Key Facts
Prostate cancer is the most common cancer in men.
It mainly affects men over 50, and becomes more common with increasing age.
Sensitive blood tests for Prostate Specific Antigen (PSA) allow very early diagnosis of prostate cancer.
Surgery and radiotherapy are both very effective treatments for prostate cancer.
Earlier diagnosis means simpler treatments and better results.
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new prostate cancer cases (2006) |
345,900 |
|
311,100 (EEA) |
|
301,500 (EU25) |
| Number of prostate cancer deaths (2006) |
87,400 |
|
70,300 (EEA) |
|
67,800 (EU25) |
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Cancer Types
Most prostate cancers are adenocarcinomas.
Some prostate cancers are very slowly growing and a man may live out his normal lifespan with the cancer present but others, often in younger men, are more aggressive.
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Causes of Prostate Cancer
There are a few risk factors for developing prostate cancer.
The main risk factor is increasing age. Prostate cancer is rare in men below the age of 50.
Prostate cancer is also more common in some families - several sites on the human genome have been identified as having a link with prostate cancer.
Finally, obesity is a significant risk factor for developing this cancer.
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Prevention of Prostate Cancer
The most immediate preventive measures that a man can take in regard to prostate cancer are to do with obesity and diet. Obesity should be avoided by either reducing, or maintaining, weight through eating a healthy diet and getting regular exercise.
In addition, a diet which is rich in vitamins D and E, selenium and lycopene (found in tomatoes) is reported to offer some protection against prostate cancer.
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Common Symptoms
The most common symptoms of prostate cancer include:
- passing urine more frequently
- getting up at night to pass urine
- pain on passing urine
- a poor urinary stream
- difficulty in passing urine - including having to wait before the flow starts and the feeling that the bladder has not emptied fully.
Other less common symptoms include:
- blood in the urine or semen
- pain and stiffness in the back and hips
- weight loss
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Diagnostic Tests
- Prostate Specific Antigen (PSA) testing. High PSA levels occur in prostate cancer, benign prostatic hypertrophy and infections of the prostate gland.
- Rectal ultrasound. A probe placed in the rectum scans the prostate gland, for any abnormal areas. Abnormalities will require further testing, probably using a biopsy.
- Biopsy. As cancer cells look different from normal prostate cells, a diagnosis can be made by examining them closely under a microscope.
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Treatment
Prostate cancer can be treated using radiotherapy, surgery or hormone therapy - alone or in combination.
In treating very early cancers which have been identified by PSA testing, only active surveillance (careful monitoring) may be required.
Active Surveillance
Prostate cancers identified using PSA testing are often diagnosed years before the first symptoms appear, or surgery or other treatment is required.
Active surveillance involves monitoring criteria including:
- the PSA level
- its rate of increase over time
- how advanced the cancer is
- the appearance of the cancer cells when samples are examined microscopically.
These can be used to discriminate between cancers that require immediate treatment and those that do not necessitate urgent intervention. Monitoring requires regular follow up with PSA blood tests and serial prostate biopsies. This practice of active surveillance saves patients the side effects of radiotherapy or surgery and their potential complications.
Radiotherapy - Brachytherapy
Radioactive implants placed in the prostate gland are a highly effective option for low risk patients.
Radiotherapy – External Beam Radiation
External beam radiotherapy is normally given as a series of short regular treatments in a radiotherapy department (each treatment may be referred to as a fraction). It is used to treat both cancer in the prostate gland and disease which has spread to other areas of the body.
External beam radiotherapy and brachytherapy are used together in some centres.
Surgery
Surgery is used mainly when the cancer is confined to the prostate gland.
In a radical prostatectomy, the entire prostate gland is removed from around the urethra together with nearby lymph nodes.
Hormone Therapy
Prostate cancer depends on testosterone for growth. Drugs that reduce testosterone or its effects will control prostate cancer growth.
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Key Trends
- The use of proton therapy as an alternative to X-ray radiotherapy. However, proton radiotherapy exposes the bladder and rectum to high doses of radiation and there is a risk of causing impotence.
- Using a combination of HDR (High-Dose Radiotherapy) brachytherapy and external beam radiotherapy together to enhance results.
- Using image-guided radiotherapy with cone beams, gold markers and stereotactic ultrasound to improve the targeting of radiotherapy treatment and reduce the effects on nearby healthy tissues.
- The use of adjuvant radiotherapy following surgery for prostate cancer. (In the treatment of some other cancers this is commonplace but is an idea which has yet to be fully explored in prostate cancer.)
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Important Research Areas
- Adjuvant chemotherapy and/or radiation following surgery for prostate cancer
- At present there are no monoclonal antibodies used in the treatment of prostate cancer. The identification of appropriate monoclonal antibodies is therefore a potential research area.
- Preliminary research suggests that proton therapy may be superior to conventional radiation for prostate cancer, but this has not been confirmed yet by randomised studies.
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Unresolved Questions
- The benefits of using combined chemotherapy and radiotherapy/surgery in controlling cancer that may have spread from the prostate gland itself.
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