A Layman s Guide to Prostate Cancer and Prostate Diseases in
Transcript Of A Layman s Guide to Prostate Cancer and Prostate Diseases in
A Layman’s Guide to Prostate Cancer and Prostate Diseases in Ireland
Men Against Cancer Support Group for Men with Prostate or Testicular Cancer
[email protected] menagainstcancer.net @CancerMac
Contents
Men Against Cancer
3
Facts about Prostate Cancer in Ireland
4
Worried about your prostate?
5
The Prostate Gland
6
Is there anything about the location of the prostate?
7
Digital Rectal Examination
8
Prostate Diseases that are not Cancer
8
Enlarged Prostate – BPH
9
Diagnosing Prostate Cancer
9
PSA – Prostate Specific Antigen
10
Prostate Cancer Treatments in Ireland
13
New Treatments for Advanced Prostate Cancer
14
Prostate Cancer, Diet, & Exercise
19
Rapid Access Prostate Cancer Clinics
21
Radical prostate treatments in Private Hospitals
21
Irish Cancer Society
22
Acknowledgements
MAC is most grateful to Dr Erik Briers, for permission to use material from the Europa Uomo booklet published for European Prostate Cancer Awareness Day [EPAD] 2013, and to the artist Jean Frichet, for waiving
copyright on the diagrams. Thanks are also due to the Irish medical practitioners who reviewed this booklet and provided their advices.
The Editor is John Dowling and he is responsible for any errors or omissions.
© Men Against Cancer 2017
2
MAC is a volunteer patient support group for men with prostate or testicular cancer and for men who have other prostatic conditions. MAC was founded in 1993 and for some years operated as one of the Irish Cancer Society’s peer-topeer patient support groups. With the dissolution of the Society’s own groups MAC now operates on an independent basis but with continued cooperation
with the Society. Many MAC members participate in the Society’s Survivors Supporting Survivors programme and other patient support programmes such
as Daffodil Centres and The Volunteer Driving Service .
MAC services are free of charge and members carry out its work in the following ways:
* Peer-to-peer support - trained volunteers talk to newly diagnosed men about their initial diagnosis or recurrence.
* Many of the referrals to MAC volunteers come from the ICS Helpline, from the hospital-based Daffodil Centres and from community-based cancer
groups and centres as well as personal contacts.
* Publications - MAC produces information leaflets, occasional newsletters and other information material and members contribute articles to various print media and the MAC website.
* Members meet patients in Rapid Access Clinics and Daffodil Centres and other hospitals.
* Public and private meetings where MAC members talk about their own experiences and about the developments in prostate cancer diagnosis and
treatment in Ireland.
* MAC is a member of the European Prostate Cancer Coalition – Europa Uomo and through this organisation MAC has access to the
leading European prostate cancer researchers and clinicians.
3
Facts About Prostate Cancer in Ireland
Over 3,000 men are diagnosed with prostate cancer in the Republic of Ireland each year and that number is rising steadily but only about 500 men die of the disease each year.
These figures show that most men who get a prostate cancer diagnosis will not die of the disease. There are several reasons suggested for this:
· A greater use by family doctors in Ireland of the PSA test as a screening procedure. This opportunistic PSA screening means that rare, potentially lethal, prostate cancers are caught earlier and can be treated more effectively.
· Most prostate cancers are slow growing and may never cause death.
· The reorganisation of cancer services in the voluntary and public hospitals into eight designated centres, combined with the introduction of Rapid Access Prostate Cancer Clinics with their Multi-Disciplinary Teams, provide an opportunity for swift referral, biopsy and advice on treatment options.
· Increased public awareness through the work of the Irish Cancer Society, the Movember movement, the 40+ community-based cancer support organisations affiliated to the ICS who are being trained by the Society,
and other organisation such as the Marie Keating Foundation which has developed a prostate cancer support service in recent years.
· Better treatments in surgery and radiation and oncology. Also, for men who develop advanced prostate cancer there are now new treatments, if their earlier treatments fail.
* And peer-to-peer support from the trained volunteers in MAC – Men Against Cancer.
4
Worried about your prostate?
Early stage prostate cancer is usually without symptoms. Before the current screening tests men tended to present with symptoms which are generally associated with troublesome conditions caused by the enlargement of the prostate.
In some cases it was discovered that the man had both an enlarged prostate and prostate cancer. With modern day tests these early stage cancer tumours are found using blood tests followed by biopsy. Late stage or advanced prostate
cancer is more likely to show symptoms. If you have any concerns about your prostate or any of the issues referred to in
this booklet please talk to your family doctor about your concerns. She/he may ask you questions about symptoms such as:
* Why are you concerned? * Are you having any difficulties passing urine?
* Have you seen any blood in your urine? * Are you having difficulty emptying your bladder?
* Are you having to get up at night to urinate? * Have you any pain and, if so, where?
* Have you been running a temperature? * Is your sexual function affected?
* Did anyone in your family have prostate cancer?
The answers you give to these questions will help the doctor decide on the next step, if any, to recommend to you. Your doctor will also want to check your family history and other relevant factors before advising you on your next steps. The doctor may suggest that you should have a simple blood test called a PSA test. If your doctor thinks your PSA result is higher than it should be, for your age, then you may be referred to a specialist for a biopsy or your symptoms may indicate that you have a bacterial infection of your prostate and that you need a course of antibiotics. If you are of African or Afro-Caribbean origin your risk of contracting prostate cancer is
higher than for those of European ancestry.
Most men who have biopsies do not have prostate cancer. A higher than normal PSA result may be due to a non-malignant enlarged prostate or due to an infection of the prostate.
Most biopsies are negative for prostate cancer. But where a cancer is confirmed many men will have the low risk form of the disease.
5
The Prostate Gland
What is the prostate and what does it do? It is a small gland, usually about the size of a walnut, deep inside the pelvic region of the body.
It secretes a prostatic fluid which is a major component of a man’s semen and it plays a role in the muscle contraction called orgasm that signals the
end of a normal sex act, or at least the end of the erection. Why is the prostatic fluid so important? In order for a single sperm to fertilise an egg produced by a woman’s ovaries the sperm must first get out of the ejaculate – the clump of tens of thousands of sperm cells produced by the testicles (testes). The prostate produces certain chemical substances which helps the separation of individual sperm from the seminal fluid. This separation is essential to allow sperm to swim a huge distance in relative terms, and at very considerable speed relative to their size, to meet up with an egg before any other sperm can do so.
6
Is there anything about the physical location of the prostate that is troublesome for a man?
Yes, the tube carrying urine (the urethra) from the bladder to the penis runs right through the prostate gland, so some conditions of the prostate can cause urinary problems, unless treated. In other cases the treatment itself may give rise to urinary problems. The prostate gland lies close to the bladder and rectum
which means that certain treatments of the prostate have a risk of some damage to these organs.
The various treatments for prostate cancer may cause a number of unwanted side effects after treatment - such as urinary incontinence (leakage), especially as the urethra runs through the prostate gland, or erectile dysfunction as the
nerves controlling erections run along the external walls of the prostate and may be damaged by treatment.
7
Digital Rectal Examination (DRE)
Because the prostate lies up against the bowel or is only millimetres away from the rectum, a doctor can easily feel the prostate by using a gloved finger in the rectum (digital rectal examination or DRE). This examination can tell the doctor if the surface of the prostate is regular or if there are any hard zones which might indicate the presence of a tumour. While the prostate itself has no function in achieving an erection of the penis, as previously mentioned, the nerves needed for an erection adhere to its sidewalls and can be affected by surgical or
radiation treatment.
Not all GPs will perform a DRE, some prefer to have this done by a specialist.
Prostate Diseases That Are NOT Cancer
Urinary Symptoms
Relative to its size and weight the prostate is the cause of more disease than any other organ in our body. Luckily, most of this disease is not cancer. Problems of the prostate are very often seen as problems with emptying the bladder. Urinary symptoms, however, may result from several diseases like a bacterial infection (prostatitis) or an enlarged prostate (BPH) and these causes should always be ruled out first before an investigation is even started to confirm the presence of
prostate cancer.
Prostatitis
Prostatitis (pronounced prosta-tight-iss) is an acute infection of the prostate caused by bacteria and characterised by fever, chills and urinary urgency. It is a rare but serious disease. Hospitalisation may be required if there is no clear improvement in 24 hours because of the dangers from the invasion of bacteria
into the blood system.
There are also a common condition in practically all men after age 50, called chronic prostatitis or inflammation in some prostate zones caused by the stagnation of the secretions or reflux of urine. Very few cases of chronic prostatitis are caused by bacteria. This condition requires patience, maybe even psycho-social
support, such as counselling, for the patient.
8
Enlarged Prostate (Benign Prostatic Hyperplasia - BPH)
An enlarged prostate is usually due to BPH (benign prostatic hyperplasia) and is one of the most common conditions in middle-aged and elderly men. Some of the symptoms are: a decrease of the urinary stream, waking up in order to empty the bladder, sometimes urgency, and most frequently - dribbling after urination. If treatments fail to improve a patient’s complaints, surgery can solve the
problem by removing the excess prostate tissue and leaving the outer prostate in place. This procedure is called a transurethral resection prostatectomy
(TURP). This is not the same as a standard prostatectomy (surgical removal of the prostate gland) sometimes used
in cases of prostate cancer.
Diagnosing Prostate Cancer
The process of diagnosing prostate cancer often starts with a PSA test and a Digital Rectal Examination. The PSA Test is discussed below, but it must be emphasized that the PSA test, while a marker test, is not a prostate cancer test.
9
What is Prostate Specific Antigen?
PSA does its work in the semen. When semen is ejaculated it is a clot of thick liquid. Imagine how difficult it is for an individual sperm to escape this thick
ejaculate in order to swim to the egg to fertilise it.
The Prostate Specific Antigen is one of the compounds produced by the prostate. It is a special kind of protein which interacts with other chemicals. This enables PSA to break other proteins into smaller pieces. This process
transforms the seminal fluid into a lighter, more free-flowing liquid that allows individual sperm to swim free to perform their function.
PSA is produced in large amounts in the prostate and some of the excess PSA leaks into the bloodstream where it actually has no function. It is this PSA
that can be measured in the laboratory with tests that are extremely sensitive so that they can measure very small amounts of PSA in the blood.
The level of PSA measured in the blood may be a useful indicator for a man and his doctor to discuss whether any action is required. If a biopsy of the
prostate is thought necessary this may confirm the presence or otherwise of prostate cancer tumours.
Elevated PSA is not a diagnosis of prostate cancer
It is important to repeat that an elevated PSA alone is not a diagnosis of prostate cancer. Even where men - say 60-70 years of age - have a PSA reading
in excess of twice the normal PSA level for their years almost half do not have a positive cancer finding on biopsy.
If there is PSA in a blood sample then somewhere in the body there is prostate tissue producing PSA. If the prostate itself has been removed by a surgical procedure or has been destroyed by radiation then the continuing presence of PSA means that there is prostate cancer tissue left behind or is growing in other parts of the body - this condition is known as a metastasis (pronounced meh-tast-a-sis).
10
Men Against Cancer Support Group for Men with Prostate or Testicular Cancer
[email protected] menagainstcancer.net @CancerMac
Contents
Men Against Cancer
3
Facts about Prostate Cancer in Ireland
4
Worried about your prostate?
5
The Prostate Gland
6
Is there anything about the location of the prostate?
7
Digital Rectal Examination
8
Prostate Diseases that are not Cancer
8
Enlarged Prostate – BPH
9
Diagnosing Prostate Cancer
9
PSA – Prostate Specific Antigen
10
Prostate Cancer Treatments in Ireland
13
New Treatments for Advanced Prostate Cancer
14
Prostate Cancer, Diet, & Exercise
19
Rapid Access Prostate Cancer Clinics
21
Radical prostate treatments in Private Hospitals
21
Irish Cancer Society
22
Acknowledgements
MAC is most grateful to Dr Erik Briers, for permission to use material from the Europa Uomo booklet published for European Prostate Cancer Awareness Day [EPAD] 2013, and to the artist Jean Frichet, for waiving
copyright on the diagrams. Thanks are also due to the Irish medical practitioners who reviewed this booklet and provided their advices.
The Editor is John Dowling and he is responsible for any errors or omissions.
© Men Against Cancer 2017
2
MAC is a volunteer patient support group for men with prostate or testicular cancer and for men who have other prostatic conditions. MAC was founded in 1993 and for some years operated as one of the Irish Cancer Society’s peer-topeer patient support groups. With the dissolution of the Society’s own groups MAC now operates on an independent basis but with continued cooperation
with the Society. Many MAC members participate in the Society’s Survivors Supporting Survivors programme and other patient support programmes such
as Daffodil Centres and The Volunteer Driving Service .
MAC services are free of charge and members carry out its work in the following ways:
* Peer-to-peer support - trained volunteers talk to newly diagnosed men about their initial diagnosis or recurrence.
* Many of the referrals to MAC volunteers come from the ICS Helpline, from the hospital-based Daffodil Centres and from community-based cancer
groups and centres as well as personal contacts.
* Publications - MAC produces information leaflets, occasional newsletters and other information material and members contribute articles to various print media and the MAC website.
* Members meet patients in Rapid Access Clinics and Daffodil Centres and other hospitals.
* Public and private meetings where MAC members talk about their own experiences and about the developments in prostate cancer diagnosis and
treatment in Ireland.
* MAC is a member of the European Prostate Cancer Coalition – Europa Uomo and through this organisation MAC has access to the
leading European prostate cancer researchers and clinicians.
3
Facts About Prostate Cancer in Ireland
Over 3,000 men are diagnosed with prostate cancer in the Republic of Ireland each year and that number is rising steadily but only about 500 men die of the disease each year.
These figures show that most men who get a prostate cancer diagnosis will not die of the disease. There are several reasons suggested for this:
· A greater use by family doctors in Ireland of the PSA test as a screening procedure. This opportunistic PSA screening means that rare, potentially lethal, prostate cancers are caught earlier and can be treated more effectively.
· Most prostate cancers are slow growing and may never cause death.
· The reorganisation of cancer services in the voluntary and public hospitals into eight designated centres, combined with the introduction of Rapid Access Prostate Cancer Clinics with their Multi-Disciplinary Teams, provide an opportunity for swift referral, biopsy and advice on treatment options.
· Increased public awareness through the work of the Irish Cancer Society, the Movember movement, the 40+ community-based cancer support organisations affiliated to the ICS who are being trained by the Society,
and other organisation such as the Marie Keating Foundation which has developed a prostate cancer support service in recent years.
· Better treatments in surgery and radiation and oncology. Also, for men who develop advanced prostate cancer there are now new treatments, if their earlier treatments fail.
* And peer-to-peer support from the trained volunteers in MAC – Men Against Cancer.
4
Worried about your prostate?
Early stage prostate cancer is usually without symptoms. Before the current screening tests men tended to present with symptoms which are generally associated with troublesome conditions caused by the enlargement of the prostate.
In some cases it was discovered that the man had both an enlarged prostate and prostate cancer. With modern day tests these early stage cancer tumours are found using blood tests followed by biopsy. Late stage or advanced prostate
cancer is more likely to show symptoms. If you have any concerns about your prostate or any of the issues referred to in
this booklet please talk to your family doctor about your concerns. She/he may ask you questions about symptoms such as:
* Why are you concerned? * Are you having any difficulties passing urine?
* Have you seen any blood in your urine? * Are you having difficulty emptying your bladder?
* Are you having to get up at night to urinate? * Have you any pain and, if so, where?
* Have you been running a temperature? * Is your sexual function affected?
* Did anyone in your family have prostate cancer?
The answers you give to these questions will help the doctor decide on the next step, if any, to recommend to you. Your doctor will also want to check your family history and other relevant factors before advising you on your next steps. The doctor may suggest that you should have a simple blood test called a PSA test. If your doctor thinks your PSA result is higher than it should be, for your age, then you may be referred to a specialist for a biopsy or your symptoms may indicate that you have a bacterial infection of your prostate and that you need a course of antibiotics. If you are of African or Afro-Caribbean origin your risk of contracting prostate cancer is
higher than for those of European ancestry.
Most men who have biopsies do not have prostate cancer. A higher than normal PSA result may be due to a non-malignant enlarged prostate or due to an infection of the prostate.
Most biopsies are negative for prostate cancer. But where a cancer is confirmed many men will have the low risk form of the disease.
5
The Prostate Gland
What is the prostate and what does it do? It is a small gland, usually about the size of a walnut, deep inside the pelvic region of the body.
It secretes a prostatic fluid which is a major component of a man’s semen and it plays a role in the muscle contraction called orgasm that signals the
end of a normal sex act, or at least the end of the erection. Why is the prostatic fluid so important? In order for a single sperm to fertilise an egg produced by a woman’s ovaries the sperm must first get out of the ejaculate – the clump of tens of thousands of sperm cells produced by the testicles (testes). The prostate produces certain chemical substances which helps the separation of individual sperm from the seminal fluid. This separation is essential to allow sperm to swim a huge distance in relative terms, and at very considerable speed relative to their size, to meet up with an egg before any other sperm can do so.
6
Is there anything about the physical location of the prostate that is troublesome for a man?
Yes, the tube carrying urine (the urethra) from the bladder to the penis runs right through the prostate gland, so some conditions of the prostate can cause urinary problems, unless treated. In other cases the treatment itself may give rise to urinary problems. The prostate gland lies close to the bladder and rectum
which means that certain treatments of the prostate have a risk of some damage to these organs.
The various treatments for prostate cancer may cause a number of unwanted side effects after treatment - such as urinary incontinence (leakage), especially as the urethra runs through the prostate gland, or erectile dysfunction as the
nerves controlling erections run along the external walls of the prostate and may be damaged by treatment.
7
Digital Rectal Examination (DRE)
Because the prostate lies up against the bowel or is only millimetres away from the rectum, a doctor can easily feel the prostate by using a gloved finger in the rectum (digital rectal examination or DRE). This examination can tell the doctor if the surface of the prostate is regular or if there are any hard zones which might indicate the presence of a tumour. While the prostate itself has no function in achieving an erection of the penis, as previously mentioned, the nerves needed for an erection adhere to its sidewalls and can be affected by surgical or
radiation treatment.
Not all GPs will perform a DRE, some prefer to have this done by a specialist.
Prostate Diseases That Are NOT Cancer
Urinary Symptoms
Relative to its size and weight the prostate is the cause of more disease than any other organ in our body. Luckily, most of this disease is not cancer. Problems of the prostate are very often seen as problems with emptying the bladder. Urinary symptoms, however, may result from several diseases like a bacterial infection (prostatitis) or an enlarged prostate (BPH) and these causes should always be ruled out first before an investigation is even started to confirm the presence of
prostate cancer.
Prostatitis
Prostatitis (pronounced prosta-tight-iss) is an acute infection of the prostate caused by bacteria and characterised by fever, chills and urinary urgency. It is a rare but serious disease. Hospitalisation may be required if there is no clear improvement in 24 hours because of the dangers from the invasion of bacteria
into the blood system.
There are also a common condition in practically all men after age 50, called chronic prostatitis or inflammation in some prostate zones caused by the stagnation of the secretions or reflux of urine. Very few cases of chronic prostatitis are caused by bacteria. This condition requires patience, maybe even psycho-social
support, such as counselling, for the patient.
8
Enlarged Prostate (Benign Prostatic Hyperplasia - BPH)
An enlarged prostate is usually due to BPH (benign prostatic hyperplasia) and is one of the most common conditions in middle-aged and elderly men. Some of the symptoms are: a decrease of the urinary stream, waking up in order to empty the bladder, sometimes urgency, and most frequently - dribbling after urination. If treatments fail to improve a patient’s complaints, surgery can solve the
problem by removing the excess prostate tissue and leaving the outer prostate in place. This procedure is called a transurethral resection prostatectomy
(TURP). This is not the same as a standard prostatectomy (surgical removal of the prostate gland) sometimes used
in cases of prostate cancer.
Diagnosing Prostate Cancer
The process of diagnosing prostate cancer often starts with a PSA test and a Digital Rectal Examination. The PSA Test is discussed below, but it must be emphasized that the PSA test, while a marker test, is not a prostate cancer test.
9
What is Prostate Specific Antigen?
PSA does its work in the semen. When semen is ejaculated it is a clot of thick liquid. Imagine how difficult it is for an individual sperm to escape this thick
ejaculate in order to swim to the egg to fertilise it.
The Prostate Specific Antigen is one of the compounds produced by the prostate. It is a special kind of protein which interacts with other chemicals. This enables PSA to break other proteins into smaller pieces. This process
transforms the seminal fluid into a lighter, more free-flowing liquid that allows individual sperm to swim free to perform their function.
PSA is produced in large amounts in the prostate and some of the excess PSA leaks into the bloodstream where it actually has no function. It is this PSA
that can be measured in the laboratory with tests that are extremely sensitive so that they can measure very small amounts of PSA in the blood.
The level of PSA measured in the blood may be a useful indicator for a man and his doctor to discuss whether any action is required. If a biopsy of the
prostate is thought necessary this may confirm the presence or otherwise of prostate cancer tumours.
Elevated PSA is not a diagnosis of prostate cancer
It is important to repeat that an elevated PSA alone is not a diagnosis of prostate cancer. Even where men - say 60-70 years of age - have a PSA reading
in excess of twice the normal PSA level for their years almost half do not have a positive cancer finding on biopsy.
If there is PSA in a blood sample then somewhere in the body there is prostate tissue producing PSA. If the prostate itself has been removed by a surgical procedure or has been destroyed by radiation then the continuing presence of PSA means that there is prostate cancer tissue left behind or is growing in other parts of the body - this condition is known as a metastasis (pronounced meh-tast-a-sis).
10