Prostate Cancer


Types of Prostate Cancer

There are several types of prostate cancer:

  • Localised Prostate Cancer: Prostate cancer that is contained within the prostate gland.
  • Locally Advanced Prostate Cancer: Prostate cancer that has spread to the area just outside the prostate gland.
  • Advanced Prostate Cancer: Prostate cancer that has spread outside of the prostate gland to other parts of the body. 


Investigations and Diagnosis

There are several investigations which a patient may undergo to diagnose prostate cancer:

  • Prostate Specific Antigen (PSA) Test: PSA is a protein made by the prostate gland which naturally leaks out into the blood. The PSA is a blood test which measures the level of PSA in your blood. It can take up to two weeks to get the result of a PSA test. Please note: a raised PSA does not always mean a patient has prostate cancer. For more information on the PSA test please click here
  • Digital Rectal Examination (DRE): A common way of diagnosing a prostate problem is for the doctor to feel the prostate gland through the wall of the back passage (rectum), using a gloved, lubricated finger. The doctor is feeling for any hard or irregular areas that may be a sign of cancer. The DRE may be carried out by a GP and will be repeated by the hospital specialist.
  • Trans-Rectal Ultrasound Guided Biopsy (TRUS): Patients will usually be recommended to have a TRUS biopsy. The aim of a prostate biopsy is to detect the presence of prostate cancer. The prostate needle biopsy involves taking a number of small pieces of prostate tissue to be looked at more closely under the microscope. This procedure will be carried out in Urology Day Care Level 3 Belfast City Hospital Tower. The biopsy is carried out under local anaesthetic, usually as a day case.
  • MRI Scan: MRI (Magnetic Resonance Imaging) uses magnets rather than X-rays to create a detailed picture of the prostate and surrounding tissues. This may be carried out as part of routine investigations.
  • Bone Scan: A bone scan may show whether any cancer cells have spread from the prostate to bone. The scan involves an injection of a safe radioactive dye into a vein in the arm. The bone scan is done in the Nuclear Medicine Department on the Lower Ground Floor of the Cancer Centre.

Once all the investigations are completed the patient will be discussed at the multi-disciplinary team meeting. Patients will then be referred to see a Consultant Urologist to discuss the results of their biopsy and any other investigations they may have had. 


Types of Treatment

Active surveillance

Prostate cancer is often very slow growing and for many men with prostate cancer, the disease may never progress or cause any symptoms. Not all prostate cancers need treatment. Active surveillance involves monitoring prostate cancer to begin with, rather than treating it straight away. Typically, monitoring includes PSA testing, regular Digital Rectal Examinations and repeat prostate biopsies every two or three years, or MRI scans.

Surgery

Pre-surgery

Prostate cancer surgery for Northern Ireland is provided at Belfast City Hospital by specialist uro-oncology surgeons.

When coming to Belfast City Hospital for surgery, patients will be asked to attend for a pre-operative assessment to ensure they are fit and safe for surgery. This assessment will take place in the Outpatient department or as part of an overnight stay.

Patients are informed of the approximate date of surgery or waiting time by their surgeon.

When patients come to the hospital for surgery they will be admitted to Level 3 of Belfast City Hospital Tower, this is a urology specialist ward. Staff on the ward will be on hand to answer any questions and can refer patients to a nurse specialist if required.

Most patients will stay in hospital for 2-4 days and will go home with a urinary catheter in situ for approximately 10-14 days. Patients will then return to hospital, generally for an overnight stay to have the catheter removed. At this time patients will have the opportunity to see a specialist physiotherapist regarding pelvic floor exercises to help regain continence as soon as possible.

Types of Surgery

For many patients with prostate cancer, surgery may be the most appropriate treatment. The main type of surgery that patients with prostate cancer will have is known as a radical prostatectomy.

Radical prostatectomy is a treatment option for fit, healthy men with cancer that is thought to be contained within the prostate gland (localised prostate cancer). It may not be suitable for patients to have surgery if they have other health problems such as significant heart disease, as these increase the risks of surgery. Surgery to remove prostate cancer is a major operation and it will take some time to recover from the operation

There are several ways of removing the prostate gland via surgery:

  • Open Retropubic Prostatectomy: This is the most common method and is done through an opening in the lower abdomen.
  • Laparscopic Retropubic Prostatectomy: This is also known as keyhole prostatectomy. This involves accessing the prostate gland through five or six openings, rather than one large one. A tube with a light and eye piece is used to look inside the body. Gas is injected into the abdomen and the area is examined with a camera. The surgeon can then cut away the cancerous gland.
  • TURBT/Transurethral Resection : A TURBT is a common operation for men who have an enlarged prostate gland. An enlarged prostate gland causes men to have difficulty passing urine from the bladder as the gland will be swollen and causing obstruction. TURBT surgery removes a section of the prostate gland to reduce the pressure on the bladder.

Radiotherapy

Radiotherapy is the use of exact, carefully measured doses of radiation to destroy cancer cells in the body. This treatment is painless; there is no sensation of heat or pain while treatment is being given. It is rather like having an x-ray picture taken but lasts slightly longer. The type of radiotherapy used to treat prostate cancer is known as external beam radiotherapy

Radiotherapy is a suitable treatment for men of any age and is as effective as surgery (radical prostatectomy) at treating localised prostate cancer. Radiotherapy may also be suitable for a small number of men whose cancer has spread outside the prostate gland (locally advanced).

Most patients are given hormone therapy as part of their cancer treatment, before starting radiotherapy to reduce the size of the prostate. Patients may also have hormone therapy during their course of radiotherapy, and sometimes for a period of time afterwards.

For general information on radiotherapy in the Belfast Health and Social Care Trust, please follow this link

Brachytherapy

Brachytherapy is a treatment for cancer that is contained within the prostate gland (localised prostate cancer). Studies show that brachytherapy is as effective at treating prostate cancer as radical prostatectomy or external beam radiotherapy in men who are suitable for treatment.

Brachytherapy treats prostate cancer by implanting tiny radioactive seeds directly into the prostate gland using thin needles. This is carried out under general anaesthetic. At Belfast City Hospital brachytherapy is given as a two-stage procedure and the treatment involves two hospital visits. The first stage is the pre-implant planning session. Two to four weeks later patients come back to the hospital for the second stage when the seeds are implanted.

For general information on the use of brachytherapy in the Belfast Health and Social Care Trust, please follow this link.

Hormone Therapy

Hormone therapy is an effective drug treatment which works by changing the hormone balance in the body which stops the male hormone testosterone from reaching the prostate cancer cells. This may be given as a combination of tablets and injections, or injections or tablets alone.

Hormone therapy is used in different ways depending on the stage of a prostate cancer and will be discussed with patients by their consultant.

Chemotherapy

Chemotherapy uses anti-cancer drugs to kill cancer cells. It is a very common treatment for many types of cancer. In the past chemotherapy was not shown to be a very effective treatment for prostate cancer. However, newer chemotherapy drugs are available which are sometimes useful if the cancer has spread outside the prostate gland and is no longer responding to hormone therapy.

For general information on chemotherapy in the Belfast Health and Social Care Trust, please follow this link.

Side Effects of Treatment

There are a number of side effects to all the treatment options for prostate cancer. The most common side effects include:

  • Erectile dysfunction (ED): or the ability to have or maintain a natural erection.
  • Loss of sex drive: All types of hormone therapy are likely to cause patients to lose desire for sex (libido)
  • Urinary incontinence: Ranging from drips of urine to leaking larger amounts.
  • Bowel problems: Radiotherapy may cause the lining of the bowel to become inflamed which leads to various symptoms such as loose, watery stools, which can sometimes be blood stained; increasing wind and more frequent bowel movements.
  • Infertility: The prostate gland and seminal vesicles which produce and store some of the fluid in semen are affected during treatment. Patients planning to have children may be able to store their sperm before treatment starts for use in IVF (In Vitro Fertilisation).
  • Hot flushes: Most men taking hormone therapy will get hot flushes due to the lowering of the male hormones in the body.


Follow Up

As part of review following cancer treatment patients will be asked to return to the hospital to see one of the Surgical or Oncology team. The frequency of these review appointments will differ for each patient. The review appointments allow the team to assess patient progress following treatment. The check-ups are also a good opportunity for patients to discuss with a doctor or specialist nurse any problems or worries they may have.

A PSA blood test will need to be checked by a patients' GP prior to each follow up appointment.

If patients notice any new symptoms, or have any worries, they should contact their GP, nurse specialist, or consultant to discuss these symptoms.

Useful Links

Please click on the links below for more information on prostate cancer: