Prostate cancer is the most commonly diagnosed cancer of UK men. If it is found early and is still confined to the gland itself then the chances of survival are excellent. Modern surgical techniques, combined with drugs such as Viagra, mean that an operation to treat prostate cancer does not signal the end of a patient’s sex-life.

The prostate itself is a small, walnut-sized gland situated near the bladder in men that produces one component of semen. There are a broad range of prostate cancers, some of which are extremely gentle and indolent and may not cause any significant ill health. However, others have the ability to spread to other parts of the body and cause more significant damage if not treated. This means it is important to catch prostate cancer early and then it is possible to treat it using a radiotherapy and surgery.

The Symptoms of Prostate Cancer

The first sign of prostate cancer can be noticed when you go to the toilet. You may find that you are going to the toilet a lot more and that you are unable to maintain a full stream whilst urinating. However, these problems are also associated with a number of medical problems and do not always signal prostate cancer.

The symptoms of prostate cancer are caused by the growth of cells, whether malignant or benign, pushing against the urethra, the thin tube which links the bladder to the penis. If you are suffering from the above symptoms then you should also look out for painful urination or ejaculation, blood in urine or semen, and pain in lower back, hips or thighs.

Again these symptoms could be caused by any number of things, including infection, but it would be wise to visit your GP to get them checked out. There are several ways that a doctor can check for prostate cancer. The simplest way is the digital rectal examination, in which the doctor insert a gloved finger into the rectum to feel for an an enlarged prostate. Following this a blood test can be conducted to look for any rises in any chemicals in the blood, and after this comes more sophisticated tests, such as ultrasound scans, and x-rays.

The Causes of Prostate Cancer

The exact causes of prostate cancer are still unclear but there are a number of factors which may increase your chances of developing it. These include, but are not limited to, a family history of prostate cancer, and a fat-rich diet.

There have been a number of studies into the link between prostate cancer and vasectomy but these have so far proved to be inconclusive.

Treatment for Prostate Cancer

Sometimes the best treatment for prostate cancer can be to not treat it at all. This is sometimes the case of older men when it is judged that surgery or other treatments may cause more harm than good.

If the cancer has spread from the prostate, or it is believed that it will spread, then surgery is normally the first course of action to remove it whilst is still possible and prevent further spreading. A prostatectomy is when the prostate gland is removed, usually along with small parts of the lymphatic system near the gland. However, this type of surgery can cause nerve damage which can prevent men from getting an erection ever again, or maintain complete control over urination. This does not mean that a man’s sex life is over though as modern “nerve-sparing” surgical techniques, when combined with drugs such as Viagra, can ensure that the effects on both function and quality of life are minimised.

Other treatment option is radiotherapy which will be precisely targeted on the pelvic area, whilst other doctors are fighting prostate cancer by using the body’s own hormones. In the latter’s case, prostate cells, including cancerous ones, which are sensitive to levels of certain male hormones, can be rendered far less active if levels are reduced. However, this can reduce the sex-drive of the patient.

Advances in Prostate Cancer Surgery

Advances in prostate cancer surgery mean that surgeons can now successfully remove the prostate without causing the problematic nerve damage which has been inevitable in the past. In addition, radiotherapy technology advances mean that far higher doses can be targeted more precisely on the prostate, killing more cancer cells with fewer treatments.

A technique called prostate brachytherapy has also made some great advances in recent times and its use is becoming more and more common. There are two methods of brachytherapy – permanent seed implantation and high dose rate (HDR) temporary brachytherapy.

Permanent seed implantation involves injecting approximately 100 radioactive seeds into the prostate gland, which give off cancer-killing radiation at a low dose rate over several weeks or months, and the seeds remain in the prostate gland permanently.

HDR temporary brachytherapy involves placing very tiny plastic catheters into the prostate gland, and then giving a series of radiation treatments through these catheters.

Another option is High Intensity Focussed Ultrasound, which uses sound waves to “melt” away the cancer.

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PROSTATE CANCER – NEW TREATMENT BY RADIOTHERAPY

Research is continuing to try and improve technology and techniques to allow radiotherapy to the prostate gland to be more effective and to have fewer side effects. One way is to reduce the amount of radiation received by normal organs (bladder, bowel etc) and this has been improving over the last few years with better machines and techniques such as “conformal radiotherapy” and “IMRT”.

Work is also being carried out on combining brachytherapy with external therapy to allow some of the benefits of brachytherapy (fewer side effects, higher overall dose to the prostate cancer) to be used for men with more advanced prostate cancer without compromising the chance of cure.

NEW HORMONE THERAPY FOR PROSTATE CANCER

Some newer prostate cancer hormone treatments have fewer side effects than older hormone based drugs. Some are also felt to be more effective. All the time researchers are testing to try and find the best hormone tablets or injections for use in prostate cancer.

Other research is going on to try and work out the best time to give hormone treatment in prostate cancer and whether it is best to combine this treatment with other types of treatments such as chemotherapy or radiotherapy. Trials are currently being run to answer these questions and the results should be available in the next few years.

IMPROVEMENTS IN CHEMOTHERAPY TREATMENT FOR PROSTATE CANCER

In the past prostate cancer did not respond very well to chemotherapy drugs. However now there are newer drugs which are more powerful against prostate cancer and these have started to be used with more frequency in late prostate cancer which has already spread to other organs and which has become resistant to hormone treatments. The best drug found so far is Docetaxel, a new type of chemotherapy drug. It has several side effects including hair loss, nausea and risk of infection. Doctors are now looking to see if Docetaxel would work even better as a combination with other drugs.

USE OF BISPHOSPHONATE DRUGS FOR PROSTATE CANCER TREATMENT

These are a group of drugs which are most often used in treating osteoporosis. It has been recently found that they can also help reduce pain associated with cancer deposits or secondaries in the bones. They may also help reduce the risk of these abnormal bones from breaking or fracturing, by slowing down the damage caused to the bone by the cancer.

Research is ongoing to look at which of these drugs is the best for treating prostate cancer with bone disease and when the best time to start treatment with these drugs is.

ALTERNATIVE TO SURGERY FOR TREATMENT OF EARLY PROSTATE CANCER

There are 2 new treatments which are being researched as an alternative to surgery for some men with localised prostate cancer. Both options would not require a general anaesthetic (you would not need to be put to sleep) making them lower risk. Both treatments also have fewer side effects than radical surgery (”prostatectomy”). However neither has been in use long enough to know if it will prevent prostate cancer from coming back as effectively as standard treatments (surgery and radiotherapy).

Cryotherapy is the killing of cancer cells by freezing them. Needles are inserted into the prostate gland under local anaesthetic and liquid nitrogen is passed along them to freeze the prostate and the cancer cells within it. Currently it is being used for men whose prostate cancer has come back despite a first more conventional treatment and so is only being trialled for use as a first treatment option.

HIFU stands for high frequency ultrasound. Here ultrasound waves are directed to where there are cancer cells and are these are used to heat them up, thus killing them. In prostate cancer the ultrasound probe would be put into the back passage and from here ultrasound waves would be fired towards the prostate gland. The results so far have been good in that the treatment is safe and effective.

NEW TREATMENTS FOR PROSTATE CANCER IN VERY EARLY STAGES OF DEVELOPMENT

There are a number of alternative treatments which are still at a highly experimental stage of development. Gene therapy aims to replace the faulty genes in cancer cells with good ones which would allow the cell to self destruct if it felt it had become too mutated. (Cancer cells have lost this self destruct ability and continue to grow and divide despite having many abnormalities which would normally force the cell to die.) Vaccine treatment looks at ways of making the bodies own immune system recognise and kill cancerous sells. Endothelin blockers are a new type of drug treatment which works by preventing the prostate cancer cells to grow.

Many people may have heard that Vitamin D is being used in the treatment of prostate cancer however this therapy is in the very early experimental stages and is no where near being used in clinics as a cancer treatment. Vitamin D has been reported to block receptors on prostate cancer cells thereby slowing the rate of their growth but there is NO clinical evidence that this is in fact the case. Some researchers claim that the active form of Vitamin D slows the growth of prostate cancer but as yet this has only been tested on mice and other small animals.

Beta-sitosterol is a herbal remedy that people have started to associate with prostate cancer treatment. This natural plant fat has apparently been proven effective for the treatment of an enlarged prostate but not necessarily prostate cancer. According to research Beta-sitosterol MAY help to prevent the emergence of prostate cancer but this has not been clinically proven yet.