The Prostate and Prostate Cancer

What is the Prostate?

The prostate is a sex gland found only in men and it is important for reproduction. It supplies the fluid needed for sperm, produced by the testes, to travel and survive. On each side of the prostate are bundles of nerves and vessels which help to control erectile function. It lies at the base of the bladder, surrounding the tube called the urethra which carries urine or semen to the end of the penis. It is normally about the size of a walnut. As men age, the gland becomes enlarged and can squeeze the urethra, giving a reduced urine flow. This can lead to problems with the prostate, more common in older men.

Position of the prostate gland

 

Awareness is key

In a recent survey of 3,500 men by Prostate Cancer UK, 54% did not know where the prostate was; 92% were clueless about its role, and 17% didn't even know they had a prostate.

Risk Factors

There are four major risk factors that can influence your risk for developing prostate cancer. Prevention can hinge on awareness and appropriate screening — neither too early, nor too late It’s important to understand your personal risk profile.

Age – Once regarded as the curse of older men, younger men are being diagnosed in their 50s, and occasionally in their 40s. In the UK more menare diagnosed between the ages of 65 and 69 than any other age bracket.

Race – Men of African-Caribbean origin are especially at risk: 70% more likely to develop prostate cancer and twice as likely to die from it. Asian men who live in Asia have the lowest risk, but if they migrate to the west, their risk increases.

Diet and lifestyle – These can also be a factor, particularly a high-fat, highly processed carbohydrate diet. Research has shown that in obese men, recovery from surgery can be longer and more difficult, and the risk of dying from prostate cancer can be higher.

Family History and Genetic Factors – According to Cancer Research UK it is estimated that inherited factors explain around 5–9% of prostate cancers.The risk is 2.1-2.4 times higher in men whose father has/had the disease; 2.9-3.3 times higher in men whose brother has/had the disease; 1.9 times higher in men with a second-degree relative (grandfather or uncle, nephew, or half-sibling) who has/had the disease. Family genetic risk is higher in men aged under 65 compared with older men, and in men with more than one affected first-degree relative or with an affected relative diagnosed aged younger than 60.

Prostate cancer risk is 19-24% higher in men whose mother has/had breast cancer (but it is not associated with breast cancer in a sister).

Prostate cancer risk is up to 5 times higher in men with the BRCA2 gene mutation and among such men under 65 years old it is more than 7 times higher.

‘Pussycats and tigers’

Evidence of cancer in the prostate need not necessarily be a cause for immediate concern, as many cancers grow so slowly that they may never develop to be life-threatening.

It often spreads first to tissues that are near the prostate, such as the seminal vesicles and the nearby lymph nodes, which are part ofthe lymphatic system. Prostate cancer has now been shown to have several variants. Research is progressing to predict more accurately the different types, and to identify which cancers are slow-growing and which are aggressive and need more urgent treatment.

Most prostate cancers are found in the outer part of the prostate, called the peripheral zone, the back of the prostate and near the rectum. Most start when normal cells begin to grow out of control.

Slow-growing cancers, (‘pussycats’), may stay within the gland, unnoticed and indolent, for many years. These may only require careful monitoring, without necessarily needing radical treatment, and can safely undergo Active Surveillance.

The more aggressive ‘tigers’, however, have the potential to spread outside the prostate, sometimes quite rapidly, when symptoms may become noticeable. These will need active treatment, ideally before the cancer starts to invade other areas of the body.

Prostate cancer is very treatable if it is detected early and contained within the gland. If prostate cancer spreads elsewhere it remains as prostate cancer. It can spread to the bones, but if it does it is not bone cancer.

 


Some facts

    • Prostate cancer is the most common cancer in men
    • Each year in the UK over 47,000 men are diagnosed with prostate cancer and about 11,800 die of it (source: Cancer Research UK)
    • If the cancer is confined within the prostate, it is generally curable, so early detection may prevent death from prostate cancer
    • Urinary symptoms (e.g. difficulty in passing urine or frequent night-time visits) may indicate cancer, but could also be caused by an enlarged prostateor an infection
    • Prostate cancer in its early stages does not normally have any symptoms
    • Early-stage disease offers a much wider choice of treatment options – more than for any other cancer
    • Once the cancer begins to spread outside the prostate, there are fewer options for treatment, though there may still be possibilities for a cure
    • If the cancer has spread to other organs or the bones, the disease can only be slowed and controlled
    • If prostate cancer spreads elsewhere it remains as prostate cancer. It can spread to the bones, but it is not bone cancer’