Cancer of the prostate diagnoses in the UK have finally exceeded that of lung cancer, which was until very recently the main malignant tumour affecting men.
Rates of prostate cancer have increased in the UK to the current 25000 or so mark. This has climbed steadily over the last few years although it does not necessarily reflect an actual increase in rates but possibly just diagnosis. Part of the reason for this is the success of previous campaigns in making men more aware of their prostates and their capacity for disease. You can find your prostate by using the Prostate Cancer charity great 3D Prostate Locator on its website.
Prostate disease is very common and gets more so the older you get. Young men beneath the age of 50 are unlikely to have significant sinister disease like cancer. They may though have inflammation or infection or both called a prostatitis and some may have a slow increase in prostate size, called Benign Prostatic Hyperplasia (BPH). Both of these conditions may contribute to symptoms like having to get up in the night to pee, pain when peeing or pain on ejaculation. More serious symptoms like blood in the urine, erectile problems, and low back pain may indicate prostate cancer.
Autopsy studies have shown that up to 29 % of men up to the age of 40 may have small cancerous areas in their prostates whilst around about 70% of men over 75 years will have the same. Very many of these men will have died of something completely unrelated and will not have been troubled by their cancer.
What causes Prostate Cancer?
Prostate cancer has a number of different causes. Genetic studies in twins have shown that slightly over 40% of cases have a genetic link. The remainder seem to be environmental, probably related to diet.
Black men have an increased risk whereas Asian men seem to show less disease. If you move Asian men to the US though, you can increase their prostate cancer risks markedly, suggesting diet is a strong factor.
Barbecued red meat, for example, contains chemicals which when fed to rats will increase their rates of prostate cancer. Anti-oxidants such as Vitamin E and selenium on the other hand are thought to be protective against it. Studies have shown that men who eats lots of tomatoes which contain natural anti-oxidants will have some protection against the disease.
Prostate inflammation seems to have some effect too with men who have a history of any sexually acquired infection showing an increased rate of cancer in later life.
How is it detected?
Most men with prostate cancer are aged 50 or over and there is a growing campaign to screen men over the age of 45 for the disease. There is a problem with this in that the methods we use are not foolproof, so we compromise using a combination of different tests at different stages to try to identify those with clinically significant disease as opposed to those in whom watchful waiting is more appropriate.
Most men under the age of 50 will not have symptoms of prostate disease. So, a mixture of blood test and physical examination is used. The blood test for Prostate Specific Antigen (PSA) is quick and gives a guide to disease activity. The values are adjusted for age. Overall a figure of less than 4 is desirable. A figure of between 4 and 10 suggests a need to investigate further. A figure of over 10 suggests a cancer until proven otherwise.
A Digital Rectal Examination (DRE) involves a doctor putting his finger inside your rectum and feeling your prostate for change in size and shape. The combination of DRE and PSA will give a good guide as to whether to progress to the next stage, biopsy.
Biopsy samples are analysed and given a score depending on how cancerous or malignant they are using a Gleason score, after the pathologist who invented it. Treatment will then be tailored to the result. Other tests such as bone scans, CAT or MRI scans of the abdomen and pelvis and chest x-ray will identify possible cancer spread. All of this adds to give a TNM score helping determine the best treatment. Extensive radical surgery may not be appropriate for men with widespread aggressive disease, who may die soon anyway.
Look after your prostate by ensuring a good mixed diet with lots of natural anti-oxidants like tomatoes. Avoid too many barbecues. Get into the swing of regular health screening with prostate health checks which you can combine with testicular, blood pressure and cholesterol screening. Being pro-active about your health means being able to make better choices about how to live your life.