A malignant tumour of the prostate gland.
Prostate cancer is the second most common cancer in European men. Prostate cancer can be found in 30% of men aged 50 and 70% of men aged over 80. However many of these cancers will not cause symptoms or interfere with life expectancy.
Prostate cancer is unrelated to benign prostatic enlargement although both conditions are very common as men grow older and are often both present in the prostate.
The causes of prostate cancer are largely unclear. Aging and hormonal influences clearly play a part. There is an increased risk if close family members have developed prostate cancer at a young age. There is also an increased risk associated with familial breast cancer. Increased dietary fat may be important.
Symptoms & Signs
Many prostate cancers are found incidentally either by measurement of the prostate specific antigen (PSA) at a routine health check or at the time of a transurethral resection of the prostate (TURP) for benign prostatic enlargement. Small tumours confined to the prostate may cause no symptoms.
Larger tumours obstruct the flow of urine causing a slow flow, increased frequency and occasionally blood in the urine (haematuria). Some prostate cancers can be detected by a palpable abnormality of the prostate on digital rectal examination.
Prostate cancer can spread outside the prostate (metastasise), commonly to the bones and lymph nodes. Symptoms of metastatic disease may be non-specific and can include loss of appetite, lethargy, weight loss and bone pain.
Complications of metastatic disease include obstruction to the flow of urine from the kidneys ultimately causing renal failure, fracture of bones weakened by involvement of tumour and compression of the spinal cord with weakness or paralysis of the legs caused by tumour in the spinal bones.
Patients can become anaemic due to involvement of the bone marrow preventing normal production of red blood cells.
Initial blood tests may include measurement of the PSA, the serum creatinine to assess renal function, the blood count for evidence of anaemia and the serum calcium as this can be elevated by metastatic disease.
A biopsy of the prostate will be necessary to prove the diagnosis. This is done by passing a needle into the prostate and does not require an anaesthetic. It can either done be done digitally with a finger in the rectum guiding the needle or an ultrasound scanner (of similar dimensions to a finger) can be inserted in the rectum and used to direct the needle.
A CT scan of the pelvis and abdomen is done to look for enlarged lymph nodes which may be involved by the cancer. A bone scan may also be necessary to look for evidence of metastatic disease in the bones.
This is carried out in the nuclear medicine department and involves an injection of a radioactive isotope into a vein in the arm with a painless scan several hours later.
If the cancer appears to be localised to the prostate and is judged (with the present level of knowledge) to be likely to reduce the remaining life expectancy of the patient, then curative treatment in the form of surgery (prostatectomy) or radiotherapy is usually offered.
In general patients should have a life expectancy of at least 10 years to benefit from prostatectomy and therefore most surgeons will not offer the operation to patients over the age of 70 years or those with other significant medical problems.
However the operation may be offered to older men if they are fit and come from a long lived family.
Last Editorial Review: 25/1/2010