Prostate Cancer What All Men Need To Know

Aug 2014

Prostate Cancer (PCa) is the commonest cancer in UK men with nearly 42,000 new cases and nearly 11,000 deaths registered in 2011, the last year for which we have complete statistics.That is equivalent to one death every hour!Furthermore, death from PCa is frequently unpleasant and slow and accompanied by problems such as kidney failure and pain due to spread into the bones.

However, PCa caught early is usually curable and we have the tools available to detect most cases early and before spread outside the prostate gland makes cure unlikely.So why do so many men die from PCa?In short the answer is lack of awareness by men, lack of up to date information for GPs and lack of a national screening programme.

The prostate gland is a sex gland about 3cm in diameter that lies immediately below the bladder and encircles the urethra, the tube that carries urine out of the bladder into the penis.Over the age of 40 it usually grows and due to its bulk, may start to block the urethra, causing urinary symptoms predominated by a slackening stream and poor bladder control with an increasingly frequent and urgent need to pass urine, often worst at night.This process is usually due to relatively harmless, benign enlargement of the prostate known as BPH which is easily treated with drugs, especially if addressed early.Much less often is it due to cancer and PCa causing symptoms is usually advanced and incurable.So, if you do notice a change in your waterworks, don’t delay and get checked out.

Early, curable PCa doesn’t usually cause any symptoms and is detected by screening.“Screening” means looking for cancer before any symptoms arise and is done by a blood test called Prostate Specific Antigen(PSA) and a simple digital examination of the prostate via the rectum – a “DRE” (see diagram).

Using these simple tests it is estimated that the UK’s PCa death rate could be halved.So why do we not have a national screening programme like that for breast cancer; after all, the numbers are similar!

The “official” reasons given are that PSA is not accurate enough, there has been no proof that screening saves lives, the screening process itself may cause anxiety and harm and then lead on to harmful overtreatment of insignificant cancers that would not have hurt you in the first place.We believe these arguments are now outdated:

Firstly, we accept that PSA has drawbacks.It may initially be normal when a cancer already exists or, more commonly, it may be raised in 2 out of 3 cases when no cancer exists. But in these cases such men usually have BPH, causing significant obstruction and need specialist urological assessment anyway.

Secondly, by measuring a fraction of PSA known as Free PSA, calculating the ratio of Free to Total PSA and measuring another component called hK2, we can accurately predict not only the likelihood of an underlying PCa but, crucially, whether it is likely to be harmless or aggressive and dangerous.

Thirdly, we now use non-invasive MRI scans of the prostate to look for possible cancers first before unnecessarily subjecting men to unpleasant and potentially dangerous random biopsies of the prostate as before.

Fourthly UK men diagnosed with early PCa are not now pressed into accepting unnecessary overtreatment by surgery or radiotherapy for potentially harmless cancers.Instead they are taken through a careful process of informed decision making which often results in mutual selection of an active surveillance programme with treatment reserved for only those cancers that eventually show signs of aggression.

This article is not the place to discuss treatment so what are the measures chaps need to take to avoid dying from PCa?

If you would like more information on Men’s Health and PCa, check our website at or ring 01206 321253 for professional advice.

Chris Booth FRCS

Clinical Director

CHAPS - The Men’s Health Charity