Getting Checked For Prostate Cancer

Blog Health News 13th March 2024 Enquiries & appointments

In this video, Consultant Urologist Mr John Donohue talks about the importance of getting your prostate checked.

What is the prostate?

The prostate is a gland but initially the size of a walnut sits underneath the bladder and you pass urine through. Imagine it’s like a donut that completely survives the bottom of the bladder and you pass here and through.

Its function is with ejaculation so when men ejaculate the sperm travels through the prostate and the prostate also adds fluid to the ejaculation.

What are the signs and symptoms?

Localised prostate cancer does not cause any symptoms whatsoever. The usual presentation is that men have symptoms of a benign enlarged prostate which causes changes in their flow and their waterworks.

That often leads to men needing to go see their GP and get a PSA check. If the results are high, this can often then lead to the diagnosis of prostate cancer but it’s a coincidence by saying that there are symptoms of prostate cancer. It can often falsely reassure men who have no waterworks issues at all that they can’t have prostate cancer. If prostate cancer is causing waterworks issues then it’s very advanced.

What is a PSA test?

PSA stands for prostate-specific antigen. Anything that causes damage to the lining of the prostate, such as cancer, allows more PSA to leak from the prostate and that’s what we detect in a blood test.

There’s no hard and fast recommendation of when men should get it checked, normally they’d say most men when they get to 50. If you have a first degree blood relative with a history of prostate cancers, such as uncle, father, brother, and they would recommend 45, or in men who are at a higher risk such as afro-caribbean.

How is it diagnosed?

It initially will present naturally but someone has a PSA that’s elevated or the prostate feels firm when they have their prostate examination. If either of these are abnormal then that leads to a referral, and we’d normally do an MRI scan which is a radiology test to look very closely at the prostate to see if there’s any abnormality there. If the PSA is high and the mri scan shows a potential abnormal area then we will do a biopsy of the prostate.

Does a high PSA level always mean cancer?

Certainly not. A high PSA can be elevated because someone has a urinary tract infection, with exercise, with ejaculation. We also will look at how PSA changes over time and that’s often a very good inclination as to if the prostate cancer is developing.

So, someone might have a slightly high PSA and three or four years later it’s still roughly the same, that’s very reassuring. It’s where if someone has a normal PSA and then a couple of years later it’s gone up significantly, then that’s one that would also lead for us to carry out investigations.

Do all cases need to be treated?

There’s many ways of treating prostate cancer but the first question we ask is does it need to be treated? In other words, if they have low grade, slow growing, small volume prostate cancer we will tend to just observe them and see if it will develop into something more significant over time.

If patients have localised prostate cancer which we think could cause some trouble in the next 10 to 15 years then we will often cure treatment. Within that, there’s a surgery to remove the prostate completely or there’s radiotherapy. Radiotherapy there’s radioactive seeds called brachytherapy which are like grains of rice put into the prostate that release the radiation slowly over a couple of months, or in more advanced prostate cancer cases we can then give external beam radiation treatment.

There’s pros and cons to all of these treatments and that’s the time you need to sit down with your urologist who can then also refer you to an oncologist and you can have a balanced chat. The most important thing to take from this is that there’s no urgency in undergoing any prostate cancer treatment. Prostate cancer is a slow process.

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