Prostate Cancer Diagnosis and Treatment

Diagnosis and treatment

When it comes to your prostate cancer treatment, it is your decision which option to choose.

A healthcare team, including different treatment specialists, will advise you on your options and help you decide what to do.

There is not always a clear medical case for choosing one type of treatment over another, so your decision may be based on your personal needs and preferences.

“The patient’s preferences are very important,” says Mike Kirby, a GP and visiting professor at the Faculty of Health and Human Sciences, University of Hertfordshire.

“We don’t necessarily know which treatment is the best choice. Individual specialists may favour one method of treatment over another because of their personal experience.

"Sharing experiences gives added value and provides a much more balanced approach. That said, all this information can be confusing to the patient and may not make reaching a decision any easier."

Initial testing

If your doctor thinks you might have a prostate problem, you will be asked about your symptoms and given a urine test to rule out infection.

You will also be asked to take some tests, including:

• PSA test: if there is a problem in the prostate, the levels of prostate specific antigen (PSA) in the blood can go up. The PSA test doesn’t test specifically for cancer but will show if there’s a problem with the gland.

• DRE: a digital rectal examination (DRE) is a quick and simple test done by your GP. They feel your prostate through your anus with a gloved and lubricated finger. They are looking for any hard areas on the gland that may be a sign of cancer.

If your GP has concerns because of the DRE or PSA result, you will be referred to a urologist in hospital for further tests. If cancer is suspected, you should be seen by the urologist within a fortnight.

You may be offered a biopsy of the prostate, a 30-minute examination which involves taking a number of small tissue samples from the gland.

It may be done either by the urologist, a specially-trained nurse or by a radiologist, who is an expert in ultrasound.

A trans-rectal ultrasound scan (TRUS) will be used to look at the prostate, measure its size and guide the biopsy needles.

A lubricated probe is passed into your anus and images of the prostate are shown on a screen. A small amount of tissue is removed from different parts of the prostate with the needles. Some men find this uncomfortable.

“A negative biopsy doesn’t always mean you don’t have cancer because it is sometimes possible to miss a small area of tumour, so you still need to be followed up,” says Professor Kirby.

With positive results, the spread of the cancer and its speed of growth will be presented to you using a scale of numbers, called the Gleason score. The scale usually runs from two to 10, with two being the least aggressive and 10 being the most aggressive.

Further tests

How aggressive your cancer is will be one of the determining factors in your choice of treatment. If the cancer is aggressive, you will be offered some further tests to check if it has spread outside the prostate gland. These may include:

• CT scan: a computerised tomography (CT) scan is a series of X-ray pictures of the body taken from different angles, enabling the doctor to see the prostate and its surrounding tissues.

• MRI: magnetic resonance imaging (MRI) produces images of the body using powerful magnets instead of X-rays.

• Bone scan: if the prostate cancer has spread to other parts of the body, bone is one of the most likely places for it to go to.

Prostate cancer can be treated in several different ways. The treatment advised will depend on how fast the cancer is growing, whether it has spread outside the gland and your age, together with your general health.

You will be looked after by a team of cancer specialists, called a multidisciplinary team, which may include a urologist, a radiotherapist, an oncologist (a cancer specialist) and a specialist nurse.

The main types of treatment are:

• Watchful waiting: men are seen regularly and have PSA blood tests, but no treatment is given unless their condition deteriorates. Useful for small, slow-growing non-aggressive cancers in elderly men where the cancer may not affect their life expectancy.

• Active surveillance: the preferred option for low-risk men with slow-growing cancers that aren’t causing any symptoms. You will undergo regular testing to check the cancer hasn’t grown or become aggressive.

• Prostatectomy: an operation in which the whole prostate is removed. It is only effective in younger men who have aggressive small cancers that have not spread outside the prostate.

• Radiotherapy: X-rays are delivered to the prostate either through the skin from the outside (external beam) or by placing small radioactive seeds directly in the prostate (brachytherapy) to kill cancer cells.

• Hormone therapy: drugs are used to lower your level of testosterone, which feeds the prostate cancer. Hormone therapy doesn’t cure the cancer but prevents its spread and growth.

Research is also continuing into a new drug called abiraterone. It has shown promising results in a trial on a small group of men with advanced prostate cancer, who have few other treatment alternatives.

However, the results are preliminary, particularly where the drug's effectiveness is concerned, and no survival advantage has been shown (or explored) in this trial.

Sharing experiences

Being diagnosed with prostate cancer can cause anxiety. Asking questions is one way of regaining control.

It may help to take a list of questions when you see your doctor.

Remember, there are some very good treatments available that can both cure and control the disease.

It may also help to speak to someone who's been in the same situation.

They are many regional prostate cancer support groups you can contact on the internet.

Several prostate cancer charities have helplines manned by men and their families who have been affected by prostate cancer and can share their experiences with you.