Prostate Cancer

Prostate cancer is the most common cancer in men in the UK. About 1 in 8 men in the UK will be diagnosed with prostate cancer at some point in their lives. Prostate cancer mainly affects men over 50, and your risk increases with age. The risk is even higher for black men and men with a family history of prostate cancer. There is currently no screening programme for prostate cancer in the UK

St George’s University Hospital is a leading centre for the diagnosis and treatment of prostate cancer.

We are one of three centres that piloted the RAPID prostate cancer diagnostic centre, where patients with suspected prostate cancer are seen and investigated on the same day. We won the prestigious HSJ award for innovations in healthcare for this service.

We work in close conjunction with an experienced team of leading Oncologists from the Royal Marsden Hospital, and offer a holistic approach to cancer with bespoke patient care and support prior to, during and following treatment for Prostate Cancer

What are the treatments?

Most men with early prostate cancer don’t have any symptoms. If there are changes in urination, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate. But it’s still a good idea to get it checked out. Possible symptoms include:

• difficulty starting to urinate or emptying the bladder
• a weak flow when urinating
• a feeling that the bladder hasn’t emptied properly
• dribbling urine after finishing urinating
• needing to urinate more often than usual, especially at night
• a sudden need to urinate – urine may leak before getting to the toilet.

One reason for men not experiencing any symptoms is the way cancer grows. You’ll usually only get early signs if cancer grows near the tube you urinate through and presses against it. Because prostate cancer usually starts to grow in a different part of the prostate, early prostate cancer doesn’t often press on the urethra and causes symptoms.

If prostate cancer breaks out of the prostate (locally advanced prostate cancer) or spreads to other parts of the body (advanced prostate cancer), it can cause other symptoms, including:

• back pain, hip pain or pelvis pain
• problems getting or keeping an erection
• blood in the urine or semen
• unexplained weight loss

Do I need any tests to confirm diagnosis?

Prostate cancer is diagnosed using several tests:

Prostate Specific Antigen (PSA) test

The PSA test is a blood test that measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. It’s normal to have a small amount of PSA in your blood. Prostate problems, such as an enlarged prostate or prostate cancer, can cause your PSA level to rise – but many other things can also affect your PSA level, including the following.

• A urine infection
• Vigorous exercise
• Ejaculation
• Anal sex and prostate stimulation

If your GP thinks your PSA level is higher than it should be, they might decide you need to see a specialist at the hospital.

 Digital Rectal Examination (DRE)

A DRE is used to see if you might have a prostate problem or prostate cancer by feeling your prostate through your rectum. Your prostate may feel:

• normal
• larger than expected for your age
• hard or lumpy – this could be a sign of prostate cancer

Magnetic resonance imaging (MRI)

An MRI scan can create a detailed picture of your prostate and the surrounding tissues. You will lie very still on a table, which will move slowly into the scanner, shaped like a doughnut or a long tunnel and takes 30 to 40 minutes.

Biopsy

A prostate biopsy involves using a thin needle to take small tissue samples from the prostate. The tissue is then looked at under a microscope to check for cancer. If cancer is found, the biopsy results will show how aggressive it is and how likely it is to spread outside the prostate.

What treatment are available?

Your treatment options will depend on a few things, including the stage of your cancer, how likely your cancer will grow and spread and your general health. All of these factors will be discussed at the St George’s Hospital Urology Multidisciplinary Meeting, which consists of specialist Doctors, Nurses, Pathologists and Radiologists, and patient-specific treatment options will be decided upon.

Prostate cancer treatment includes:

Robot-Assisted Radical Prostatectomy (RRP)
This is an operation to remove the whole prostate, including cancer inside it which we offer using our Da Vinci Robot at St George’s Hospital. Side effects can include leaking urine and erection problems.

External beam radiotherapy
This uses high-energy X-ray beams to destroy cancer cells from outside the body. Side effects can include problems urinating, bowel problems such as passing loose or watery bowel movements, erection problems, and extreme tiredness. If you receive radiotherapy, you will be transferred to the Royal Marsden Hospital for this to be performed.

Brachytherapy
This is a type of internal radiotherapy. Side effects can include problems urinating, erection problems and bowel problems. If you have Brachytherapy performed, you will be transferred to the Royal Marsden hospital to receive this.

High-intensity focused ultrasound (HIFU) or Cryotherapy
HIFU uses ultrasound to heat and destroy cancer cells in the prostate, and Cryotherapy uses extreme cold to freeze. Both are newer than other prostate cancer treatments, so we don’t know how well it works in the long term and the side effects. Because of this, they are only available in specialist centres in the UK and are not performed at St Georges Hospital. Side effects can include urinary problems and erection problems.

Hormone therapy
Prostate cancer cells usually need the hormone testosterone to grow. Hormone therapy works by stopping your body from making testosterone. Hormone therapy won’t eliminate prostate cancer, but it can control it. The side effects include hot flushes, loss of desire for sex, problems getting or keeping an erection, extreme tiredness, breast swelling or tenderness and weight gain.

Chemotherapy
Chemotherapy uses anti-cancer drugs to kill prostate cancer cells. It doesn’t get rid of prostate cancer but aims to shrink it and slow down its growth. Chemotherapy is usually only used to treat advanced prostate cancer. Side effects include extreme tiredness, feeling and being sick, loss of appetite, hair loss, bowel problems, a sore mouth, and a low immune system.

An alternative to treatment in certain circumstances includes active surveillance or watchful waiting.

What happen if I do not get treatment?

If left untreated, prostate cancer can grow and possibly spread to nearby tissues or further away to other sites in the body.

Is there anything I can do to help myself?

If you’ve just been diagnosed with prostate cancer, you might feel scared, worried, stressed or even angry. Your feelings may change over time. There’s no right way to feel, and everyone reacts in their way. Everyone has their own way of dealing with prostate cancer, but you may find some of the following suggestions helpful.

Look into your treatment options.
Find out about the different treatments that you could have. Bring a list of questions to your doctor or nurse. And ask about any side effects, so you know what to expect and how to manage them.

Talk to someone
Share what you’re thinking – find someone you can talk to. It could be someone close or trained to listen, like a counsellor, doctor, or nurse.

Set yourself some goals.
Set goals and things to look forward to – even if they’re just for the next few weeks or months.

Look after yourself
Take time out to look after yourself. When you feel up to it, learn some techniques to manage stress and relax – like breathing exercises or listening to music.

Eat a healthy, balanced diet.
We don’t know for sure if any specific foods influence prostate cancer. But eating well can help you stay a healthy weight, which may be necessary for men with prostate cancer. It’s also good for your general health and can help you feel more in control.

Be as active as you can
Keeping active can improve your physical strength and fitness and lift your mood. We don’t know if physical activity can also help with some side effects of treatment. Even a tiny amount can help. Take things at your own pace.

Information from Prostate Cancer UK (PDF)

What is Personalised Cancer Care?

 Personalised Cancer Care means your team will support you to take an active role in your cancer care by giving choices and control based on what matters most.

Together with your key workers’ team, like your Clinical Nurse Specialist and Macmillan Support worker, we will aim to help you access the care and support that meets your individual needs from the moment you receive your cancer diagnosis so that you can live as full, healthy and active a life as possible.

You will be invited to complete a Holistic Needs Assessment (HNA) to identify any concerns you may have when you have been diagnosed with cancer. These concerns may be physical, emotional, practical, financial and spiritual.

You will answer a simple set of questions or fill in a checklist about all areas of your life. It is to find out about the concerns you may have. You are often asked to rate how important these concerns are to you. It could help you decide what to discuss first during the assessment.

Once you have completed the assessment, your Clinical Nurse Specialist will discuss your needs, maybe face-to-face in a clinic or over the phone. During the discussion, you and your Clinical Nurse Specialist will agree on the best ways to manage your needs and concerns. They will write down what you have decided in a document called a care plan.  They may write it during the discussion. Or they may make notes and send them to you afterwards. Your care plan will record the following:

• The main concerns you talked about
• Suggestions and actions to help you manage your concerns
• Services that may be able to support you, and any referrals that are made
• What is already being done to help – for example, the services you are already using
• Information about who to contact if you need more help
• The details of other health or social care professionals with whom you have agreed to share the information.

You may not wish to complete the holistic needs assessment at this time. The care you receive will not be affected in any way, and we will be happy to discuss this again in the future

 Health and wellbeing information and support also include:

• Access to the Macmillan Information & Support Centre to find out what support is available in the community, e.g., practical, financial, and how to access it
• Help with understanding cancer and its treatment and how to manage its impact through videos and workshops run by healthcare professionals at St George’s and in the community.
• Attend wellbeing activities which are great opportunities for you and your carers to get together with others affected by cancer.