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5 things you need to know about prostate cancer. Dr Stephanie Gibbs, Consultant Clinical Oncologist on this common condition in men

February WEL

1. The low down on prostate cancer

The prostate is a gland found in men and is the size of a walnut, situated underneath the bladder. Prostate cancer has overtaken lung cancer as the commonest cancer in men now that people are smoking less. 1 in 8 men will be diagnosed with condition. In the majority of men there is no obvious underlying cause. The symptoms of prostate cancer may be passing urine more frequently, poor flow and needing to get to the toilet urgently, although these are very similar to the symptoms of normal age related enlargement of the prostate gland.

2. How to get a diagnosis
We are fortunate in having a blood test called a tumour marker which may detect prostate cancer. A protein called prostate specific antigen (or PSA) is released into the blood stream by the normal prostate gland but is usually much higher if there is a cancer present. However there is no National Screening programme for prostate cancer, though most General Practitioners are happy to arrange the blood test for you if you see them with urinary symptoms. If your PSA test is raised your GP will refer you to a Urologist for further investigation and you will have an MRI scan of the pelvis and then a biopsy.

3. The available treatments for early stage cancer
Your Urologist will discuss surgery to remove the prostate gland by undergoing a robotic prostatectomy or by open surgery. The other option is radiotherapy treatment and a referral is made to see a Clinical Oncologist to discuss hormone treatment combined with external beam radiotherapy. Image guided radiotherapy accurately targets the prostate gland with high energy irradiation to destroy the cancer cells. For the very earliest cancers there is also a treatment called brachytherapy which involves placing radioactive seeds directly into the prostate gland.

4. Treatment of advanced cancer
Advanced prostate cancer spreads to the bones or pelvic lymph glands, it rarely travels to the lungs or liver. Hormone treatment is prescribed which deprives the cancer of the male hormone Testosterone, and is highly effective in suppressing the growth of the cancer. The hormone is given as an injection either monthly or three monthly. Patients may live for many years with advanced prostate cancer but stay on treatment for the rest of their life. Chemotherapy is also used if appropriate, sometimes at the time of diagnosis or later on when the cancer becomes resistant to hormone therapy.

5. What’s new?
SpaceOAR Hydrogel has been designed to reduce radiation to healthy organs and tissue around the prostate by creating a space between the prostate and back passage and helps decrease side effects from radiotherapy. Upfront chemotherapy with a medicine called Docetaxel has been shown to improve survival when patients with advanced disease are first diagnosed with bone metastases. A bone seeking radio active injection called Radium-223 can be used to treat painful bone metastases. Interesting research has been published this year on new hormones for relapsed early disease and treatment targeting abnormal genes.

Dr Stephanie Gibbs has a clinic every Monday afternoon at The Holly Private Hospital

Date: 12/03/2020