Mr Shalom Srirangam is a Consultant Urological Surgeon at The Oaklands Hospital in Salford and specialises in urological conditions in men and women.
Here, he answers some of the most commonly asked questions about prostate cancer - the most common cancer in men in the UK - and explains what patients can expect from a prostate assessment.
What is prostate cancer?
“Prostate cancer is cancer of the prostate gland – a gland which is roughly the size of a walnut and is found at the base of the bladder. The prostate is a male-only gland and it surrounds the first part of the tube that carries urine from the bladder to the penis. The prostate gets larger as men age and this is called benign prostate enlargement. In a proportion of men, prostate cancer can develop within the prostate gland and this is most common in men aged 65 and over.”
What are the symptoms?
“This is one of the difficult things about prostate cancer as it often doesn’t present with any specific symptoms. Consequently, we have to rely on common symptoms caused by benign prostate enlargement, which can include difficulty passing urine and poor flow, as well as needing to pass urine more frequently in the day as well as at night, often with urgency.
“These are also symptoms of any lower urinary tract (enlarged prostate and bladder related) issues, so it does not necessarily mean that you have cancer if you have these. If patients are experiencing blood in the urine, dramatic and unexplained weight loss or severe pain in their bones as well as these symptoms, they should definitely see a doctor as this could be a sign of something serious.
“A lot of men view urinary problems as a sign of simply getting older and put up with them rather than seeing their doctor because they’re worried about what an examination might involve. I always recommend getting checked out to put your mind at rest. It’s particularly important for men with a family history of prostate cancer, or who are of Afro-Caribbean origin, to get checked as they get older, as the risks are the higher for these groups.”
What is a PSA test?
“The PSA test is a simple blood test which may be helpful in detecting prostate cancer by measuring the level of prostate-specific antigen (PSA) - a protein made only by the prostate gland - in your blood. Your doctor may recommend this test as well as a digital rectal exam (DRE), where a finger is inserted gently into the anus to feel the prostate for lumps, however the test is not infallible and it does not detect all prostate cancers.
“If the test reveals a high PSA level it does not mean patients automatically have cancer and the reading could be attributed to benign prostate enlargement, temporary inflammation, recent ejaculation or even sporting activities such as cycling.
“Although the test is not perfect, the PSA test is simple, practical and the best method we currently have in widespread use, particularly when combined with other checks. There isn’t a prostate cancer screening programme in the UK at present, however this would be very much welcomed by some health care professionals.”
I’ve seen my GP, had a PSA test with a high reading and have been referred to a urologist, what happens next?
“Typically, a urologist like myself will review your history and symptoms, perform a digital rectal examination to assess the prostate and repeat the PSA test.
“If the results provide cause for concern, a patient will be referred for a special MRI scan of the prostate. Some years ago, patients would have received a prostate biopsy at this stage, which is invasive, uncomfortable and can cause infections. However, medical scanning science has progressed and now a non-invasive MRI prostate scan is the most common next step if there is concern regarding the prostate. If the MRI reveals further abnormalities a biopsy may be required but this is not the case for all patients. If it shows cancer, an individualised treatment programme will be put in place, in combination with a multidisciplinary team of medical experts.”
What are the biggest myths surrounding prostate cancer?
“There are a few misconceptions, apart from the obvious embarresment, surrounding prostate cancer which can often make men reluctant to see a doctor. The first is that if you have urinary problems it has to be cancer – this is simply not true, and patients could just have symptoms due to an enlarged benign prostate or an overactive bladder.
The second is that if you see a doctor you will have to have a prostate biopsy. This is no longer necessarily the case and will only be pursued if an MRI scan provides cause for concern.
Thirdly, many men believe that impotence is a guaranteed outcome of prostate cancer treatment. While this can be the case for some patients, it is not true for all and a number of measures can be taken to help maintain erections following prostate treatment.
“Even though there have been numerous awareness campaigns designed to encourage men to not ignore health problems and share their feelings and concerns, many are still reluctant to do so, particularly when it comes to personal matters like these. I urge those with concerns to visit their doctor as soon as possible. At the best it will give them peace of mind that nothing is wrong. At worst it means we can start providing early and effective treatment and the best chance of recovery.
“When caught early prostate cancer is highly survivable. Many prostate cancers are low grade and low risk so it’s perfectly possible to live a full, active and enjoyable life with prostate cancer.”