiple small exposures to the radiation. This option is useful if the cancer has spread locally beyond the prostate. However, there are also side-effects associated with external beam radiotherapy. Internal radiotherapy, or brachytherapy, is also increasingly available and can be used if the cancer hasn’t spread. It involves the surgical insertion of radioactive pellets into the prostate. It’s worth discussing all the options with your Consultant.

No treatment is free of risk and therefore patients are increasingly opting for active surveillance if the cancer is not very aggressive and thus patients avoid any potential side-effects.

When will it be over?

The follow up of prostate cancer is very straightforward. The PSA is tested regularly. As long as the PSA is undetectable following surgery or very low after radiotherapy, no other scans are necessary. The longer the time interval following treatment without a rising PSA, the less likely there will be evidence of the disease coming back.

A final word

Prostate Cancer is a long road. Getting that diagnosis may change your life, for a short time or a longer time – but it’s very unlikely it’ll be the end of it. There are so many more questions to answer before you know what your experience will be. We’ve come to think of cancer in black or white terms: It beats you or you beat it - when in fact you can live with cancer for many years.

Remember, raised PSA levels or suspect rectal exams are not cancer diagnoses. Only a biopsy can tell you if you have cancer. Unfortunately, it can’t confirm that you don’t. So my advice – don’t worry too much if you can help it. There’s never been a better chance of surviving cancer than there is today.

Monday 16 November 2015

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