Symptoms of prostate cancer
At the early stage, prostate cancer does not usually produce any symptoms. Later on symptoms are usually similar to those of benign prostatic hyperplasia, a benign increase in the size of the prostate. Symptoms may include difficulty passing urine, such as decreased force or interruptions in the urinary stream, and having to wait for the flow of urine to start. Prostate cancer may also cause an overactive bladder, which means you have to rush to the toilet and go frequently.
In middle-aged or older men, blood in the urine or semen may be a sign of prostate cancer. This may be normal in younger men. Constant back pain that is caused by a metastatic tumour can sometimes be the first symptom of the cancer.
If you have trouble urinating, it is always a good idea to have your PSA level tested with a blood test and get your prostate checked for abnormalities. A raised PSA level and lumps or hardenings on the prostate may be signs of cancer. The PSA level is also often measured in routine occupational healthcare checkups and you can request a PSA blood test yourself if you are worried that you might have cancer.
Some prostate cancers develop slowly and treatment may not even be necessary. Often, a man with prostate cancer will die of other causes before the prostate cancer becomes life-threatening. Surgery and radiation therapy provide the greatest benefits with moderately aggressive forms of cancer that, at the time of diagnosis, have not yet spread but that are progressing and would generally lead to death without treatment. 15-20% of diagnosed cancers are aggressive and have usually already spread by the time they are detected. In these cases the prognosis is worse than that with less aggressive forms of prostate cancer.
Treatment of prostate cancer
Localised prostate cancer is treated with surgery or radiation therapy. The majority of operations are currently carried out with robotically assisted techniques where a surgeon controls a robotically assisted surgical system. Patients recover quickly from these operations and the operations are short. The surgery is also highly accurate and patients will usually be allowed to go home the following day.
Radiation therapy is also sometimes needed in addition to surgery. It can also be administered if the cancer recurs. In some cases, radiation therapy may be the only option. It is usually administered in small daily doses over a period of about two months. The patient will need around 40 separate sessions of treatment. In the future, the aim is to administer larger individual doses to decrease the number of treatment sessions.
Treatment of metastatic prostate cancer
Metastatic prostate cancer, or cancer that has spread from the part of the body where it started, is treated by stopping the production of the male hormone, testosterone. This can be done with drugs or with surgery to remove the testicular tissue. The cancer will then go into remission (like going to sleep) and will become completely asymptomatic. This treatment does not cure the cancer, which means it will return at some stage.
Nowadays it is even possible to efficiently treat metastatic prostate cancer with drugs and thus prolong lives. Radioisotope therapy or radiation therapy on metastases will slow the growth of the cancer. New and effective treatments are also available for even the most seriously ill patients, providing them with additional good years of life.
If the cancer has spread to other areas, the prognosis is usually 2-3 years. However, new treatments mean that the prognosis is improving and more and more people with cancer will potentially be able to live for up to ten years.
When should I go and see a doctor?
If you experience difficulty urinating, your urination difficulties worsen or appear suddenly, then it is a good idea to go and see a doctor. If you are an older man and you find blood in your urine or semen then it is a good idea to go and see a doctor.
Professor Teuvo Tammela from the University of Tampere was interviewed for this article.