IDENTIFYING AND DEALING WITH PROSTATE CANCER
By Bro Dr Adu Appiah-Kubi (Council 14, Obuasi)
Introduction
Prostate cancer is the most common cancer in men with over 40,000 new cases diagnosed every year.
Prostate cancer usually develops slowly, so there may be no signs you have it for many years.
Symptoms often only become apparent when your prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis).
When this happens, you may notice things like an increased need to urinate, straining while urinating and a feeling that your bladder has not fully emptied.
These symptoms should not be ignored, but they do not mean you definitely have prostate cancer. It is more likely that they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).
What is the prostate?
The prostate is a small gland in the pelvis found only in men. About the size of a satsuma, it’s located between the penis and the bladder and surrounds the urethra.
The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.
Why does prostate cancer happen?
The causes of prostate cancer are largely unknown. However, certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent.
Men who have first degree male relatives (such as a father or brother) affected by prostate cancer are also have higher risk of having prostate cancer.
Tests for prostate cancer
There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you.
The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy.
The blood test, known as a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer. Men are not routinely offered PSA tests to screen for prostate cancer, as results can be unreliable.
This is because the PSA blood test is not specific to prostate cancer. PSA can be raised due to a large non-cancerous growth of the prostate (BPH), a urinary tract infection or inflammation of the prostate, as well as prostate cancer. Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not. This means a raised PSA can lead to unnecessary tests and treatment.
However, you can ask to be tested for prostate cancer once the benefits and risks have been explained to you.
How is prostate cancer treated?
For many men with prostate cancer, treatment is not immediately necessary.
If the cancer is at an early stage and not causing symptoms, a policy of “watchful waiting” or “active surveillance” may be adopted. This involves carefully monitoring your condition.
Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy.
Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.
All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary incontinence. For this reason, many men choose to delay treatment until there is a risk the cancer might spread.
Newer treatments, such as high-intensity focused ultrasound (HIFU) or cryotherapy, aim to reduce these side effects. Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy. However, the long-term effectiveness of these treatments are not yet known.
Living with prostate cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can have an effect on your life. As well as causing physical problems such as erectile dysfunction and urinary incontinence, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
NB: The author is Obsterician Gynaecologist at the Sunyani Regional Hospital and a lecturer at University of Health and Allied Sciences (UHAS)