Prostate cancer is the most common solid cancer in men in the Western world and the second most common cause of death from cancer after lung cancer. 1 in 8 white men will be diagnosed with prostate cancer in their lifetimes. This risk doubles for those with a father or brother with prostate cancer. While the risk is lower for Asian men, the risk is rising towards that for white men due to the Westernised diet in the UK. Hence, prostate cancer is becoming a serious issue in the Asian community, especially for men in their 60s and older.
Prostate cancer is usually without any symptoms until it has spread to other regions of the body when it is too late for cure. Hence, it is vitally important to go looking for it rather than wait until it gives symptoms. The best way to do this is with regular blood tests for a marker called prostate-specific antigen (or PSA).
If the PSA is raised, an MRI scan of the prostate should be performed. This is a non-invasive test where the man lies still in the scanner for about 30 minutes and pictures are taken of the prostate. If the MRI is suspicious for cancer, a biopsy is then performed.
A biopsy of the prostate can be done while the man is awake (under local anaesthetic) or asleep (under general anaesthetic) depending on the hospital and the surgeon’s preference. If done under general anaesthetic, as is my preference, then the biopsy needles can go directly into the prostate and not through the rectum. This increases the accuracy of the biopsy and reduces the risk of infection from the biopsy. Also, I prefer to fuse the MRI pictures onto the ultrasound at the time of biopsy so I can be more accurate in taking samples from any suspicious areas; this is called a fusion prostate biopsy and is a state-of-the-art diagnostic test for prostate cancer.
If there is cancer found, then there are 3 things the doctor will tell you:
How aggressive is the cancer? This is the Gleason grade of the cancer and goes from a score of 6 (not aggressive) to a score of 10 (very aggressive). How aggressive the cancer is gives us an idea of how likely it is to spread.
How much cancer is there? This is the number of cores taken that are positive for cancer and the maximum amount of cancer in any one core. If there is a lot of cancer in the prostate, then this is worse than if there is a small amount.
Is there any spread of cancer? If the cancer is of low grade (less aggressive) then there is little chance of spread, but if the cancer is high grade, then we will do scans (CT, bone scans, or PET scans) to check if there is cancer has spread outside the prostate to lymph nodes or bones.
If the cancer is found to have spread to the bones, then treatment is with hormones to keep the cancer at bay for as long as possible- usually a few years. But if as we hope the cancer is contained in the prostate or has gone only to close by lymph nodes then surgery or radiotherapy is given with curative intent. There are highly precise surgical and radiotherapy techniques nowadays that have far fewer side effects than treatments in the past, including robotic surgery and stereotactic radiotherapy, and their cure rates are very high.
The key message therefore is to get checked – it’s a simple blood test and possibly an MRI scan. It could save your life!
(Professor Prasanna Sooriakumaran is a Professor of Urology Cleveland Clinic Lerner College of Medicine, Visiting Professor of Urology University of Oxford, Visiting Professor of Urology & Robotic Surgery All-India Institute of Medical Sciences.)