What are the symptoms of prostate cancer and what should you check for?
Prostate cancer is the most common cancer in men in the UK, with about 55,000 new cases every year.
Only a small group of high-risk men are eligible for regular screening, because the harms associated with the blood test used outweigh the benefits in most cases.
However, tens of thousands more black men aged 45-74 are to be invited for checks as part of an ongoing trial to find better ways of testing for the disease.
What is prostate cancer?
The prostate is a gland that is about the size of a walnut which sits just below the bladder within the pelvis.
It surrounds the urethra - the tube that takes urine out of the body through the penis.
Prostate cancer - abnormal and uncontrolled cell growth - often develops slowly.
There may be no signs or symptoms for years and some people never develop any problems from it.
But in others, the cancer can be aggressive and deadly.
Prostate cancer that is detected early has the best chance for successful treatment.
How common is prostate cancer?
One in eight men will get prostate cancer in their lifetime and for black men, that risk doubles to one in four.
There are about 12,200 prostate cancer deaths every year, according to Cancer Research UK.
It is most common in older age - among men over 75. Cases in the under-50s are rare.
Your risk of prostate cancer is higher if you have a close relative - a father, brother, grandfather or uncle - who has had prostate cancer.
What symptoms should people check for?
The common ones are:
- needing to urinate more frequently - particularly at night
- difficulty starting to urinate, weak flow and it taking a long time
- blood in urine or semen
These symptoms can be caused by other conditions too - but it is important to have any changes checked by a doctor.
Is there a test for prostate cancer?
There is no single, diagnostic test. Doctors make a diagnosis based on various measures.
This can include a prostate-specific antigen (PSA) blood test and a scan, as well as a biopsy, which involves taking a small tissue sample to examine in the laboratory.
A high PSA does not always mean cancer. It can go up if there is an infection, for example.
Some men with a raised PSA may have a prostate cancer that would not have caused problems or needed treatment.
Men over 50 can usually ask their GP for a PSA blood test if they want to. Your GP will explain the potential benefits and risks.
If you decide you want a PSA test, you should refrain from sexual activity and vigorous exercise, such as cycling, in the two days beforehand as this can affect the results.
Doctors are also considering whether adding MRI scans to PSA tests might improve the situation.
Will there be a prostate screening programme?
The disease is the most common cancer in the UK that does not have a screening programme.
Campaigners including cyclist Sir Chris Hoy, who announced his cancer is terminal, have argued that some groups of men at high risk should be tested regularly.
That means men with a BRCA2 gene variant and a family history of breast, ovarian, pancreatic, or prostate cancer.
BRCA2 is involved in repairing DNA and some mutations lead to cancers being both more common and more deadly.
The screening committee said these men, a few thousand each year, should be invited for a PSA blood test every two years between the ages of 45 and 61.
Some are already getting informal screening as their families are known to NHS genetics clinics.
It recommended:
- no screening programme for all men as it is "likely to cause more harm than good"
- no screening for black men due to "uncertainties" around the impact
- no screening based on family history (more generally) - as the disease is so common that it doesn not narrow down the risk
According to the committee, screening - which would involve a blood test then scans of the prostate and a biopsy - can miss deadly cancers and detect those that never need treatment.
It said the small number of lives saved would be outweighed by the number of patients harmed by unnecessary treatment, which can lead to a loss of bladder control.
Although not eligible for routine screening, tens of thousands of black men will be invited to take part in research investigating better ways of testing for the disease.
The government announced it is investing in the TRANSFORM trial, which means all black men aged 45-74 will be offered the chance to take part.
Charity Prostate Cancer UK, which has long campaigned for the inclusion of black men in screening, welcomed the move, saying it was "a truly historic moment".
How is prostate cancer treated?
Different treatment options are available and your doctor will advise which might be most suitable.
If the cancer is at an early stage and not causing symptoms or growing quickly, it might be possible to keep it under observation.
Some prostate cancers can be cured with treatments such as surgery and radiotherapy.
Hormone therapy may also slow cancer growth.
It may also be possible to destroy the cancer cells using extreme cold (cryotherapy) or high-intensity focused ultrasound.
<small>Source: BBC Health</small>
