What you need to know and what he needs to do
Prostate enlargement commonly starts around the age of 50 and symptoms (see below) affect three-quarters of men in their seventies. Most cases are benign (BPH), but one in eight men develops prostate cancer – there are around 47,000 new cases and over 10,000 deaths each year.
But UK survival rates have tripled in the last 40 years, and more than 80% of affected men live at least another 10 years, thanks to earlier diagnosis and better treatments.
Your man is more at risk as he gets older, and if he has a family history of prostate cancer, is black African/Caribbean, has had another cancer, or is tall or overweight.
British researchers recently said that every four-inch increase in a man’s waist may increase his risk of developing fatal prostate cancer by 13%, so a healthy diet and regular exercise may help to protect.
The prostate gland surrounds the bladder outlet pipe (urethra).
As it enlarges, it can slow urine flow and cause frequent, urgent or painful urination (including at night), a poor/hesitant stream, blood in the urine, infections, or even total blockage (obstruction).
These symptoms may be caused by prostate cancer, BPH or other conditions. Prostate cancer may also spread to bones and other organs, so pain, weight loss and/or symptoms elsewhere may be the first signs.
Screening for prostate cancer before symptoms occur has pros and cons – see tips box (right).
If your man has symptoms, it’s safest to get them checked out, although they’ll probably turn out not to be cancer. Many men put this off because they’re worried about an uncomfortable back passage examination, but it doesn’t take long and helps the doctor to decide whether an urgent referral for suspected cancer is needed.
He’ll also need a PSA test (a blood test that measures levels of a prostate hormone), and urine checks for blood and infection.
His GP may refer him to a specialist urologist, according to NICE guidelines (National Institute For Health And Care Excellence; nice.org.uk). He may need a prostate biopsy (tissue sample taken via the back passage using a local anaesthetic), before or after a magnetic resonance scan.
He may also need a bone or CT scan or X-rays, depending on his symptoms.
If it turns out to be cancer, his Gleason score, which grades severity and spread, will be calculated, and he’ll be given full information about treatments available, the likelihood of success, and possible side effects (including those that affect urinary and sexual function).
Options may involve surgery, chemotherapy (including hormone treatment), high-intensity focused ultrasound (HIFU) treatment and/or radiotherapy.
However, if your man has low-risk localised cancer, he may prefer active monitoring, which aims to avoid unnecessary treatment until it progresses or he changes his mind. He should also see a specialist nurse for support and will need regular follow-up checks.
6 things to know about PSA screening
1. It’s a blood test that may be raised in prostate cancer, but also in BPH and prostatitis (inflammation).
2. It can give ‘false positive’ results, suggesting someone has cancer when they don’t.
3. It can give ‘false negative’ results when someone does in fact have cancer.
4. Screening is available free on the NHS, on request, for men over the age of 50.
5. The Prostate Cancer Risk Management Programme’s new advice leaflet (see at nhs.uk) provides more details.
6. Prostatecanceruk.org also has more info and advice.