Prostate Cancer

Your risk of developing prostate cancer increases with age, but that doesn’t mean it’s a disease that only affects older people.

If you’re 50 or over, it’s important to talk to your GP about keeping yourself healthy and any ongoing tests you may need as part of your health check-ups.

If you have a family history of prostate cancer or sub-Saharan African ancestry, you need to start that conversation earlier at 40 to 45.

Guidelines can be different, depending on where you live — so check with your doctor.

Prostate cancer is more common in Black men of sub-Saharan ancestry, although we’re not entirely sure why.

It also tends to develop at a younger age and grow faster in Black men than in any other group

Certain genes, passed on from your parents (or other relatives), can affect your prostate cancer risk.

If your father or brother had prostate cancer before the age of 60, you may be twice as likely to develop the disease yourself.

If you have more than one male relative with prostate cancer, your risk could be 5 times more.

If there is a strong family history of breast or ovarian cancer, especially on the same side of the family (mother’s or father’s side), your risk is increased.

A PSA test is really just a blood test. You’ll have a small blood sample taken from your arm and sent off for lab testing. It is a simple test which does not require fasting or any other type of preparation.

PSA, or prostate specific antigen, is a protein made by your prostate and found in the blood. PSA is found in both healthy cells and cancerous cells, so it’s pretty normal to have some PSA in your blood. When problems with the prostate happen, the levels of PSA in the blood rise. Understanding how much PSA you have in your blood is important, especially if the levels go up. This is where PSA testing comes in.

PSA testing is one of the first checks to find prostate problems and a high PSA level does not always mean you have cancer. PSA levels can also increase if there is growth, inflammation (prostatitis) or infection of the prostate. Sometimes even ejaculation can raise the PSA, so your doctor may tell you to not to ejaculate for a few days prior to the test. It’s important to keep track of your PSA levels even after cancer treatment, as this can help indicate if the cancer has returned.

You might be tempted to groan at the thought of a DRE — but it does help some doctors get a better idea of anything unusual going on with your prostate

The back of the prostate sits close to the rectum, and prostate cancer is often found here. To get right to it, the doctor inserts one gloved, lubricated finger into the rectum. This helps them estimate the size of the prostate and feel for lumps or anything unusual.

Although this exam may sound painful, it’s usually just a bit uncomfortable or awkward. A normal DRE does not mean you don’t have prostate cancer but it is important to do, together with the PSA test. Also, just because the prostate feels a bit abnormal does not always mean you have prostate cancer — it just may be something your doctor needs to investigate further.

A needle is inserted into the prostate through the back passage (rectum) guided by a small device (called an ultrasound probe) that is also passed into your back passage so your doctor can see an image of the prostate. TRUS first measures the size of your prostate, using sound waves to build up a picture of the prostate gland. It might be a little uncomfortable (it is similar to the DRE), but should only take a few minutes. Then, the needle is used to take samples of tissue from the prostate.

Local anaesthesia is used for a TRUS. This type of anaesthesia numbs the area tissue samples will be taken from.

A needle is inserted into the prostate, through the skin between the back passage (rectum) and testicles. An ultrasound probe is then placed in the back passage to allow the doctor to see where to pass the needle to take small samples of tissue from your prostate.

So you don’t feel anything, general or local anaesthesia can be used for a transperineal biopsy, depending on your health and how many tissue samples are going to be taken. General anaesthesia puts you to sleep. Local anaesthesia may be used at some centres for a perineal biopsy. This type of anaesthesia numbs the area that tissue samples will be taken from.

After a biopsy, a pathologist uses a microscope to check how the samples look compared to normal prostate tissue, and identify any obvious patterns. There are 5 different patterns usually recognised. They record the most common pattern, the second most common pattern, and the most aggressive pattern found.

Prostate tissue that looks close to normal but contains some abnormal cells is typically referred to as Gleason pattern 3, and indicates a slow growing tumour. If there are more abnormal cells, looking irregular and different from the normal prostate cells, then a Gleason pattern of 4 or 5 is assigned, with 5 indicating very aggressive cancer.

From here, a Gleason Score is determined. This can be done by adding together the numbers of the two most common patterns found. This can also be done by adding together the number of the most common Gleason pattern found, plus the highest pattern number found.

For example, if the pathologist has assigned the most common pattern as 3 and another (worse) pattern as 4, the Gleason score is 7.

Gleason scores tend to range from 6 to 10, with 6 being the lowest grade of cancer.

When the cancer is only within prostate and has not spread to the tissue surrounding the prostate.

When the cancer has spread to tissue immediately surrounding the prostate.

If the cancer spreads outside the prostate, this is known as advanced (metastatic) cancer. Common places for the cancer to spread include the lymph nodes in your pelvis, tissue in and around your pelvis and abdomen, and bones in the hips and back.

Advanced prostate cancer can present as: