Prostate cancer

You may have:

• difficulty in starting to pass urine
• a weak, sometimes intermittent flow of urine
• dribbling of urine before and after urinating
• a frequent or urgent need to pass urine
• rarely, blood in your urine or semen and pain when passing urine

These symptoms aren't always caused by prostate cancer but if you have them, see your doctor. These symptoms are similar to those produced by a common benign (non-cancerous) condition called benign prostatic hyperplasia, where your prostate becomes enlarged.

If prostate cancer spreads to other parts of your body, other symptoms can develop such as:

• pain in your bones, such as your back and hips
• weight loss
• impotence

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor may do some of the following tests, or refer you to a urologist.

• A blood test to examine the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein that is made by both normal and cancerous prostate cells. The test can be inaccurate as a high PSA level doesn't always indicate cancer and can be caused by other prostate conditions.
• A digital rectal examination (DRE) - an examination of your prostate. Your doctor will feel your prostate through the wall of your rectum (back passage). If you have prostate cancer, it may feel harder than usual, or knobbly.
• A prostate biopsy, where your doctor uses a needle to remove a small piece of tissue from your prostate. The sample will be sent to a laboratory to find out if you have cancer and if so, how fast it's growing.
• An ultrasound to examine your prostate gland, using a small device inserted into your rectum.
• CT scan, MRI scan and bone scans can help your surgeon see how far the cancer has spread (if at all). Doctors are currently trialling a new urine test to look for a protein made by PCA3 (prostate cancer gene 3). However, it's not available at the moment.

Sometimes, particularly for slow-growing tumours, no treatment is the best course of action. This is often called active monitoring or watchful waiting. Your condition will be closely monitored by your doctor with routine check-ups. If tests show that the cancer is growing or causing symptoms, your doctor may suggest that you start having treatment.

Surgery is a common treatment for prostate cancer. It's most suitable for otherwise healthy men (usually, those under 70) whose cancer hasn't spread beyond their prostate. There are several types of surgery used, including:

• radical prostatectomy - a major operation to remove the whole of your prostate and some surrounding healthy tissue
• keyhole surgery (a laparoscopic prostatectomy) where your prostate is removed through smaller incisions and robot-assisted surgery
• very rarely, an orchidectomy - where your surgeon removes your testicles to get rid of the main source of the male sex hormone testosterone, which can help the cancer grow

Sometimes, if part of the prostate cancer is pressing on your urethra, you may have an operation called transurethral resection of the prostate (TURP) to relieve your symptoms and make it easier for you to pass urine.

• Radiotherapy, which uses X-rays to destroy cancer cells.
• Hormone therapy, which blocks the action of testosterone. This can slow the growth and spread of prostate tumours but won't kill the cancer cells. Hormone therapies include taking a medicine called bicalutamide or having injections of a medicine called goserelin.
• Chemotherapy, which uses medicines to destroy cancer cells. Your doctor may recommend a medicine called docetaxel combined with a steroid called prednisolone if hormone therapy isn't working (hormone refractory cancer).
• High intensity focused ultrasound (HIFU). This treatment uses heat to target and destroy cancer cells. It may only be available as part of a clinical trial and only if the cancer is in its early stages or if your cancer has come back.
• Cryotherapy, which uses liquid nitrogen to freeze and kill cancer cells. This may only be available as part of a clinical trial and only if your cancer is in its early stages or if your cancer has come back.

Research suggests that you may be able to reduce your risk of developing prostate cancer through certain lifestyle changes such as:

• stopping smoking
• eating a healthy, balanced diet with at least five portions of fruit and vegetables a day - especially tomatoes, which contain a substance called lycopene that may be protective
• consuming less meat and dairy products
• being physically active - you should exercise for 30 minutes at least five times a week