Five things to know about Prostate Cancer

In a blog like this, while I wait for something to happen (first consultant appointment next week), you the reader need something to keep you going so here are five top things that I've learned about the prostate and its associated cancer.

1. What is the prostate?

It's a little gland, typically about the size of a walnut, that sits around the urethra (the tube down which your wee comes from the bladder), above and behind your testicles. This means that if it swells, your flow of urine is restricted. So, one of the symptoms of prostate cancer for example is difficulty passing water - although it might just be that your prostate has grown, because the little blighter will do that all through your life (just like your ears). What's it for, I hear you cry. It makes the fluid in which your sperm are transmitted, through the urethra, when you come. If you have the prostate removed, you'll have a dry orgasm whenever you have sex. In other words, you still get the good bit, but without the mess.

2. What happens if I get prostate cancer?

Early on, absolutely nothing happens. I'm a great example of that. No symptoms at all. I was lucky, because a routine blood test detected a raised PSA - a sign of possible prostate cancer. However, if you've not caught it early then the first signs may be difficulty weeing, as described above, blood in the urine, pain during weeing, not being able to get it up (although there are several causes of this, both physical and psychological), weeing yourself unexpectedly (do you actually ever do that expectedly?). There are more - Google it.

The cancer itself is caused by mutations in cells inside the prostate that gradually spread, only very slowly (many men will die with prostate cancer but not from it). The more of these cells there are, the higher will be your PSA reading so a way of monitoring it and its treatment is by regular blood tests.

The cancer cells are categorised by the Gleason Score (from 6 to 10) which indicates how aggressive the cancer is. If it's 6 then it's least aggressive, 7 is moderately aggressive (that's my score) and 8-10 is the most aggressive. Essentially, the bad news is that the higher the score, the lower your life expectancy is. Think on that a moment.

A highly aggressive cancer is likely to have spread outside the prostate and will metastasise - that is, create new cancers elsewhere in the body. For this reason, you can have your cancerous prostate removed, but the prostate cancer cells may still be elsewhere in your body and your PSA starts to rise again.

3. Should I get tested and when?

You should talk to your doctor about this one. If you're over 50, it's likely that your doctor will begin looking forward to sticking his finger up your bum (trust me, he enjoys it as little as you do). This test simply checks whether your prostate is enlarged and whether it is still smooth. If there's a change, then he may want you to have blood tests.

You may be at higher risk if you are a coloured man and you are certainly more at risk (two and half times more) if your father had prostate cancer. Therefore, your doctor needs to know that and will possibly test you earlier than 50.

4. What treatments are there for prostate cancer?

There are three main treatments and a variety of other experimental and unproven ones which are not on offer through the NHS as far as I know.

One option of course, is to do nothing. If you are advanced in years and you are not suffering from the effects of the cancer, it may be best to leave it alone and simply monitor it actively (regular PSA tests etc.).

The most impactful treatment is radical prostatectomy. This involves taking out the entire prostate - not an easy job as the urethra goes through the middle of it. For that reason, this treatment is often "robotically-assisted", meaning that the surgeon uses a machine that does the work, but under his control. As a result of this operation, you may suffer some incontinence; you'll almost certainly have erectile disfunction, at least to begin with; you'll definitely not be able to father children and you may find it tricky to wee.

You need to consider whether the risk of a potential drop in quality of life is worth it.

The next treatment is external beam radiotherapy. The upside of this radiotherapy is that you can carry on with your life during your treatment and you don't get the potential side-effects that surgery can cause. A carefully targeted beam of X-rays is applied to the prostate externally over around 20 to 40 sessions. This kills the cancer cells. You may need hormone treatment as well in order to make the prostate smaller. In this case you'll potentially suffer side-effects such as growing breasts and getting hot flushes! However, these reverse once you stop the treatment. As a result of the radiation, you may get bowel or bladder problems and you are likely to feel weary, particularly towards the end of your treatment. Barrel of laughs, huh?

An alternative is brachytherapy and this is what I am going to have. With this treatment you are still receiving radiation but it is directly implanted into your prostate in the form of radioactive "seeds". These have a short half-life of around twelve months (although they are most effective in the first two)  and they stay put in your prostate, unless they manage to work themselves out in which case you may find one in the toilet, in your bed or, ahem, yes, elsewhere. Therefore, when having sex, you'll need to use a condom for at least two months.

The benefit of this treatment is that it is highly targeted and minimises the impact on other organs such as the bowel or bladder. The side-effects include blood in the urine and a burning when you wee - you might also get leakage so get some Tena pads in! If you find you can't wee at all then you'll need to be catheterised for a while. You may feel constipated and your semen will be brownish. You may also suffer from not getting it up, although this can be treated.

5. Can I prevent prostate cancer?

Unfortunately, no one knows what causes prostate cancer, yet. The usual stuff - eat well, drink less, exercise more, stay trim and so on, all apply. However, you need to live your life because the cancer might not get you, but a bus might!

Hopefully that's helpful, but if you want more details, call your local hospital for a leaflet, or contact Prostate Cancer UK who can help you with advice and a listening ear.
If you're in the US, then you should get in touch with The Prostate Cancer Foundation.
In Canada, look up Prostate Cancer Canada.
In Australia, check out the Prostate Cancer Foundation of Australia.
And in New Zealand, get support from The Prostate Cancer Foundation of New Zealand.

(If any other organisations wish to be listed here or readers have found great support elsewhere, then please let me know by posting in Comments and I shall add them.)

Meanwhile, I'm waiting to see the specialist so, when I do, there'll be the next exciting episode of The Prostatic Adventures of Radioactive Rod! You can subscribe by hitting the Subscribe button (clue's in the name) at the top of the screen - then you won't miss a single thing!