Prostate cancer is the most common cancer in men in the UK, with over 40,000 new cases diagnosed every year. It often causes no symptoms, but men who are worried about it can request a prostate specific antigen (PSA) test. Your doctor will explain the pros and cons of this, as an abnormal level isn’t specific to prostate cancer (it can also indicate urine infection or inflammation of the prostate), and many men have unnecessary invasive tests as a result.
If your doctor does suspect cancer, the usual next step is to take tissue samples through a rectal biopsy, but there are problems with this; the needle might need to be pushed through the prostate several times to find cancerous tissue, and there is a risk of infection.
Transrectal biopsies can also find cells that look like cancer but do not grow or spread in the vast majority of cases. These mean that men commonly die with prostate cancer, not from it. However, many men have unnecessary treatment ‘just in case’, when these so-called cancers can be safely watched for years via active surveillance.
Also, once a man is diagnosed with prostate cancer, and advised to have treatment rather than active surveillance, the entire prostate is treated with radiotherapy or surgery. Both cause damage to surrounding tissue, which leads to side-effects. 5-20% of patients can become incontinent, and 30-60% suffer from impotence. So the benefits of invasive treatment need to outweigh the risks, but there is only a 5% improvement in survival over giving no treatment at all for those with medium to high risk cancers.
Things are finally changing for the better. We can now find significant cancers in the prostate by carrying out an MRI scan. If the MRI is clear then men can avoid a biopsy altogether, and if they do need a biopsy (to confirm a cancer flagged up on the scan), they can have a MRI guided biopsy through the skin rather than rectum. This is more accurate, can be done under local anaesthetic and sedation, and has a lower risk of infection.
If cancer is found, many men can now benefit from ‘focal therapy’ treatment, which has a far lower risk of side-effects as only the tumour is targeted, not the whole prostate. Focal therapy can use a number of energy sources to destroy the cancerous tissue precisely. Men return to normal activities 2-4 weeks after treatment, whereas recovery from surgery and radiotherapy can take over three months.
Advanced imaging, and less invasive biopsies and therapies mean men will have fewer and better biopsies, and treatments that have a lower rate of side-effects. So, the outlook for men who are worried about prostate cancer, and those who are then diagnosed, is improving significantly.
I have been working with Bupa Cromwell Hospital and Bupa’s London Health Clinics to create a new patient pathway for prostate cancer diagnosis and treatment, available whether you have health insurance or are self funding. This provides a seamless journey from the first abnormal PSA result through MRI, biopsy and treatment as required. For more information about this see www.bupacromwellhospital.com/prostate.
Professor Hashim Ahmed, Consultant Urological Surgeon, Bupa Cromwell Hospital