Tony Lambert delphine1939@videotron.ca
10 Jnavier 2007
Prostate cancer
Prostate cancer is now the most commonly diagnosed cancer of UK men.
The prostate is a small, walnut-sized gland situated near the bladder in men - it produces one component of semen.
There were 24,700 new cases of prostate cancer diagnosed in the UK in 1999.
If prostate cancer is caught at a time when it is confined to the prostate, generally it can be cured by radiotherapy and surgery
Professor Alan Horwich, Institute of Cancer Research
Learn more about survival rates for this cancer
If found early, while still confined to the gland itself, chances of survival are excellent, and modern surgical techniques, combined with drugs such as Viagra, mean that life-saving operations don't have to mean the end of sex lives.
Professor Alan Horwich, is based at the Royal Marsden Hospital in London and the Institute of Cancer Research, where he carries out research funded by Cancer Research UK.
He said: "There are a broad range of prostate cancers, some of which are extremely gentle and indolent, which may not cause any significant ill health.
"Others have the ability to spread to other parts of the body and cause damage there."
He added: "If prostate cancer is caught at a time when it is confined to the prostate, generally it can be cured by radiotherapy and surgery."
Symptoms
The first sign of prostate cancer is usually problems passing water - usually an increased frequency or difficulty maintaining a full stream.
However, these symptoms are shared with benign prostate enlargement.
The symptoms are caused by the growth of cells, whether malignant or benign, pushing against the urethra, the thin tube which links the bladder to the penis.
Other symptoms to look out for are:
- Painful urination or ejaculation
- Blood in urine or semen
- Pain in lower back, hips or thighs
Of course, all of these symptoms could be caused by something else, for example infection - but should be investigated.
The doctor has several methods to check for the presence of prostate cancer.
The simplest of these is the digital rectal examination, in which a gloved finger is inserted into the rectum, through which an enlarged prostate can be felt.
Blood tests are the next step - prostate cancers cause the levels of certain chemicals in the blood to rise.
More sophisticated tests include the use of ultrasound scans, and x-rays.
Causes
The causes of prostate cancer are not yet understood.
However, there are certain things which place some men at higher risk of developing the disease than others.
These include other family members who have had prostate cancer.
There is some suggestion that a fat-rich diet may contribute to prostate cancer, but this is not proven.
Studies linking the cancer to vasectomy, an operation to remove a man's fertility, are contradictory.
Treatments
The key decision in prostate cancer is whether or not to treat at all.
In many older men, the cancer progresses so slowly that surgery and other treatments may cause more harm than good.
However, for those whose cancer is more aggressive, either already spreading or liable to spread beyond the prostate, surgery is usually the first option.
A prostatectomy means that the prostate gland is removed, normally along with small parts of the lymphatic system near the gland.
Unfortunately, the operation often causes nerve damage which can make it nigh-on impossible for men to achieve erection afterwards, or maintain complete control over urination.
However, modern "nerve-sparing" surgical techniques - combined with drugs such as Viagra - mean that the effects on both function and quality of life can be minimised.
As well as surgery, another option for doctors is radiotherapy which will be precisely targeted on the pelvic area.
And doctors are also tackling prostate cancer using the body's own hormones.
Prostate cells, including cancerous ones, are sensitive to levels of certain male hormones, and can be rendered far less active if levels are reduced.
However, one unwanted by-product of this is to lessen the natural sex drive of the patient.
The main advances in prostate cancer treatment are being made in surgery and radiotherapy.
Surgeons are learning how to remove the prostate without causing the problematic nerve damage which was inevitable in the past.
And radiotherapy technology advances mean that far higher doses can be targeted more precisely on the prostate, killing more cancer cells with fewer treatments.
Recent advances include the use of a technique called brachytherapy.
There are two major methods of prostate brachytherapy, permanent seed implantation and high dose rate (HDR) temporary brachytherapy.
Permanent seed implants involve injecting approximately 100 radioactive seeds into the prostate gland.
They give off their cancer-killing radiation at a low dose rate over several weeks or months, and the seeds remain in the prostate gland permanently.
HDR temporary brachytherapy instead involves placing very tiny plastic catheters into the prostate gland, and then giving a series of radiation treatments through these catheters.
Another option is High Intensity Focussed Ultrasound, which uses sound waves to "melt" away the cancer.
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Predicting the future
It is hard to predict precisely the prognosis of an individual cancer patient.
This is because so many different factors can affect the chances of a particular patient surviving the disease.
Below are the latest (September 2003) survival rates for common cancers in England, Scotland and Wales.
They are an average taken from the outcome of large numbers of cancer patients, so can only be seen as a rough guide.
|
Cancer survival: Men |
|
% rates five years after diagnosis |
|
|
England |
Scotland |
Wales |
|
Bladder |
69.3 |
67.6 |
70.9 |
|
Breast |
70.3 |
71.5 |
66.2 |
|
Colorectal |
44.8 |
44.1 |
40.1 |
|
Kidney |
42.3 |
38.9 |
35.4 |
|
Leukaemias |
35.2 |
33.2 |
32.3 |
|
Lung |
7.4 |
7.0 |
8.0 |
|
Lymphoma (Non Hodgkin's) |
46.1 |
41.0 |
41.6 |
|
Melanoma |
73.8 |
79.2 |
63.1 |
|
Oesophagus |
8.3 |
6.3 |
8.0 |
|
Pancreas |
4.2 |
3.0 |
6.0 |
|
Prostate |
53.8 |
53.6 |
48.8 |
|
Stomach |
12.8 |
9.9 |
9.9 |
|
Testicular |
93.6 |
92.0 |
88.8 |
|
Source: Eurocare 3 study (2003) |
|
Cancer survival: Women |
|
% rates five years after diagnosis |
|
|
England |
Scotland |
Wales |
|
Bladder |
64.1 |
59.7 |
64.9 |
|
Breast |
73.6 |
72.3 |
69.5 |
|
Cervical |
63.8 |
60.6 |
58.7 |
|
Colorectal |
46.6 |
46.7 |
38.2 |
|
Kidney |
41.4 |
39.1 |
34.5 |
|
Endometrial |
73.7 |
71.8 |
70.8 |
|
Leukaemias |
37.7 |
36.5 |
35.4 |
|
Lung |
7.7 |
6.8 |
7.5 |
|
Lymphoma (non-Hodgkin's) |
50.7 |
47.6 |
49.8 |
|
Melanoma |
85.6 |
90.1 |
79.1 |
|
Oesophagus |
11.8 |
10.0 |
7.3 |
|
Ovary |
31.5 |
30.1 |
29.1 |
|
Pancreas |
4.4 |
3.2 |
5.9 |
|
Source: Eurocare 3 study (2003)
There are various factors that might make survival rates higher or lower for an individual patient.
Age
For some cancers at least, the higher the age of the patient at diagnosis, the less the chance of five-year-survival.
For example, for breast cancer in women, the European average 5-year survival for 45-54-year-olds is 81% - for 55 to 64-year-olds it falls to 75%.
This, of course, may not be due to the cancer - a 50-year-old patient is more likely to die from other natural causes over then next five years compared with a 40-year-old.
Stage at diagnosis
Some patients will have more advanced cancer, with a larger tumour or affecting more parts of the body by the time treatment commences.
This can have an impact on the likely success of treatment.
Where you live
There are fairly wide variations between cancer survival rates between different European countries.
However, there are also wide variations in survival even between different health authorities in the UK.
This may be due to differences in the treatment offered - or reflect, perhaps, the length of time it takes to get diagnosed in different parts of the country.
There may also be an influence from the general underlying health of different populations.
For example, lung cancer five year survival is just over 2% in Northumberland - and almost 9% in Kensington and Chelsea.
Different cancer types
Obviously, there is a big difference in survival between testicular cancer and lung cancer - but even within particular types of cancer, there are subtypes.
Some may be more aggressive than others - which could make them harder to treat, more likely to recur or likely to be at a more advanced stage at diagnosis.
This page is intended to offer only very general information. For more specific information, contact your doctor. |
