Prostate Cancer, Getting a Second Opinion & Your Treatment Options

Prostate cancer is the most common cancer in men in the UK. It forms when cells in the prostate gland begin to grow out of control.

It progresses slowly, and may present no symptoms for some time. Prostate cancer is highly treatable in the early stages, but can spread to other areas of the body.

Over 47,500 men are diagnosed with prostate cancer in the UK each year, and one in eight men will be diagnosed with it in their lifetime. It’s important to recognise that trans women, non binary people and some intersex people may have a prostate and therefore can develop prostate cancer. The survival rate for prostate cancer is high, with 78% of sufferers living with the condition for over ten years.*

Read on to find out more about prostate cancer with information updated on a regular basis.

What is Prostate Cancer

Prostate cancer is a cancer which occurs in the prostate gland. The prostate gland sits between the penis and bladder, and produces fluid which, when mixed with sperm, produces semen. It also contributes to urine control in the body.

Types of Prostate Cancer

Adenocarcinoma

Adenocarcinoma is a type of cancer that can occur in any mucus producing gland in the body, including the prostate. Adenocarcinoma is by far the most common type of prostate cancer, as most of the cells in the prostate are of this type.

Sarcomas

Sarcomas are a rare type of cancer which can affect any part of the body. In the prostate, they develop in the muscular cells. Some sarcomas are aggressive but others are not. Speak to your specialist if you are diagnosed with prostate sarcoma to define which type you have, and the best treatment options available to you.

Small cell carcinoma

Small cell prostate carcinomas are rare, and make up just 1% of all prostate cancer diagnoses. They generally occur in men over the age of 65 and are often diagnosed with cancers in other areas of the body. The prognosis for small cell prostate carcinoma is poor, but treatment is available to prolong, and maintain a good quality of life.

Squamous cell carcinoma

Squamous cell prostate carcinoma is very rare form of prostate cancer, making up less than 1% of all diagnoses. It is an aggressive form of prostate cancer, and does not respond well to standard treatments meaning prognosis is usually poor. However with new treatment developments, there may be options to make you feel more comfortable and enhance quality of life. As with small cell carcinoma, it can spread quickly and often presents with cancers in other parts of the body. It is worth seeking a second opinion and alternative treatments to squamous cell carcinoma of the prostate to ensure the most effective treatment is utilized.

Causes of Prostate Cancer

The cause of prostate cancer is unknown, however there are a number of factors which can increase the risk of developing it. These factors include:

Age – Diagnoses most often occur in men over the age of 50

Ethnicity – Prostate cancer is more common in African-Caribbean men, and men of African descent

Family history – Risk is increased for those with male relatives who developed prostate cancer before the age of 60, or close female relatives who have developed breast cancer

Obesity – Research suggests a possible link between obesity and prostate cancer

Diet – Research suggests a possible link between prostate cancer and diets which are high in calcium

A combination of age, ethnicity, and family history are likely to put individuals at the highest risk. Your general health, age and other factors can also influence the risk of prostate cancer.

The Main Symptoms of Prostate Cancer

Prostate cancer often does not present any symptoms until it has grown large enough to press on the urethra and affect urination.

The main symptoms of prostate cancer are:

• Difficulty in passing urine
• Weak urine flow
• Needs to urinate more often, and more urgently, especially at night
• Blood in urine or semen

These symptoms also occur from an enlarged prostate which is a common issue as men get older, which is not a form of cancer and therefore it is advised to go for regular health checks as you age. This can help to spot any issues and diagnose cancer early if it that.

Signs that a prostate cancer may have spread to other parts of the body include back pain, pain in the testicles, and rapid weight loss.

How is Prostate Cancer Diagnosed?

Getting a diagnosis for possible prostate cancer starts with a doctor’s appointment. Your doctor will discuss your symptoms with you, and may carry out tests such as a rectal examination to check for abnormalities, or a prostate specific antigen blood test.

Following the results of these tests, you may be referred to a specialist who may suggest an mpMRI scan or for a biopsy to be taken and sent to a pathologist for confirmation.

The mpMRI scan can help specialists confirm the presence of cancer in the prostate, and how likely it is to grow.

Stages of Prostate Cancer

Doctors use a system called TNM to stage thyroid cancer. This stands for Tumour, Node, and Metastasis.

Tumour or T, describes the size of the tumour. There are four stages within the T stage:

T1 – Cancer is too small to be seen or felt during examination or scan.

T1a – Cancer is less than 5% of removed tissue – most likely found during surgery for other reasons, not as part of a cancer examination.

T1b – Cancer is in 5% or more of removed tissue – most likely found during surgery for other reasons, not as part of a cancer examination.

T1c – Caner is found by biopsy after blood test or other test indicates the possible presence of cancer.

T2 – Cancer is completely inside the prostate gland.

T2a – Cancer is only present in half of one side of the prostate gland.

T2b – Cancer is present in more than one half of one side of the prostate, but not present in both sides.

T2c – Cancer is present in both sides of the prostate but is completely inside the prostate gland.

T3 – The cancer has broken through the covering of the prostate.

T3a - The cancer has broken through the covering of the prostate.

T3b – The cancer has spread to the seminal vesicles (semen carrying tubes).

T4 – The cancer has spread into nearby organs, for example the bladder.

Node or N, describes whether the cancer has spread into lymph nodes.

N1 – Is split subdivided into N0 and N1.

N0 – Cancer has not spread to lymph nodes.

N1 – N1is divided into N1a and N1b.

N1a – Cancer has spread to lymph nodes close to the thyroid gland in the neck.

N1b – Cancer has spread to other lymph nodes near the prostate.

M, or Metastases, describes whether the cancer has spread to other parts of the body.

M0 – Cancer has not spread to other parts of the body.

M1 – Cancer has spread to other parts of the body.

M1a – Cancer cells are present in the lymph nodes outside of the pelvis.

M1b – Cancer cells are present in the bone.

M1c - Cancer has spread to other parts of the body.

It’s important to get an accurate confirmation of staging and grading as this may impact the treatment you receive.

What are Gleason Scores?

Another way prostate cancer is staged is using the Gleason score. This is a complex scoring system which we have simplified here.

The Gleason score is calculated on how healthy cancerous cells look under a microscope. Tumours with the appearance of healthy tissue are usually less aggressive, reducing the speed or likelihood of cancer spreading to other areas of the body.

Pathologists assign a Gleason score by examining cell arrangement in two different locations on a scale of three to five. The healthier looking the tissue, the lower the score. These scores are then added together to give an overall score of between six and ten.

A Gleason score of six is a low grade cancer, seven is medium risk, and eight to ten is a high g=grade, more aggressive form of cancer. The gleason score is likely to also have an impact on your treatment plan.

Coping with Prostate Cancer

Receiving a prostate cancer diagnosis can come as quite a shock, and may leave you feeling stressed and anxious. If you are struggling with any part of your diagnosis or your symptoms, it is important to access the right information and look into all treatment options available to you. There are a number of prostate cancer charities out there such as Prostate Cancer UK who can help you find support with different aspects of your diagnosis including support if you’re experiencing Fatigue or advice relating to exercise and diet. Advice is also available for relatives and friends as it can be an anxious time for them too.  

Prostate cancer is one of the most treatable cancers, and prostate cancer survival rate in the UK has doubled in the last 40 years.  

Prostate Cancer Treatment Options  

There are a number of treatment options for prostate cancer and the treatment or combination of treatment you receive will depend on a number of factors. While your doctor may advise you on a treatment plan, it’s important to consider all options to make an informed decision on the right plan for you. You may also be able to access modern treatment outside of your home country too.

The type and stage of your prostate cancer will determine the treatments offered to you. In many cases no immediate action may be necessary, but it is important that you regularly see your specialist and are checked for signs of growth.

Radiotherapy is often used to treat prostate cancer which has not spread beyond the prostate gland. It is also used to slow the progression of cancer which has spread beyond the prostate. This form of treatment has a number of long- and short-term side effects which you should discuss with your specialist before commencing treatment.

In more advanced cases, the prostate gland may be removed completely. This surgery comes with a number of side effects which you should discuss with your multi-disciplinary care team.

Other new treatments becoming more readily available include brachytherapy. HIFU, NanoKnife, CyberKnife and Tomotherapy.

How to Get a Second Opinion for Prostate Cancer 

It’s widely encouraged for patients to get a second opinion about their diagnosis and/or treatment options.  As prostate cancer does not always present symptoms, you may seek confirmation or your diagnosis and want a deeper understanding of the stage of your cancer. Whatever the reason, Oncolomed can help facilitate second opinions with prostate cancer specialists from leading hospitals globally. Find out more about the benefits of getting a second opinion for prostate cancer.

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