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Prostate cancer

Your prostate is a gland that produces the liquid part of semen. It's about the size of a walnut and lies at the base of your bladder.

The front of your prostate surrounds your urethra - the tube that carries urine from your bladder and out through your penis. Any change in the size or shape of your prostate, such as changes that occur if you have prostate cancer, can narrow this tube, making it difficult for you to pass urine.

 

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Prostate cancer

Each year about 1,500 men in the HK are diagnosed with prostate cancer, making it the most common cancer in men. It mainly affects men aged over 50.

Cancerous tumours can grow through your prostate and spread to other parts of your body (through your blood or your lymphatic system) where they may grow and form secondary tumours. This spread of cancer is called metastasis.

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 GP. 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

The exact reasons why you may develop prostate cancer aren't fully understood at present. But you're more likely to develop prostate cancer if:

  • you're over 50
  • you have close relatives who have had prostate cancer
  • several women in your family have had breast cancer - you may have inherited a faulty gene which may increase your risk of prostate cancer
  • your diet is high in fat, meat and dairy products

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP 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.
Active monitoring

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

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.

Non-surgical treatments
  • 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

Getting enough vitamin D may reduce your risk of developing a number of cancers, including prostate cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure

Question: What is a high PSA level? What might cause it other than prostate cancer?

Answer: A blood test to measure your prostate-specific antigen (PSA) level can be used to detect prostate cancer. However, having a high PSA level doesn't necessarily mean you have prostate cancer - it can be raised for several other reasons.

Explanation: Your PSA level is checked with a blood test. PSA is a protein that is produced by both normal and cancerous cells in your prostate. PSA levels vary among individuals and increase with age - there is no fixed normal level. Your GP uses the following levels as a guide to decide if you need further tests:

  • 3.0 ng/ml or below is considered normal for men aged 50 to 59
  • 4.0 ng/ml or below is normal for men aged 60 to 69
  • 5.0 ng/ml or below is normal for men aged over 70

A high PSA level doesn't necessarily mean that you have prostate cancer. The level can be raised for several other reasons, such as:

  • benign prostatic hypertrophy - enlarged prostate
  • prostatitis - inflammation of your prostate
  • a urinary tract infection
  • ·old age
  • acute urinary retention - when you're unable to pass urine
  • recent prostate examinations - a prostate biopsy, a rectal examination or a urinary catheter

PSA tests can be inaccurate. Generally though, the higher your PSA level is, the more likely you are to have prostate cancer. Occasionally, you can be diagnosed with prostate cancer and have a normal PSA level, although this is quite rare.

PSA blood tests are also used to monitor progress and treatment. A PSA level that remains steady usually means that your tumour is stable and isn't growing. A PSA level that decreases shows that your tumour is shrinking and responding to treatment.

Question: What is the Gleason score? How does it grade prostate cancer?

Answer: The Gleason score is a grading system that allows doctors to predict how quickly a cancerous tumour in your prostate may grow and spread. This information is often used to plan your treatment.

Explanation: The Gleason system is the most commonly used grading system for prostate cancer. It's a system that looks at cells from your prostate to predict how your tumour will behave. Usually, a biopsy (a small sample of tissue) is taken from your prostate and sent to a laboratory for testing and grading.

Grading is done by looking at the patterns of cells within each sample taken and how abnormal they look. There are five different types of pattern, which are graded from one to five. One is the least aggressive type of cancer and five is the most aggressive. All the biopsy samples taken are graded, then the two most frequently occurring patterns or the two areas with the highest grade are added together to get a Gleason score of between two and 10.

The lower the score, the more slow-growing your cancer is and the less likely it is to spread. A low score is usually six or less. Tumours that score highly are more likely to grow quickly and spread to other parts of your body. A high score is between eight and 10.

The Gleason score acts as a guide for your doctor to help him or her plan the best course of treatment for you. It's not a fail-safe approach - most tumours grow as expected, but not all of them do.

If you have any questions about prostate cancer or the Gleason system, talk to your doctor.

Question: Will treatment for prostate cancer affect my sex life?

Answer: Treatment for prostate cancer can affect your sex life. How it's affected will depend on the type of treatment you have.

Explanation: Treatments for prostate cancer can affect your sex life in different ways. However, it's important to remember that not everybody will be affected to the same degree.

A common side-effect of treatment for prostate cancer is impotence (erectile dysfunction). This is when you can't achieve or sustain an erection. Impotence can be caused by:

  • radiotherapy to your prostate
  • surgery, such as a radical prostatectomy or orchidectomy (an operation to remove your testicles)
  • hormone therapy

Erectile dysfunction is often temporary, but it can be permanent, especially if you have had a radical prostatectomy. Sometimes it improves once you have finished your treatment - for example, if you have hormone therapy. With other treatments, such as radiotherapy, erectile problems may not occur until several years after treatment.

There are medicines that you can take to treat impotence, such as sildenafil. Or you could try using a vacuum pump or penile implants. Talk to your doctor to find out what options are available to you.

Some men find that they have a lower sex-drive after treatment. This is usually caused by an orchidectomy or hormone therapy, which lead to a lower level of testosterone in your blood. Sometimes changing to a different type of hormone therapy can help. Talk to your doctor about the options available to you.

Treatment can also affect the type of orgasm you have. After a radical prostatectomy, you will always have a dry orgasm. This means that when you ejaculate, no semen will come out. The strength of your orgasm and the ability to have an orgasm may also be affected. Cancer treatments may also affect your fertility. If you plan to have a family, your sperm can usually be collected and used for artificial insemination or in vitro fertilisation (IVF) treatments.

If you're worried about how treatment for prostate cancer will affect your sex life, talk to your doctor.

Question: Why isn't there a national screening programme for prostate cancer?

Answer: There isn't currently a screening programme for prostate cancer because of concerns about how accurate the prostate-specific antigen (PSA) test is. However, if you're concerned about prostate cancer, you can ask your GP for a PSA test.

Explanation: The most commonly used test to check for prostate cancer is called a PSA test. It involves a blood test to measure the levels of a protein called PSA, which is produced by both normal and cancerous cells in your prostate.

There has been much debate over whether the PSA test should be used in a nationwide screening programme but doctors have decided it may actually cause more harm than good.

This is because the PSA test is not a precise test. There can be many reasons why you may have a high PSA level, and these aren't always related to you having prostate cancer. Different factors such as old age or a urinary infection can raise your PSA level.

Also, you can have a normal PSA level even if you do have prostate cancer, although this is rare. The imprecise nature of the PSA test could lead to many men being put under unnecessary stress and worry when they don't have prostate cancer.

It's also not currently clear what effect earlier detection and treatment for prostate cancer has on how long you live. Many prostate tumours are so slow-growing that they will have no impact on a man's life. If you had a tumour like this and it was found through screening and treated, it may cause a lot of unnecessary physical and mental suffering. Finally, most prostate cancers are found in much older men, usually aged 75 to 79. At this late stage in life, the potential for prolonging life through early detection is very small.

  • Further Information
    • The Prostate Cancer Charity 0800 074 8383 www.prostate-cancer.org.uk
    • CancerHelp UK 0808 800 4040 www.cancerhelp.org.uk

 

  • Source
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    • Prostate cancer. Macmillan Cancer Support.www.macmillan.org.uk, published February 2010
    • The prostate. Macmillan Cancer Support.www.macmillan.org.uk, published February 2010
    • Prostate cancer symptoms. Cancer Research UK.www.cancerhelp.org.uk, published September 2009
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010:467-69, accessed 24 June 2010
    • Prostate cancer risks and causes. Cancer Research UK.www.cancerhelp.org.uk, published June 2010
    • Prostate cancer diagnosis and treatment. National Institute for Health and Clinical Excellence (NICE), February 2008.www.nice.org.uk
    • Prostate cancer tests. Cancer Research UK. www.cancerhelp.org.uk, published September 2009
    • Treatment for prostate cancer. Macmillan Cancer Support.www.macmillan.org.uk, accessed 24 June 2010
    • Treatment options for prostate cancer. Cancer Research UK.www.cancerhelp.org.uk, published September 2009
    • Docetaxel for the treatment of hormone-refractory metastatic prostate cancer. National Institute for Health and Clinical Excellence (NICE), June 2006.www.nice.org.uk
    • Vitamin D and cancer prevention: Strengths and limits of the evidence. National Cancer Institute.www.cancer.gov, published June 2010
    • The PCA3 test for prostate cancer. Cancer Research UK.www.cancerhelp.org.uk, published September 2009
    • Transurethral resection (TUR) of the prostate. Cancer Research UK.www.cancerhelp.org.uk, published September 2009
    • Grading and staging of prostate cancer. Macmillan Cancer Support.www.macmillan.org.uk, published February 2010
    • Factors in deciding treatment for prostate cancer. Cancer Research UK.www.cancerhelp.org.uk, published September 2009
    • Sex and prostate cancer. Cancer Research UK.www.cancerhelp.org.uk, published September 2009
    • High dose rate brachytherapy. The Prostate Cancer Charity.www.prostate-cancer.org.uk, published October 2008
    • Surgery: Radical prostatectomy. The Prostate Cancer Charity.www.prostate-cancer.org.uk, published August 2008
    • Aim of Prostate Cancer Risk Management. NHS Cancer Screening Programmes.www.cancerscreening.nhs.uk, accessed 29 June 2010
    • Why isn't there UK PSA screening? Cancer Research UK.www.cancerhelp.org.uk, 29 June 2010
    • Consensus vitamin D position statement. British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society and the Primary Care Dermatology Society, December 2010
    • The Prostate Cancer Charity 0800 074 8383 www.prostate-cancer.org.uk
    • CancerHelp UK 0808 800 4040 www.cancerhelp.org.uk

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