But still you might ask, why is there no screening programme, why are men dying of this cancer, why does the nation seem to be ignoring this problem ? And some ask why is it that resources have been poured into breast cancer management and not apparently into prostate cancer management ?
The prostate gland is closely associated with sexual function and fertility in men : it produces most of the fluid in the ejaculate. It is therefore a very hormone sensitive gland. As men age their hormone balance alters and the prostate gland responds to these changes by enlarging. Because it is a doughnut shaped gland, with the tubing bringing both urine and ejaculate to the outside world running through the middle of that doughnut, then as it gets bigger it causes some symptoms. As a man grows older it is normal for urinary frequency to increase by day and there to be a need to pass urine at night too. The stream of urine becomes weaker and there can be delay in starting to pass urine and also some urine dribbled after passing urine. Urine infections become more likely. And all of this is a normal ageing process and can be managed with tablets to shrink the prostate gland and improve symptoms.
The prostate gland produces a substance called prostate specific antigen ( PSA) and some of this can be measured in a blood sample. As the prostate gland grows gradually larger with age then it is normal to find a gradually increasing amount of PSA in the blood : and as with all blood tests a laboratory produces a normal range which for PSA varies with age.
The difficulties with detecting prostate cancer are a result of this background situation. Symptoms of a prostate gland enlarging because of cancer are just the same as symptoms of a normal slowly enlarging prostate gland : only if the symptoms develop rapidly might one be suspicious. Rectal examination of the prostate gland will reveal the size and texture of the prostate gland : it should feel smooth and not hard. But with the most thorough of examinations of this sort, only about a third of the gland itself can be felt… a cancer growing on the dark side of this particular moon would not be palpable.
And prostate specific antigen (PSA)”¦ why can’t that be used for screening for prostate cancer ? The normal range for this test is quite wide and a one off test does not tell us much . For example, the normal range for a man in his 50s would be up to 4.0 in most labs. If man A had a level of 0.8 and man B had a value of 3.2 then both would be regarded as normal. But if one year earlier man B’s PSA level had been 0.8 the his PSA has gone up by four times in 12 months and this is abnormal , even though both readings are reported as normal.
For PSA to be used as a screening test to alert to the possibility of a cancer the it has to be used on a regular basis : a series of values. A rise each year of 15% is acceptable as part of the normal ageing process: a rise above that is suspicious and would result in further investigations. Even the, two thirds of those referred for further investigations will not have prostate cancer.
At Private GP Services we recommend a PSA test every 12 months for men over 50, watching carefully for any sudden change in the rate of rise in the values but we are equal careful not to claim that this scheme will detect all prostate cancers nor that the test is specific for it.
There is one circumstance in which a one off level could be regarded as useful. Recent research has shown that men with a PSA level less than 1.0 at the age of 60 have virtually no risk of going on to develop prostate cancer in their lifetime. Levels over 2.0 at the age of 60 suggest a higher than average risk and would encourage annual blood tests and review.
Just as with breast cancer, prostate cancer is not of just one type : some are aggressive and shorten lives, others are so slow growing that no action is needed and men go on to live with their prostate cancer, dying of entirely other causes. Research continues as to how to distinguish these and how best to manage prostate cancer and it is true to say that the wide variety of options confirms that no treatment is ideal.
If you are concerned about prostate cancer and would like to discuss this please make an appointment. At FACEmed, we offer Well Man screening that assesses this area and more.