Photo: Ivan Samkov

How fast does cancer spread in prostate?

This is because, unlike many other cancers, prostate cancer usually progresses very slowly. It can take up to 15 years for the cancer to spread from the prostate to other parts of the body (metastasis), typically the bones. In many cases, prostate cancer won't affect a man's natural life span.

nursingtimes.net - Prostate Cancer | Symptoms, Causes, Treatment - Nursing Times

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Routinely screening all men to check their PSA levels is a controversial subject in the international medical community. In some countries, such as the USA, all men over 50 are recommended to have annual PSA test. However, many European countries, including the UK do not offer routine PSA screening.

There are several reasons for this.

PSA tests are unreliable and often produce results that suggest the presence of prostate cancer when no cancer exists (a false-positive result). This means that many men undergo often invasive and sometimes painful biopsies for no reason. Also some experts have questioned whether an early diagnosis of prostate cancer is actually worthwhile. While it is true that treating the condition in its early stages is normally more successful, the side effects of the various treatments are potentially so serious that most men choose to delay treatment until it is absolutely necessary. Also many men who received an early diagnosis then reported that they wish they have never been told. This is because they had to live for many years with the anxiety that the diagnosis gave them, yet the actual condition itself caused no significant physical pain. Finally, there is no compelling evidence that a routine screening PSA programme affects the number of people dying from prostate cancer. However, if you decide that you wish to have your PSA levels tested even if you do not have any symptoms, your GP will be able to arrange it for you.

Diet

As mentioned eating foods high in lycopene may prevent prostate cancer. Lycopene is what is known as an antioxidant - a special molecule that can help prevent damage to cells.

Foods high in lycopene include:

CHEN L, STACEWICZ-SAPUNTZAKIS M, DUNCAN C, SHARIFI R, GHOSH L, VAN BREEMEN R, ASHTON D, BOWEN PE (2001). Oxidative DNA damage in prostate cancer patients consuming tomato sauce-based entrees as a whole-food intervention. Journal of the National Cancer Institute. 93(24):1872-1879; doi:10.1093/jnci/93.24.1872 HEIDENREICH, A., AUS, G., ABBOU, C.C., BOLLA, M., JONIAU, S., MATVEEV, V., SCHMID, H.P., ZATTONI, F. on behalf of the European Union of Urology (2007). Guidelines on Prostate Cancer. ILIC D, O’CONNOR D, GREEN S, WILT T. (2006). Screening for prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004720. DOI: 10.1002/14651858.CD004720.pub2. KUMAR, J., BARQAWI, A.B, CRAWFORD, E.D. (2004). Epidemiology of Prostate Cancer. Business Briefing: US Oncology Review. KUMAR S, SHELLEY M, HARRISON C, COLES B, WILT TJ, MASON MD (2006). Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006019. DOI: 10.1002/14651858.CD006019.pub2.

NICE (2007). Draft guidelines on the diagnosis and treatment of prostate cancer.

MILES CL, CANDY B, JONES L, WILLIAMS R, TOOKMAN A, KING M. Interventions for sexual dysfunction following treatments for cancer (2007). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005540. DOI: 10.1002/14651858.CD005540.pub2.

Expert view

Dr Chris Parker on the questions to ask

We asked Chris Parker, senior lecturer and honorary consultant in clinical oncology at the Institute of Cancer Research and Royal Marsden Hospital, what he would want to know about prostate cancer.

I have been diagnosed with prostate cancer. Can it be cured?

When men are told they’ve got prostate cancer, the word cancer obviously makes them they feel extremely anxious. But it is important to realise that prostate cancer is not like other cancers and in particular it is the only one that often does not require any treatment at all. Men can live with prostate cancer for decades without it causing them any problems whatsoever.

What is a risk group?

Most cases of prostate cancer are localised (confined to the prostate gland). Localised prostate cancer is divided into three risk groups:

Low risk. Intermediate. High risk.

The risk groups are based on:

What the prostate feels like when the doctor examines you.

What the tissues samples look like under the microscope.

What the prostate specific antigen (PSA) is in the blood.

If the prostate feels normal, the tissue samples look relatively normal under the microscope and the PSA level is less than 10, that’s a low-risk prostate cancer. At the other end of the scale, if the prostate feels very abnormal and the tissue samples look aggressive under a microscope and the PSA level is more than 20, that is a high-risk localised prostate cancer.

Will I need treatment?

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The treatment is very different for the three risk groups. Men with low-risk localised prostate cancers are often observed rather then treated immediately. During this period of observation they have regular blood tests, to measure the PSA and will usually have repeat biopsies over the few years. As long as the cancer doesn’t progress, they can continue with observation. If the PSA level rises significantly, or the biopsies show cancer progression, then they can go on to have either surgery or radiotherapy. This is called an active surveillance policy.

What is the best treatment for me?

The cure rate is no different between surgery or radiotherapy. They do, however, differ in terms of convenience and side effects. All treatment can cause adverse effects on bladder function, bowel function and sexual function, which is why not all men with prostate cancer require treatment. If treatment had no side effects then we would treat everyone, but treatment can have significant adverse effects so we aim to target treatment only to those who need it.

Lifestyle

Support for carers

Being a carer isn’t an easy role. When you’re busy responding to the needs of others, it can deplete your reserves of emotional and physical energy and make it easy for you to forget your own health and mental wellbeing. Research on carers’ health shows that high numbers of carers suffer health effects through caring. And if you’re trying to combine caring with a paid job or looking after a family, this can cause even more stress. But putting yourself last on the list doesn’t work in the long-term. If you are caring for someone else, it’s important to look after yourself and get as much help as possible. It’s in your best interests and those of the person you’re caring for.

Look after your health

Eat regularly and healthily. If you don’t have time to sit down for every meal, try to make time to sit down for at least one of your day’s meals. Instead of relying on fast food snacks, go for healthier options, e.g. fruit.

Look after your emotional health

It’s understandable if there are times when you feel resentful and then guilty for feeling like this. Combine that with exhaustion, isolation and worries about the person you’re caring for and it’s easy to forget about you. Don’t be hard on yourself – you’re human and those feelings are natural.

Look for support

Friends and family may not always understand what you’re going through and it can be helpful to talk to people in the same situation. Carers UK has a lot of useful information on its website and runs a helpline. Visit the website at www.carersuk.org (links to external site) or call CarersLine on.

Download the Carers UK booklet New To Caring (links to external site).

The Princess Royal Trust for Carers has a chatroom on its website and also runs 129 carers centres nationwide which provide information and advice and emotional support. For more information visit www.carers.org (links to external site).

Find out what benefits you’re entitled to

You can find out the services available in your area by contacting your social services or local carers’ organisation or by visiting Carers UK’s Finding Help page at www.carersuk.org/.

Other people to contact:

Your GP and primary care team.

Social services.

For details of government services and information for carers, go to www.direct.gov.uk/carers (links to external site).

For more on support for patients and carers:

Macmillan

Cancer Backup (both link to external sites).

Social care

Social care for people with cancer

If you’ve been diagnosed with cancer, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it’s important to know exactly what kind of assistance is available and where you can get it. If you’re finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will be responsible for assessing exactly the kind of help you need. There are so many sources of help that it’s essential to have a social worker to guide you towards the correct course. Social services can provide assistance with meals, laundry and/or a sitting service, where someone can come to your home. For more advanced care, an occupational therapist will be able to provide a more detailed assessment of your needs at home, making life easier by arranging equipment and making adaptations to your home. A care attendant may also be organised to come and help with housework, dressing and washing, or even just to keep you company and give your carer a break. Look into this as soon as you can, as many care attendants have waiting lists.

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Social care options include:

Care attendants

Crossroads is an organisation in England and Wales that helps carers for patients by visiting homes and taking over the responsibilities of care for a while. Visit the Crossroads website at www.crossroads.org.uk (links to external site), or phone.

Meals on wheels

Contact your local council about its meals on wheels service. It will usually be able to offer financial assistance to help pay for this. Go to www.local.direct.gov.uk (links to external site) for details of your eligibility.

Benefits

You may be eligible for income support, disability living allowance or attendance allowance. Get in touch with the Benefit Enquiry Line for more details on (textphone) or online at www.dwp.gov.uk (links to external site).

Home adaptations

Your occupational therapist will assess your home and make changes to create a comfortable and practical place to live during your treatment. This could mean anything from putting a shower downstairs to adding handrails around the house.

For more on support for patients and carers:

Macmillan

Cancer Backup (both link to external sites).

Real stories

Ian’s story

‘The first reaction I had was sheer horror’

Ian Liston was diagnosed with prostate cancer nearly five years ago, following what he thought would be a routine, annual check-up with his GP. “I thought I was in perfectly good health. My doctor asked if I’d had any problem urinating. I’d been going to the toilet two or three times at night, which seemed a bit unusual, and I never felt that I’d completely emptied my bladder. “When somebody tells you you have cancer, your first reaction is one of sheer horror. Not just for me, but also my wife. We were extremely shocked. “When I calmed down, I found out what was going to happen, how long the disease was likely to last, and what treatments I would need. I tried to find out as much as possible. Knowing as much as I did and preparing myself made the illness a lot easier for me. “When I was diagnosed with prostate cancer, there was evidence that the cancer had spread to my bones. Once it’s escaped the prostate, you have to leave the prostate where it is rather than removing it, and try to control the cancer from outside. “One of the most effective ways of doing that is hormone therapy, mainly Casodex and Zoladex. Zoladex is an easy drug to take: I take it either once a month or once every three months as an injection in my tummy, so I don’t have to take pills every day. “The main adjustment I made was changing my eating patterns. I stopped eating so many dairy products, and started using soya milk and soya yoghurt. I also cut down on red meat. I try to eat more fish and chicken. I’m trying to live a better lifestyle, including going to the gym. “My advice to other men is to be aware of their bodies and not wait until diagnosis. I would say that if a man notices any changes, such as wanting to urinate two or three times a night, feeling pain, or feeling that your bladder is never quite empty after a pee, then you really should see your GP, because it could be an indicator of cancer. “It might not necessarily be prostate cancer, but I think if you’re ever in any doubt about what’s happening in that part of your body you should talk to your GP because he or she will check you properly. Like any disease, the earlier it’s found, the more that can be done to help you.”

Useful links

NHS Choices links

External links

nursingtimes.net - Prostate Cancer | Symptoms, Causes, Treatment - Nursing Times

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