PSA (Prostate Specific Antigen) Testing Explained

Prostate cancer does not always present with symptoms in the early stages and quite often by the time symptoms are noticeable the cancer may have moved to an advanced stage.  As the UK does not have a national screening campaign this means that many men go undiagnosed until they are at an advanced stage.

Critically, it is essential to catch prostate cancer at the earliest opportunity in order to be able to have the option to take advantage of newer, less invasive treatment pathways. Prostate cancer screening needs to become more like that for breast cancer, but right now it lags behind progress made in that sector by many years. This is despite prostate cancer now overtaking breast cancer as a killer in the UK.

So, what can men do to check if they have prostate cancer?

The most common test at the moment is a simple blood test known as a PSA test. PSA stands for prostate specific antigen which is a hormone present in the blood produced by the prostate gland, and which can increase due to several causes, one of which is prostate cancer. However, a high PSA reading does not automatically mean the patient has cancer as many benign conditions can cause a rise, as can recent sexual activity or even cycling.

A PSA test may identify cancer in its early stages as detection makes it much more treatable. The need for early screening is supported by the fact that one man dies of prostate cancer every 45 minutes, mostly due to late diagnosis.

But did you know that if you’re over the age of 50, you are entitled to request a PSA test by visiting your GP?  The GP will take you through a series of questions and symptom checks to ensure you are aware of the possible consequences, but you can insist on the test regardless.

The following will help to explain the terminology and clarify any questions you may have regarding early screening for prostate cancer including PSA tests and DRE’s (digital rectal examinations). Remember, if you don’t understand what your doctor is saying, tell them and ask for further clarification.

What is a PSA Test, and What Does It Involve?

The prostate gland produces a type of protein called Prostate Specific Antigen (PSA). Some PSA leaks out of the prostate and into the bloodstream, so it’s completely normal for some PSA to be in your blood. Your doctor will take a blood sample and send it to a laboratory which will measure how much PSA is in your blood. This will be referred to as your PSA level.

Why is a PSA Test Carried Out?

The main reason that a PSA test is carried out is to check if anything is going wrong with your prostate such as Benign Prostatic Hyperplasia (also known as Benign Prostatic Enlargement), Prostatitis or prostate cancer. A test can also be carried out for the following reasons:

  • If you have difficulty passing urine.
  • If a close relative (particularly your father or a brother) has been affected by prostate cancer.
  • If You’re from an African or Caribbean background as there is a higher risk of you developing prostate cancer.
  • Your doctor wants you to get tested to rule out prostate cancer.
  • There’s a strong family history of other types of cancer such as breast cancer.

What Your PSA Level Will Tell You

If you have a raised PSA level, then the most usual causes of this are:

  • You have a urinary tract infection.
  • Your prostate is inflamed, which is medically known as Prostatitis.
  • Your prostate is becoming enlarged as part of the aging process; this is called Benign Prostatic Hyperplasia (BPH).

It’s important to note that 2 out of 3 men with a raised PSA level will not have prostate cancer. However, for some, it can be a sign.

A PSA test on its own will not confirm whether you have prostate cancer or how advanced it is. It is often accompanied by another examination known as a Digital Rectal Examination (DRE).

What is a Digital Rectal Examination?

A Digital Rectal Examination is a relatively straightforward procedure and one of the first examinations your GP will do if you have a raised PSA level. A DRE will give your doctor a much better idea of the size, shape and current condition of your prostate. Your doctor will be looking for any unusual lumps, shapes or hardened areas. Having this examination, together with a PSA test, will help your doctor decide what may be the best next step for you.

What to Expect During a Digital Rectal Examination

Because your prostate can’t be checked from outside of your body, you’ll be asked to lie on your side. Your doctor will then put a lubricated, gloved finger into your rectum to feel your prostate.

Although you may feel a little bit uncomfortable or embarrassed, this procedure shouldn’t be painful. It is much better for you and your doctor if you relax throughout. And remember, your doctor will have done this many times and will fully understand how you might be feeling.

What is a Normal PSA Level?

To a certain extent, this depends on how old you are. The older you get, the higher your PSA level is likely to be. So, when your doctor receives your results, he/she will take this into account. In certain cases, there may be slight differences in men’s PSA levels but don’t worry, your doctor will explain this to you.

Age/Suggested Upper Level of PSA (Ng/Ml)

40 – 49 years old: 2.5

50 – 59 years old: 3

60 – 69 years old: 4

70+ years old: 5

Please note, NHS Wales levels differ. An Age/Suggested Upper Level of PSA (Ng/Ml) of  than 3 is abnormal if less than 70 years old.

It’s important to highlight that with any medical test; it’s better to get a clear answer of “no you don’t have cancer”, or “yes you do have cancer”. But a PSA test can’t definitively tell you whether you have prostate cancer or not. It’s best used as a guide to the possibility of you having prostate cancer. In fact, as many as 8 out of 10 men who have a raised PSA level will not have prostate cancer.

The Benefits and Drawbacks of Taking a PSA Test

Almost every medical test or procedure will have its benefits and drawbacks. But taking a PSA test is a good idea because it can help detect prostate cancer at its earliest and most treatable stage. Regardless of this, it’s important to be aware of the benefits and drawbacks associated with PSA so you can make an informed decision that’s right for you. After all, testing for prostate cancer early and before you have any symptoms is entirely your choice.

The Benefits of Taking A PSA Test

  • It helps to detect prostate cancer before any symptoms develop.
  • It will reassure you if your test results come back as normal.
  • It may find cancer in the early stage, which makes treating it more effective.
  • For many men and their families, knowing is better than not knowing.
  • Even if advanced cancer is found and treatment isn’t successful, having a test earlier may help you live longer.

The Drawbacks of Taking A PSA Test

  • Your test results could come back with a false negative. This means that your PSA level could be normal even though there’s cancer in your prostate.
  • Your PSA level could be raised even though you don’t have prostate cancer. This is called a false positive result.
  • If your PSA level is raised then you will be considered for non-invasive investigation, in the form of Multiparametric MRI scan, rather than an immediate invasive test, such as prostate biopsy.
  • A PSA test can’t tell whether prostate cancer will be slow or fast growing.
  • The treatment for early stage prostate cancer might not help you live longer. And some treatments themselves have adverse side effects.

Making a Decision That’s Right for You

Your reasons for taking a PSA test can be different from those made by a relative, friend or colleague. But it’s important to make a decision that you feel is completely right for you. Here’s some things to think about and consider:

  • Think through all of the benefits and drawbacks that we’ve mentioned. This will also help you come up with some questions when you speak with your doctor.
  • Speak to your partner to see if they have any thoughts.
  • Also, speak to any men in your family that have taken a PSA test.
  • Do further research. There’s plenty of websites out there that offer advice (but avoid general web searches, stick with respected charities, national bodies and the NHS websites).

If you have a raised PSA level, then you may be given an appointment to have a non-invasive investigation, in the form of Multiparametric MRI scan. This allows your specialist to assess the prostate externally, and, according to recently published evidence, a negative scan will allow you to be fully reassured that there is no clinically significant cancer present.

Crucially, if the scan does show an abnormality, your specialist can advise if this is localised to your prostate, and more importantly, accurately “target” this area using a biopsy, rather than a traditionally performed random prostate biopsy.

But please remember that being anxious and worried is completely normal. Many hospitals across the UK now have specialist nurses who can talk to you if you have any questions or concerns.

What Should I Do If I Can’t Make a Decision?

It’s important to remember that every man is different. For some, it’s important that they’re involved in all decisions when it comes to their health. However, others prefer to not make decisions for themselves and instead opt to take their doctor’s guidance. If you’re struggling to make a decision, then talk to your doctor and let them know that you are thinking about having a PSA test.

What Happens If I Request a PSA Test and My Doctor Say “No”?

Within the Prostate Cancer Risk Management Programme (PCRMP), there’s information that helps GP’s provide balanced information to asymptomatic men who ask about PSA testing. A PSA test is free and available to any man over 50 years old who requests one.

Your doctor should use the National Institute for Health and Care Excellence (NICE) guidance and their clinical judgement when you request a PSA test.

So, before going to see your GP:

  • Consider the benefits and drawbacks and why you want to have a PSA test.
  • Have your reasons for wanting a test clear in your mind.
  • Write these reasons down, so you don’t forget anything.

Are There Any Circumstances When I Shouldn’t Have a PSA Test?

Your PSA level can be affected by several factors which may cause a false level of PSA in your blood. For this reason, you should tell your doctor if any of the below applies to you:

  • If you’ve ejaculated in the past 48 hours.
  • If you’ve had a Digital Rectal Examination in the past 7 days.
  • If you’ve had a prostate biopsy in the past 6 weeks.
  • If you’ve recently or currently have a urinary infection.
  • If you cycle frequently.

You must also tell your doctor about any medication or herbal remedies you may be taking.

Will I Need to Have a Second PSA Test?

This will ultimately depend on the results of your first test. But, you should talk about the possibility of a second test with your doctor. However, if the results of your first test were borderline or not conclusive enough, your doctor may want to do a second test to measure the level of free PSA in your blood. This is because PSA travels in the blood in 2 forms:

  • Bound to a protein in the blood. This is medically known as Bound PSA.
  • Unattached to a protein in the blood. This is medically known as Free PSA.

A Free PSA test measures the amount of unattached PSA to the total amount of PSA in your blood. The higher amount of free PSA means there’s a lower chance of you having prostate cancer.

A second PSA test may also be more likely if your father or brother have had or currently have prostate cancer or if you’re from an African or Caribbean background.

Will I Be Referred To Someone Else Following The Test(s)?

Following your PSA test(s), your doctor might refer you to a hospital to a urologist who specialises in prostate cancer for further tests and/or examinations. For example, you may need to have a prostate biopsy. You should let your urologist know if you have any concerns or questions and what the results might mean before the procedure takes place.

During this test, a thin needle is passed through the perineum (the skin between your scrotum and your anus) which takes small samples of tissue from the prostate gland.  Sometimes (but not often) a rectal biopsy is used where a small probe is passed into your back passage, and then a specialist needle will take the tissue samples through the rectal wall. These samples will then get sent to a specialist lab to be examined under a microscope.

A biopsy is used to detect the presence of cancerous prostate cells and how aggressive they’re likely to be. Thanks to a variety of biopsy techniques and equipment to analyse the results, doctors are able to predict when cancer is slow-growing or when it’s likely to be aggressive. This, in turn, can help your urologist and doctor choose the best course of treatment.

Prost8 UK and Our Campaign Initiatives 

At Prost8 UK we strongly support getting a PSA test as soon as you can. Receiving a prostate cancer diagnosis in its non-metastatic form (whilst it is still contained within the prostate capsule) doesn’t just make it far more manageable and treatable, but it also means that you could receive far less invasive treatment options such as focal ablation.

These ground-breaking procedures treat prostate cancer cells directly whilst avoiding damage to surrounding tissue and organs. This is important as it can minimise some of the less desirable side effects which often accompany more invasive treatment options such as surgery or radiotherapy which often lead to erectile dysfunction and incontinence.

Focal ablation includes HIFU (high intensity focal ultrasound) which uses focused soundwaves to create a point of heat which destroys cancerous cells with minimal damage to the surrounding tissue. Sometimes cryotherapy is the better option which uses needles to inject ice directly into the cancerous tissue to destroy the cells, again with minimal collateral damage.

The advantages of HIFU and cryotherapy treatment for prostate cancer is that it is usually performed as a day stay procedure with fast recovery times and minimal life affecting side effects.

Prost8 UK is campaigning to raise funds to buy, donate and deploy focal therapy suites into strategic NHS hospitals across the UK. This will provide accelerated access to these preferred treatment pathways and better lifestyle outcomes for up to 12,000 men each and every year who are diagnosed with early stage prostate cancer. As it stands right now these men are routinely offered the same invasive treatments that are given to those with advanced cancers.

If you would like to support our very important cause and help us help all men in the UK, then please visit our donation page today.

Written by Lloyd Parkinson. 

Endorsed by: 

Professor Hashim U. Ahmed PhD, FRCS(Urol), BM, BCh, BA(Hons) – Chair & Professor of Urology, Imperial College London. Chair, NCRI Prostate Research Group. Hashim specialises in raised PSA, investigations for prostate cancer, MRI image-fusion targeted prostate biopsies, focal therapy, high intensity focused ultrasound (HIFU), cryotherapy, enlarged prostate, benign prostate hyperplasia, greenlight laser for prostate and Rezum water vapour therapy.

Professor Iqbal Shergill BSc FRCS (Urol) FEBU – Consultant Urologist in Wrexham, North Wales, and Urologist in Chester, Cheshire specialising in contemporary prostate cancer diagnosis (Multi-parametric MP-MRI and Transperineal Template Mapping Biopsies), laser management of kidney stones, and minimally invasive treatments for benign prostate disorders (Urolift, Rezum and HOLEP) and all urological conditions.

Mr David Eldred-Evans, MBBS, BA(Hons) – Senior Clinical Research Fellow, Imperial College London and Specialist Registrar in Urology. David’s research has focused on prostate cancer screening using imaging and he has received research grants from the BMA Foundation, Urology Foundation, Imperial Health Charity and the Royal College of Surgeons.

Paul Sayer – CEO and founder of Prost8 UK, a charity leading the challenge to widen the availability of focal therapy treatments for both early stage and radio-recurrent prostate cancer. Lead for the ‘Prostate Cancer – Know Your Choices’ campaign launching in late 2020 to ensure that men understand that there are options other than radiotherapy and surgery in suitable cases. Also championing early diagnosis to enable more men to access less invasive treatment pathways.  

Victor Griffin – Expert clinical application specialist of the HIFU system with Sonacare Medical Inc., supporting clinical trials in the UK and surgical teams internationally. 

Major Mark Vertue TD MBA, BSc Hons, Cert Ed, RN – Head of Department and Trustee & Clinical Director at Prost8 UK.

A New Treatment for Men with Recurring Prostate Cancer Following Radiotherapy

Radiotherapy is one of the most common treatments currently prescribed for prostate cancer in the UK.  However, following radiotherapy treatment, there is a 1 in 5 chance that prostate cancer will return even if the treatment was initially deemed successful. In the past, men in this unfortunate situation have been treated with a palliative care strategy which involves careful monitoring and hormone therapy.

The hormones used as part of a palliative care strategy suppress testosterone which helps to keep prostate cancer under control for up to 3 years. However, long term use can lead to adverse medical conditions such as heart disease, diabetes, thinning of the bones and weight gain.

The alternative is a prostatectomy (surgical removal of the prostate) which generally causes significant problems and side effects. The tissues within and surrounding the prostate gland become “sticky” with considerable scarring and fusion as a result of the initial radiotherapy. As a result, side effects can include incontinence, bowel damage (which can lead to a colostomy) and a loss of erectile function.

The Alternative: High Intensity Focused Ultrasound (HIFU)

HIFU is a highly effective and minimally invasive treatment option approved by NICE and the NHS which has so far been primarily used to treat early stage treatable prostate cancer.

It is now accepted as an alternative treatment in the setting of radio-recurrent prostate cancer following radiotherapy as a result of highly successful studies over a number of years and has recently become approved for general use, albeit available only in a very limited number of hospitals.

In this form the treatment is known as Salvage HIFU. HIFU treatment (also known as focal therapy) limits the areas it targets by overlaying precision MRI scans and live ultrasound imaging to locate and localise cancerous tissue within the prostate gland. This way, less tissue becomes damaged and side effects occur less often whilst ensuring that the cancer is treated.

The Groundbreaking Study by Imperial College London

A recent study and trial by Imperial College London involved 356 men with recurrent prostate cancer following radiotherapy who were treated using refuge focal therapy. After they received the treatment, 3 in 4 of the men did not experience any disease progression in the following 6 years and did not need any hormones or invasive surgery. Meanwhile, less than 1 in 100 men experienced any significant complications. Only 0.3% suffered some minor rectal injury.

In addition to the 12,000 men each year with early-stage prostate cancer who could be treated with focal therapy, there are at any time a further 10,000 men in the UK with recurrent prostate cancer following radiotherapy who could also be suitable for this treatment.

Currently, there are very few NHS hospitals and private centres that offer HIFU. This is expected to increase in the next couple of years as the benefits of this treatment are better proven, and as men become more aware of it, along with the ongoing campaigning work of the Prost8 UK charity.

How It Works

Roughly two-thirds of men who have localised failure following radiotherapy develop unifocal cancer (one place) or unilateral cancer (one side) and the main location of the recurrence is usually the main (index) lesion prior to radiotherapy.

Localised prostate cancer is quite often multifocal and consisting of an index lesion which drives the cancer. Over time, this can lead to metastatic cancer spreading out from the prostate to other parts of the body. Secondary lesions are usually cancers that lie dormant and are deemed as insignificant.

In fact, more than 89% of recurrent cancer following radiotherapy grows from the cancer remnant in the location of the original index lesion. The majority of the time, secondary lesions are successfully treated by radiotherapy.

What’s Involved During HIFU Treatment?

Before receiving HIFU treatment, patients will have an MRI scan and usually a biopsy taken from the prostate. This helps the medical team to ensure they are only targeting the area of the prostate that’s affected by the cancer.

A single session of HIFU treatment can last up to 3 hours, although, the exact time will depend on the size of the prostate and how much of it is being treated. Once under a general anaesthetic, the surgeon and medical team will place a small hollow tube (known as a catheter into the bladder). The HIFU probe will then be placed in the rectum.

This probe will then release highly controlled ultrasound waves that generate pinpoints of heat accurately targeting just the cancerous tissue and a small margin around it within the prostate. During the treatment, the surgeon will use the ultrasound scanning to ensure that the probe is correctly positioned. The probe only treats small areas at a time (about the size of a small grain of rice) so the treatment will be staged and energy redirected until all the cancerous cells have been targeted and destroyed.

Recurrent Prostate Cancer and Why We’re Campaigning

Prost8 UK is the only prostate cancer charity working solely to promote awareness of the enhanced lifestyle outcomes provided by focal ablation for men with early-stage or recurrent prostate cancer.

Currently, more than 95% of men with a new prostate cancer diagnosis will not even be told about this treatment option, let alone offered it. Too many GP’s and clinicians involved in prescribing treatments for this disease are unaware of this less invasive treatment pathway and its efficacy. But, Prost8 UK are working hard with forward thinking urology specialists nationwide to change this as soon as possible.

In addition, the charity is actively fundraising to buy and deploy focal therapy equipment into strategic NHS hospitals across the UK to create focal therapy centres of excellence and so accelerate access to the treatment.

To support the campaign and help Prost8 UK to help up to 20,000 men each year in the UK, then please donate today via the website (www.prost8.org.uk), or by calling 0203 858 0848.

How Does Cryotherapy Treat Prostate Cancer?

Cryotherapy is a type of treatment that uses sub-zero temperatures to freeze and eliminate cancerous prostate cells. It is also known as cryoablation and cryosurgery. During the procedure, thin needles put into the prostate and gas is then passed down the to destroy cancerous cells.

Who Can Have Cryotherapy?

Cryotherapy can be a suitable treatment for men who have localised prostate cancer that has low to medium risk of spreading, it can also be used in the salvage situation after a previous treatment has failed. It can sometimes be an option if the cancer has started to break out of the prostate but not if it has spread to other parts of the body (known as advanced prostate cancer).

Types of Cryotherapy

There are 2 different types of cryotherapy for prostate cancer that are available to men. These are focal cryotherapy and whole-gland prostate cryotherapy.

  1. Whole-gland prostate cryotherapy treats the entire prostate, including cancerous cells and healthy cells.
  2. Focal cryotherapy only treats the area of the prostate that is affected by cancer. It uses less needles which means that less healthy tissue is frozen compared to whole-prostate cryotherapy.

Before the Cryotherapy Procedure

Before a patient receives cryotherapy, they will get a letter that will outline specific ways they can prepare beforehand. The procedure is carried out most usually under a general anaesthetic, but occasionally a local anaesthetic may be a better option. If a patient is going to receive cryotherapy under a local anaesthetic, they will normally be given some medication to sedate them prior to the procedure. Those who are about to receive cryotherapy will normally need to stop eating and drinking 4 – 6 hours before the procedure is set to take place.

During the Cryotherapy Procedure 

Patients receive cryotherapy for prostate cancer in hospital. It is either carried out in an operating theatre under general anaesthetic. At the start of the procedure, a surgeon will place a tube called a warming catheter into the urethra (just for clarification, the urethra is what carries urine from the bladder and out of the body). This warming tube protects the urethra from sustaining any damage during the procedure, by circulating a warm fluid. The surgeon will then place the cryotherapy needles though the area of skin between the legs and behind the testicles (known as the perineum). A transrectal ultrasound probe is used to make sure the needles are in the right location. The probe is inserted into the rectum and gives a clear image of the prostate throughout the cryotherapy procedure. A machine (known as a ICEfx system or VisualIce) then sends gas circulating through the needles to freeze and destroy cancerous cells within the prostate. Once the procedure is complete (usually within 1 to 2 hours), the surgeon will remove all the needles and the transrectal probe and place a urethral catheter (usually a Foley catheter). Once the patient is fully awake, nurses will check to see if they are in any pain and provide painkillers if they need them.

Following The Cryotherapy Procedure 

Before a patient can leave the hospital, the catheter will be checked to ensure that urine is draining from the bladder. The surgeon will tell the patient how long they will need the catheter for. A dressing will also be placed on the perineum to keep it clean, and a course of antibiotics will be prescribed to help prevent any infection. If the procedure was carried out with a general anaesthetic, then the patient will not be able to drive home as it takes time to wear off fully. However, you might still be able to go home that day, but in some cases, an overnight stay is required.

What Are The Advantages of Cryotherapy?

If you are thinking about having cryotherapy, then it’s important to speak to your doctor before deciding whether to have it or not. They can help you choose if it’s the right course of treatment for you. Cryotherapy is a relatively new treatment when compared to other conventional procedures, and more research needs to be carried out to determine how effective it is in the long term. But, there are some clear advantages to choosing it as a treatment option.

  • It is less invasive than other treatments.
  • You won’t be in the hospital for very long (a day or overnight)
  • You might be able to have the treatment if your prostate cancer has returned after brachytherapy or radiotherapy (salvage treatment).
  • If your cancer comes back after receiving cryotherapy; you might be able to have it as a treatment option again as long as the cancer hasn’t spread to other parts of the body (advanced prostate cancer).

Questions to Ask Your Doctor

If you think cryotherapy might be a suitable treatment, then it’s important to compile a list of questions for when you go to see your doctor or surgeon. Some of the most commonly asked questions to consider are:

  • Where is cryotherapy available?
  • Are there other prostate cancer treatments available?
  • What are the side effects?
  • My radiation therapy didn’t work, can I have cryotherapy instead?
  • Will I also need hormone therapy?
  • How will we know if the treatment has been effective?
  • Will my PSA level be checked regularly following the treatment?

Centres That Offer Cryotherapy and/or HIFU

Because cryotherapy is a relatively new treatment, it currently isn’t offered in many locations in the UK. However, below are the centres that do offer the treatment.

  • Professor Hashim Ahmed: Imperial College London (And HIFU)
  • Mr Tim Dudderidge: Southampton Hospital (And HIFU)
  • Mr Manit Arya: Imperial College London (And HIFU)
  • Mr Stuart McCracken: Sunderland
  • Mr Iqbal Shergill: Wrexham Maelor (And HIFU)

Cryotherapy and Our Campaigning Efforts

At Prost8 UK, we strongly believe in promoting less invasive prostate cancer treatments, including cryotherapy. We also campaign for earlier awareness of the symptoms through newer, simpler and more accurate prostate cancer screening. If you would like to support our very important cause and help us help all men in the UK, then please visit our donation page today. Alternatively, you could donate to our latest fundraising campaign which will see one of our supporters attempt to climb the Three Peaks in under 24 hours.

 

Everything You Need to Know About Hormone Therapy For Prostate Cancer

This reference material is aimed at men who are receiving, or about to receive, hormone therapy as a treatment on its own or as part of a combination treatment plan for prostate cancer. It contains information to help you understand the important factors surrounding hormone therapy for prostate cancer. It may also benefit partners, family members or support networks so they may better understand what can be a confusing area of medical practice. The content herein can provide points to discuss with your healthcare team when you feel comfortable and ready to do so. Your team will consist of a number of health professionals with different expertise, and they work together to make sure you are supported. Each member brings specialist skills that are important in managing your care and making decisions around your treatment needs.

The way you experience prostate cancer is entirely personal. It’s not the same for every man, even if it’s the same type of cancer. Depending on the stage of your prostate cancer (and other conditions), your experience might actually be very different to somebody else’s. When it comes to dealing with prostate cancer, it’s important to take each stage as it comes. It means that you can breakdown an overwhelming situation in smaller (and more manageable) steps. For some, prostate cancer and the impact of treatment might be minimal and quickly resolved. But, for others, the impact can be more difficult to deal with, which may require more support.

You can use the information we provide as a guide for further discussions with your healthcare team. Being informed about hormone therapy for prostate cancer treatment will enable you to participate in decisions that will lead to improved experiences and better care.

What Are Male Sex Hormones?

Hormones are substances that are produced by glands in the body which function as chemical signals. They travel through the bloodstream and affect actions of cells and tissues all around the body. Androgens (male sex hormones) control the maintenance and development of male characteristics and sex drive. Testosterone and dihydrotestosterone (DHT in short) are the most abundant androgens in men. The majority of testosterone is produced in the testicles, but a small amount is also produced by the adrenal glands (small glands found above each kidney).

How Do Hormones Stimulate Prostate Cancer Growth?

Androgens are needed for the normal function and growth of the prostate. They are also necessary for cancer to grow in the prostate. Androgens promote the growth of both healthy and cancerous cells by activating the androgen receptor. Once activated, the receptor stimulates the expression of particular genes that contribute to the growth of prostate cells. Early-stage prostate cancer needs a high level of androgens in order to grow. Such prostate cancers are known as androgen sensitive (also referred to as androgen dependent or castration sensitive) because treatments that block androgen activity or decrease androgen levels can suppress the cancers growth. Prostate cancers that are treated with surgery or drugs that block androgens will eventually become castration resistant. What this means is that they can continue to grow even when androgen levels are low. Historically, these types of tumours were also called androgen independent, hormone resistant or hormone refractory. However, these terms are not really used in the modern-day because tumours that they become castration resistant may respond to newer antiandrogen treatments.

How Does Hormone Therapy Treat Prostate Cancer

Hormone therapy might be used in several different ways to treat prostate cancer, including early-stage prostate cancer, relapsed/recurrent prostate cancer and advanced or metastatic prostate cancer.

Early Stage Prostate Cancer

Men with early stage prostate cancer (localised prostate cancer) will often receive hormone therapy before, during and after radiation therapy. Or, in rare circumstances they might receive hormone therapy following a prostatectomy (surgery to remove the entire prostate gland). When it comes to early stage prostate cancer, factors are used to determine the risk of it returning following treatment. These factors include the tumour’s grade (which is measured using a grading system called the Gleason score), the extent to which the tumour has spread, and whether the cells are found close to the lymph nodes. The length of treatment with hormone therapy for a man with early stage prostate cancer depends on the risk of recurrence. Hormone therapy for intermediate-risk prostate cancer is usually given for a period of 6 months. But, when prostate cancer is graded as high-risk, it may be prescribed for 18-24 months, or longer.  Men who receive hormone therapy after having a prostatectomy may have less likelihood of recurrence than with a prostatectomy alone. However, there is no substantive evidence that they will live longer overall. Men who receive hormone therapy after having radiotherapy for intermediate or high-risk prostate cancer live longer overall without recurrence than men who just have radiotherapy.

The use of hormone therapy in early-stage prostate cancer is to essentially shrink the tumour to a size where treatment can be more effective and cause fewer side effects. Its use in surgery and radiotherapy is well established, and studies are also being carried out to see if it would be useful for patients undergoing ablation treatments such as HIFU (High intensity Focused Ultrasound) and Cryotherapy.

Relapsed/Recurrent Prostate Cancer

Hormone therapy is a standard treatment for men who have a prostate cancer recurrence after having radiotherapy or a prostatectomy. It is sometimes also recommended for men who have a biochemical recurrence or an increase in the prostate-specific antigen (PSA) level following surgery or radiotherapy (especially if the PSA level doubles in less than 3 months).

Advanced or Metastatic Prostate Cancer 

Essentially prostate cancer when it spreads to other parts of the body remains a prostate cancer; in other words, it does not transform into another type of cancer. Hormone therapy therefore is used as a standard treatment for men who have metastatic prostate cancer (the cancer has spread to other areas of the body) when it is first diagnosed. It is used to shrink the cancer even if it has spread to other tissue, bones or organs. At this point it is not used as an aid to treat the cancer, but it can help to keep it under control (sometimes for a number of years). It can also help manage the symptoms of advanced or metastatic prostate cancer such a bone pain. How long hormone therapy controls for this grade of prostate cancer for varies from case and to case. It depends on how far the cancer has spread and how aggressive it is when treatment begins.

The Different Types of Hormone Therapy

The type of hormone therapy that men receive will depend on whether their cancer has spread, other treatments they are currently having, and their personal preference. It is possible to receive more than one type of hormone therapy simultaneously.

Implants or Injections

This type of hormone therapy is medically known as androgen deprivation therapy (ADT in short). It works by stopping the brain from telling the body to produce testosterone and is just as effective at controlling prostate cancer as surgically removing the testicles. Both implants and injections are administered via a needle. Injections are given in a way that is similar to a vaccination where liquid is injected into the muscle or under the skin. Men that receive injections will typically have them in their abdomen (stomach area), arm(s), thigh(s) or buttock, but it does depend on type of injections they are receiving. Implants, however, are administered via a larger needle that places a tiny tube that sits under the skin which releases the drug slower than an injection would.

LHRH Agonists

LHRH (Luteinizing Hormone-Releasing Hormone) agonists are the most common type of implant or injection. They are used to effectively chemically castrate men.

When androgen levels are low, this causes the pituitary gland (a gland in the brain that controls hormones) to produce luteinizing hormones which stimulates the testes to produce androgens.

There are several different types of LHRH agonists that used in the UK, including:

GnRH Antagonists

GnRH (Gonadotrophin Releasing Hormone) antagonists are used less than LHRH agonists. GnRH antagonists can also be known as GnRH blockers. In the UK, there is one type currently available which is called Degarelix (Firmagon). It can be used as a first treatment for advanced or metastatic prostate cancer that has spread to the bones. It can also prevent metastatic spinal cord compression (MSCC for short), which can occur if cancerous cells grow in or near the spine.

Antiandrogens 

This type of hormone therapy is used to reduce the ability of androgens to stimulate the growth of cancerous prostate cancer cells. It doesn’t lower the overall androgen level in the body and is usually used in combination with LHRH agonists. There are a few different types of antiandrogens that are used in the UK, which are:

Orchidectomy 

Before we explain this type of hormone therapy, please note that even though it is medically classed as a type of hormone therapy, it is in fact, surgery. An orchidectomy is radical surgery to remove the testicles, or parts of the testicles that produce testosterone. It is not used as often as other types of hormone therapy. It is very effective at reducing testosterone levels which normally drop to their lowest very quickly. However, an orchidectomy can’t be reversed, so it is only offered as an option to men who require long-term hormone therapy.

How Will I Know That Hormone Therapy Is Working?

Unfortunately, doctors predict how long hormone therapy will be effective for in suppressing the growth of prostate cancer. Because of this, men who receive hormone therapy for more than a couple of months are tested on a regular basis to determine the level of PSA in their blood. An increase in PSA may indicate a man’s prostate cancer has started growing again. A PSA level that continues to increase while hormone therapy keeping androgen levels low is an indicator that a man’s prostate cancer may have become resistant to hormone therapy.

Intermittent Hormone Therapy

If a man is receiving life-long hormone therapy and experiencing problems with the side effects, they may be able to have intermittent hormone therapy instead. This involves halting the hormone therapy when their PSA level is low enough, and then starting it again if the PSA level rises or if the symptoms get worse.

Potential Side Effects Of Hormone Therapy

Like all hormone therapy for prostate cancer there can be side effects. Not all men experience side effects in the same way. Side effects are also not an indicator that treatment isn’t working. Some men find that their side effects get easier to cope with the longer they’re on hormone therapy. Sides effects can include:

  • Depression and Anxiety

Some men experience depression and anxiety while on hormone therapy. The therapy itself can cause this, or because they have prostate cancer (or a combination of both). Another contributing factor can also be the impact that the cancer and hormone therapy might be having on their personal relationships.

  • Weight Gain

Some men find that they put on weight while on hormone therapy, particularly around their waistline. Hormone therapy affects the way the body metabolises food which can cause this. Physical changes can be difficult to deal with, particularly if a man has never had any problems with their weight in the past.

  • Breast Tenderness and Swelling

Hormone therapy can cause tenderness and swelling (gynaecomastia) in a man’s breasts. It is caused when testosterone and oestrogen levels change. Tenderness can affect one or both breasts and can sometimes cause long-lasting pain. Enlargement that is entirely due to adipose (fatty) tissue is called pseudogynaecomastia.

  • Hot Flushes

Hot flushes are one of the most common sides effects of men on antiandrogens or LHRH agonists. They can differ from a few seconds of feeling overheated to hours of sweating, which can be uncomfortable to experience. Hot flushes can be similar to the ones that women get when they are going through the menopause.

  • Fatigue 

Hormone therapy for prostate cancer can cause various levels of tiredness (fatigue) from mild to severe. Some men find that this effects the way they live their day-to-day life. It can affect energy levels, motivation and emotions. Some men find that tiredness can come on quite suddenly, which means that there needs to be caution in some situations; for example, when driving.

  • Loss of Bone Mass

Long-term hormone therapy can cause bones to lose their bulk because testosterone helps to keep them strong. GnRH antagonists, LHRH agonists and an orchidectomy (surgery to remove the testicles) can all have this effect. Antiandrogens as less likely to cause a loss of bone mass.

  • Erectile Dysfunction 

Lower amounts of testosterone can cause issues with getting and maintaining an erection which is known as erectile dysfunction. Other prostate cancer treatments, such as radiotherapy and surgery, can also cause erection problems.

  • Muscle Mass Loss 

Testosterone plays a major role in how men’s bodies are physically made up. Hormone therapy can cause a decrease in muscle mass and an increase in body fat. This can change the way the body looks. Some men can also experience aches and pains in their muscles while they are on hormone therapy.

  • Loss of Body Hair 

Some men lose body hair while on hormone therapy. This is because testosterone plays a key role in the growth of hair. It is less common for men to lose hair from their head, but if this does happen, it normally grows back once they stop their hormone therapy.

  • Lack of Libido 

A lack of libido (reduced interest in sex) is common for men on hormone therapy for prostate cancer. However, it is often caused by anxiety and fatigue rather than the therapy itself (although, it can contribute to it). Most men notice their sex drive returns when their hormone therapy ends, but for some, it’s an on-going problem.

  • Problems Concentrating

Men who are currently on hormone therapy might find it difficult to concentrate or focus on specific tasks. However, there isn’t much evidence to suggest that this is directly caused by hormone therapy. For example, feeling depressed and stressed is normal for men with prostate cancer and can affect concentration levels and memory.

Side effects normally last for as long as a man is on hormone therapy. They normally improve once testosterone levels start to rise again. Depending on the type of therapy, this could take months or several years, and for some, the side effects may never go away completely. But, this ultimately depends on the type of hormone therapy, how long a man has it for, and what other treatment they are receiving at the same time.

What Can Be Done to Reduce the Side Effects?

Men who experience loss of bone mass during long term hormone therapy might be prescribed medication to slow down or reverse it. Exercise may also help to reduce side effects, including loss of bone mass, weight gain and fatigue. The sexual side effects of hormone therapy can be some of the hardest to deal with. Medication such as Viagra doesn’t normally work for men who are undergoing hormone therapy because it does not address the loss of libido that is caused by a lack of androgens. When men stop taking hormone therapy, the loss of libido will eventually go away. However, if hormone therapy has been used for a number of years, then these side effects may not completely disappear.

Does Hormone Therapy Help With HIFU?

Hormone therapy is sometimes given to men for about 2 to 3 months prior to HIFU (high-intensity focused ultrasound). It can make the prostate gland smaller and ultimately easier to treat. Some men may also be offered an operation called transurethral resection of the prostate (TURP) which removes prostate tissue to improve urine flow. It is sometimes used before a man receives HIFU to reduce the risk of urinary issues following the treatment. However, please note that if a man has a large prostate, they might be offered alternative treatments before receiving HIFU. The grade of the prostate cancer and Gleason score will also be used to determine the best course of treatment.

How Does HIFU Treat Prostate Cancer?

High-intensity focused ultrasound (HIFU) is a non-invasive procedure that uses high-frequency ultrasound energy to heat and destroy cancerous prostate cells. Ultrasound energy travels into the prostate gland from a transducer (transrectal probe) that enters through the back passage (rectum). The basic concept of how HIFU works is that it targets, burns and destroys cancerous prostate tissue similar to the way a magnifying glass can use the sun’s rays to burn a hole in a leaf. However, instead of using light as a source of energy, HIFU uses sound. When the sound waves are aimed at the prostate, they increase tissue temperature, only destroy cancerous cells and protect the surrounding healthy tissue.

HIFU can be suitable for men whose cancer is still within their prostate (localised prostate cancer). It can sometimes also be an option if the cancer has started to break out of the prostate or has spread to the tissue that surrounds the prostate (locally advanced prostate cancer). It is not an option if the cancer spread outside of the prostate and to other areas of the body (advanced prostate cancer). HIFU can also be used to treat prostate cancer that has returned after a man receives radiotherapy (recurrent prostate cancer). This is known as salvage HIFU but is only a treatment option for men with localised or locally advanced prostate cancer.

What Happens During the HIFU Procedure?

A typical HIFU procedure takes about 1 to 1 and a half hours. However, it does depend on the size of a man’s prostate and how much of it is being treated. Some HIFU procedures can take up to 3 hours. Once under anaesthetic, a surgeon will place a thin, hollow tube called a catheter into the bladder. This will be placed either through the penis (urethra) or through the wall of the abdomen (stomach area). The surgeon will then place the transducer (transrectal probe) into the man’s back passage. The transducer will then give out beams of ultrasound waves that will kill the cancerous prostate cells. The surgeon will use ultrasound scanning throughout the procedure to ensure that the transducer is in the right position and targeting the right area of the prostate. The transducer only treats a very small area at a time (but with pinpoint accuracy), so the surgeon will move it until all cancerous tissue has been destroyed. Most men are able to go home on the same day that they receive HIFU. A doctor or nurse will check that they have recovered from the anaesthetic and that they are fit enough to go home. Before leaving the hospital, they will also be shown how to look after their catheter, which will remain in place (usually for a week) to help with passing urine.

What Happens Following HIFU?

Following HIFU, men will have regular check-ups with their doctor or nurse at the hospital to begin with, and then with their GP. The purpose of these check-ups is to:

  • Monitor how the cancer has responded to HIFU
  • Deal with any side effects that men might be experiencing
  • Allow men to ask questions or raise concerns.

A PSA test will also be carried out every 3 to 6 months for the first couple of years following HIFU to determine how well it has worked. A PSA level is most likely to reach its lowest within a few months following the treatment. A steady rise in a PSA level can be a sign that the prostate cancer has come back. If it does come back, then a doctor or nurse will discuss further treatment options. Some men may also need to have other tests such as an MRI scan, CT scan or bone scan. These are to determine whether the prostate cancer has spread to other parts of the body.

Why Prost8 UK Are Campaigning For HIFU

At Prost8 UK, we strongly believe in campaigning for less invasive treatments for prostate cancer like HIFU (and cryotherapy) for men with early-stage prostate cancer. We also campaign for earlier awareness of the symptoms of prostate cancer through newer, simpler and more accurate cancer screening. If you would like to support our cause and help us help all men in the UK, then please make a donation today via the website, or by calling 0203 858 0848.

Prostate Cancer Screening: Today And The Future

When evaluating someone with Lower Urinary Tract Symptoms (LUTS), the doctor will use the International Prostate Symptom Score (IPSS) along with a physical examination (including a digital rectal exam or DRE). In addition, a number of tests will be undertaken, such as a urine test called a urinalysis. Depending on the clinical situation, some other tests may be requested in consultation between the patient and the doctor.

These Include:

  • Prostate specific antigen (PSA) – a blood test to screen/ exclude prostate cancer
  • Urinary cytology – a urine test to screen/exclude for bladder cancer
  • A measurement of post-void residual volume (PVR) – the amount of urine left in the bladder after urinating
  • Uroflowmetry, or urine flow study – a measure of how fast urine flows when you urinate
  • Cystoscopy – a direct look in the urethra and/or bladder using a small flexible scope
  • Urodynamic pressure-flow study that tests the pressures inside the bladder during urination
  • Ultrasound of the kidney or the prostate

The Studies Determine the Diagnosis, Which May Be:

  • Urinary tract infection (UTI) – typically treatable with a course of antibiotics
  • Benign Prostatic Hyperplasia (BPH)
  • Chronic prostatitis
  • Bladder
  • Urinary stone
  • Neurological diseases such as Multiple Sclerosis (MS), spinal cord injury and disease.

International Prostate Symptom Score (IPSS)

The IPSS is an eight-question, (7 symptom and 1 quality of life) questionnaire used to derive a score (0-35) and determine the management of Benign Prostatic Hyperplasia (BPH), which is the most common prostate problem. There are various treatment options for BPH, which can be explored with the Urologists that provides them.

Typically, a score of 0-7 indicates mild symptoms, 8-19 moderate symptoms and 20-35 severe symptoms. Higher scores indicate more severe symptoms. Regardless of your score, if the symptoms are bothersome, you should consult with your doctor.

What If Your Prostate Specific Antigen (PSA) is Raised?

PSA is an enzyme found in a man’s blood produced exclusively by prostate cells. Its function is to make semen become more liquid. PSA is produced exclusively by epithelial prostatic cells, both benign and malignant.

  • The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml).
  • If you are aged 50 to 59, a PSA lower than 2ng/ml is normal higher is abnormal.
  • If you are aged 60-69, a PSA lower than 3ng/ml is normal; higher is abnormal.

A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that is not cancer, such as:

  • Enlarged prostate or BPH, discussed above.
  • Prostatitis.
  • Urinary infection

PSA Accuracy

About 15 out of every 100 men with a normal PSA level have prostate cancer. About 75 out of every 100 men with a raised PSA level do not have prostate cancer.

Pros and Cons of the PSA Test

You have the right to a PSA test if you are over the age of 50 and are aware of the pros and cons that come with having the test.

Pros

  • It may reassure you if the test result is normal.
  • It can find early signs of cancer, meaning you can get treated early PSA testing may reduce your risk of dying if you do have cancer.
  • If you have a family history of Prostate Cancer, this particularly means if your father or a brother has had Prostate Cancer, your chances of also getting Prostate Cancer are higher than if no one in your family has had it and it is very advisable to be tested.
  • If you are of black ethnic origin or are overweight or obese: these have increased risk factors for Prostate Cancer.
  • More information can be found in the Genetics and Prostate cancer page.

Cons

  • It can miss cancer and provide false reassurance.
  • It may lead to unnecessary worry and medical tests when there’s no cancer.
  • It cannot tell the difference between slow-growing and fast-growing cancers.
  • It may make you worry by finding a slow-growing cancer that may never cause any problems.

Digital Rectal Examination (DRE)

Doctors use the digital rectal exam (DRE) as a relatively simple test to check the prostate. Because the prostate is an internal organ, your doctor cannot look at it directly. But because the prostate lies in front of the rectum, he or she can feel it by inserting a gloved, lubricated finger into the rectum. It may be performed in the screening of prostate cancer.

Not all medical institutions agree on when men should begin screening (routine testing) for prostate cancer or even if a DRE should be part of the screening. To help detect prostate cancer in its early stages, it is recommended that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.

What Happens During a Digital Rectal Exam?

The doctor will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete. You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.

What Happens After the Digital Rectal Exam?

You may go on with your normal activities. Your doctor will discuss the test results with you. If he or she detects a suspicious lump or area during the exam, further testing will be the next step.

The Future of Testing

Advances in technology, especially the understanding of genomics, proteomics, DNA microarrays, and bioinformatics have led to high expectations about the future of prostate cancer detection, diagnosis, non-invasive therapy, and surveillance after treatment.

Magnetic Resonance Imaging (MRI)

In specific with regard to prostate cancer, some recent studies have indicated that the use of a mpMRI (Multiparametric Magnetic Resonance Imaging) prior to biopsy is able to pick up prostate cancer at an early stage. Nowhere else in modern medicine are the errors of over-diagnosis, over-treatment, missed-diagnoses and poor risk-stratification more extreme. A new study called RE-IMAGINE being run jointly by Imperial College London and University College London will be looking at its accuracy in diagnosing prostate cancer.

The Re-IMAGINE Consortium has been created to undertake discovery that will correct these four key errors. The project will combine the underlying molecular changes in the cancer with state-of-the-art imaging. This will allow the prediction of prostate cancer status for the individual (low, medium or high risk) without recourse to biopsy. It will also allow prediction of which prostate cancers are likely to progress over time and which are not, this has largely eluded scientist so far. By doing so, men will be subject to fewer but better biopsies, improved risk stratification, appropriate treatment allocation, more benefit, less harm and more cost-effective care.

New Blood Tests

When you combine mpMRI with a new blood test being developed by Queen Mary University London, there may not be a need for biopsies at all. The new blood test looks for Circulating Tumour Cells (CTCs). These are cells that have left prostate cancer tumours and have entered the bloodstream. Potentially this new test could help diagnose not only if prostate cancer is present but also how aggressive it is.

However, it is important to remember that CTCs were not detected in some men demonstrating that is may not be suitable for all men. This research is also in its early stages and has only been used on one hundred men. More research on bigger populations will be needed to truly validate whether this test is a useful tool or not.

The Future of Treatment 

Cancer treatment has come a long way in the past 50 years. Procedures are more precise and less damaging. However, there are 2 different types of treatment that we as a prostate cancer charity wholeheartedly support; Cryotherapy and HIFU (Hyper Intensity Focal Ultrasound).

Cryotherapy

Cryotherapy is a treatment that uses extremely cold temperatures to freeze and destroy cancerous cells. In general, it is also known as cryoablation or cryosurgery, but there actually are two types.

  • Whole-prostate cryotherapy treats the entire prostate, including both the cancerous cells together with the surrounding healthy prostate tissue.
  • Focal cryotherapy only treats the part of the prostate that is affected by cancer. It uses fewer needles, which means that less healthy tissue is frozen than in whole-prostate cryotherapy.

It’s important to note that focal cryotherapy isn’t suitable for all men. It all depends on the size of the cancer together with where it is located in the prostate.

What Is Involved When Receiving Cryotherapy 

Cryotherapy is typically carried out while under a general anaesthetic, so patients won’t feel anything during the procedure. However, if patients are unable to have a general anaesthetic, then they might be offered an epidural. During the first stage of the procedure, a tube is passed through the penis and into the bladder, which is known as a warming catheter. Throughout the procedure, warm liquid is passed through the tube so that the urethra and rectum wall doesn’t freeze. The surgeon will then place an ultrasound probe into the rectum to take images of the prostate.

Once the ultrasound probe is in place, and the surgeon is happy with the projected images, thin needles will be placed through the perineum and into the prostate. Freezing gases are then passed through the needles at a temperature of about -40oC, which freezes and destroys prostate tissue. The prostate is then allowed to warm up naturally. The process of freezing and warming is typically carried out twice. Most patients can return home on the same or following day.

HIFU (High Intensity Focused Ultrasound)

In recent years, HIFU has provided a less invasive treatment option which has been shown to reduce the side effects that are typically associated with conventional prostate cancer treatments. It eradicates cancer in the prostate with fewer complications with a process known as Focal Ablation. It generates a pinpoint of heat that is then targeted at cancerous cells around the prostate by focusing ultrasound waves. This type of treatment minimises damage to the nerves that surround the prostate gland, which can preserve sexual function in addition to avoidance of damage to the apical sphincter in order to preserve unitary continence.

How Does HIFU Work? 

The simplest way to explain how HIFU works is to visualise how a magnifying glass focuses light rays from the sun. There’s a transducer that focuses soundwaves, creates heat and destroys tissue at the point to which its aimed at. A typical HIFU procedure lasts between 1 and half hours, depending on the size of the prostate. And, is either carried out under general anaesthesia or an epidural. During the procedure, a catheter is placed through the penis and will stay in place for roughly 1 – 3 weeks. Following HIFU treatment, patients will stay in hospital for 2 – 4 hours for what is known as the recovery period. Once released from hospital, patients can leave to further recover in the comfort of their own home.

Why Prost8 UK Is Campaigning 

At Prost8 UK, we strongly believe in promoting less invasive treatment options for men with early-stage prostate cancer, including Focal Ablation. The most common version of Focal Ablation is HIFU which uses sound waves to create a point of heat, which destroys the cancerous cells with minimal damage to surrounding healthy tissue. We also campaign for earlier awareness of the symptoms of prostate cancer through newer, simpler and more accurate screening. If you would like to support our cause and help us help all men in the UK, then please make a donation today.

Prostate Cancer Grading and The Gleason Score Explained

When prostate cancer is graded, a system is used known as the Gleason Score to determine how aggressive the cancer is. The Gleason Score ranges from 1-5 and describes how much of the tissue taken from a biopsy looks like healthy tissue or abnormal tissue.

When you are diagnosed with cancer, you may find that the doctors looking after you may talk about your Gleason score and what the stage of your prostate cancer is. Your doctors will try and explain things in easily understood language, but some of the terminology used can be somewhat confusing. The following will help to explain the terminology and clarify any questions you may have. If you do not understand what your doctor is saying, tell them and ask for further clarification.

How The Gleason Score Is Determined

Pathologists grade prostate cancer using number from 1-5 based on what tissue looks like under a microscope. This grading system is what is known as The Gleason Score. Because prostate cancers often have areas with different grades, 2 grades are assigned to make up the majority of cells affected by the cancer. These 2 grades are added to yield the Gleason score. The highest a score can be is 10.

The first number that is assigned is the grade that is most common in the cancerous tumour. For example, if the score is written as 2+3, this means that the tumour is grade 2 and less is 3, which is added up to make a Gleason Score of 5. The higher that the score is, the most likely it is that the cancer will grow and spread more quickly than a lower score.

Grades 1 and 2 are not usually used for biopsies; the lowest score found on a biopsy is 6. These types of cancers are typically called low-grade and are likely to be less aggressive. Cancers that score 8-10 are considered high-grade. They are likely to grow and spread quickly. However, a cancer that scores 9-10 is twice as likely to grow and spread quickly as cancer with a score of 8 would.

Can The Gleason Score Really Tell The Cancer Grade for The Entire Prostate?

Biopsies are samples of tissues that are taken from different areas of the entire prostate. The Gleason Score that is determined following a biopsy reflects the cancer’s overall grade. In most cases, multiple biopsies are taken from the prostate to reduce the risk of over or underscoring.

TNM Staging

TNM staging is a system that is used by doctors to stage prostate cancer. Doctors use this information to determine what the best course of treatment is for a patient. The most suitable treatment option depends on the stage of the cancer, the severity of symptoms and a man’s general health status. TMN stands for Tumour, Node, Metastasis.

T – Tumour

Tumour (T) describes the size and extent of the area affected by the cancer (tumour). There are 4 stages of cancer stage in prostate cancer. This is T1 to T4.

T1

T1 staging means that the cancerous cells are too small to be seen on a scan or felt during a prostate examination. T1 is divided into T1a, T1b and T1c.

  • T1a means the cancer consists of no more than 5% of the removed tissue.
  • T1b means the cancer of consists of more than 5% of the removed tissue.
  • T1c cancers are normally found following a biopsy, for example, after a raised PSA level has been discovered.

T2

T2 staging means the cancer is entirely inside the prostate gland. T2 is divided into T2a, T2b and T2c.

  • T2a means the cancerous cells are only in half of one side of the prostate gland.
  • T2b means that the cancer is in more than half of one side of the prostate but has not grown and spread to the other side of the gland.
  • T2c means the cancer has affected both sides of the prostate gland. But, hasn’t spread to other parts of the body.

T3

T3 staging means the cancer has broken through the covering of the prostate gland. T3 is divided into T3a and T3b.

  • T3a means the cancer has broken through the covering of the prostate which is known as the capsule.
  • T3b means the cancer has grown and spread to the seminal vesicles.

T4

T4 means the cancer has grown and spread to other organs.

N – Node

Node (N) describes whether the cancer has spread to the lymph nodes. Lymph nodes are part of the immune system and are found throughout the body. The lymph nodes close to the prostate gland are a commonplace for prostate cancer to spread to. Symptoms depend on which lymph nodes are affected by the cancer. The most common is swollen lymph nodes. N is split into N0 and N1.

  • N0 means that the lymph nodes don’t contain cancerous cells.
  • N1 means there are cancerous cells in the lymph nodes.

M – Metastasis

Metastasis (M) means that the cancer has spread to other parts of the body from where it first started. M0 and M1 are the 2 stages of Metastasis.

  • M0 means the cancer hasn’t spread to other parts of the body.
  • M1 means the cancer has grown and spread to other parts of the body outside the pelvis. M1 is split into M1a, M1b and M1c.
  • M1a means there are cancerous cells in the lymph nodes that are outside of the pelvis area.
  • M1b means there are cancerous cells in the bone.
  • M1c means there are cancerous cells in other body parts or organs.

Treatment

The Gleason Score helps a medical team decide the best course of treatment. But, the type of treatment will also depend on a few other things, including:

  • Age and general health status
  • PSA blood test levels
  • The type of cells that the cancer originated from
  • How a patient feels about the suggested treatment(s)
  • What the cells look like under a microscope

A patient might not receive treatment straight away. Sometimes a medical team like to monitor cancer and start treatment if it starts to grow or spread. If a patient does start to receive treatment, this can include:

  • Surgery to completely remove the prostate
  • Chemotherapy
  • Internal or external radiotherapy
  • Hormone therapy
  • Cryotherapy (Focal Ablation)
  • High Intensity Focal Ultrasound (Focal Ablation)

HIFU and Why Prost8UK Are Campaigning

At Prost8 UK, we strongly believe in promoting less invasive treatment options for men with early-stage non-metastatic prostate cancer, including Focal Ablation. The most common version of Focal Ablation is HIFU (high intensity focal ultrasound) which focuses sound waves to create a point of heat which destroys the cancerous cells with minimal damage to surrounding healthy tissue. We also campaign for earlier awareness of the symptoms through newer, simpler and more accurate prostate cancer screening. If you would like to support our very important cause and help us help all men in the UK, then please visit our donation page today.

Prostate Cancer Grading and The Gleason Score Explained

Written by Lloyd Parkinson. 

Endorsed by: 

Professor Hashim U. Ahmed PhD, FRCS(Urol), BM, BCh, BA(Hons) – Chair & Professor of Urology, Imperial College London. Chair, NCRI Prostate Research Group. 

Major Mark Vertue TD MBA, BSc Hons, Cert Ed, RN – Head of Department and Trustee & Clinical Director at Prost8 UK. 

Victor Griffin – Expert clinical application specialist of the HIFU system with Sonacare Medical Inc., supporting clinical trials in the UK and surgical teams internationally. 

Paul Sayer – CEO Prost8 UK and lead for the campaign to access less invasive treatment pathways for men with early stage prostate cancer. 

Prost8 UK Initiative Launches at The Palace Of Westminster

On Thursday 11th July Prost8 UK officially launched in the Palace of Westminster. The event marked the formal launch of our initiative to accelerate the availability of less invasive prostate cancer treatment options by taking action to raise up to £10m over the next two years. This is so Prost8 UK can buy and deploy at least one set of focal ablation equipment (both HIFU and Cryotherapy) into each of the NHS Cancer Care Regions.

The event was attended by many leading urological medical professionals, partners, supporters and representatives of the charity. It was hosted by Sir David Amess MP, a committed supporter of better treatment options for men with prostate cancer. There were demonstrations of the latest focal ablation equipment and technology that was provided by representatives from Sonacare Medical and BTG Galil.

Prost8 UK Initiative Launches

Special Thanks

We would like to say a special thanks to:

Sir David Amess MP for inviting Prost8 UK to host the launch in such prestigious surroundings. Sir David has also now accepted an invitation to become a patron of the charity.

Professor Hashim Ahmed of Imperial College London, also a patron of Prost8 UK, for lending his authority and support in leading the medical aspect of the proceedings. The charity was proud to welcome many of the top names in prostate cancer treatment and urology to the reception under Prof Ahmed’s leadership.

To our headline sponsors Alex Gonzales of Sonacare Medical and Cynthia Azucena of BTG Galil. Alex and Karen Cornett of Sonacare even flew in from the United States especially to support Prost8 UK on the day.

To our digital partners Phil Thomas, Dan Bacon, Lloyd Parkinson and James Higgs of Revive.Digital.

Prost8 UK Initiative Launches

Statement from Prost8 UK’s Founder

‘I would like to say a big thank you to all those who joined Prost8 UK for the launch in the Palace of Westminster. The feedback we have received has been exceptional, and it has really put the charity on the map. The hard work really starts in earnest now our initiative has launched. I think it was made clear on the day just what the charity’s aims are and how everyone can get involved in the journey. Prost8 UK is going to create a real legacy so please make sure you are part of it. We can truly make a difference to literally 1000’s of men each and every year who have an early-stage prostate cancer diagnosis by providing better lifestyle outcomes than the usual invasive treatment routes on offer right now in the UK.’

The charity still has some important tasks ahead including:

Donations

We are seeking support from, or links to, philanthropically minded corporates or individuals who can help to raise some initial seed funding IRO £35k (no donation is too small to contribute towards that total). This is to fund campaign costs and some initial staffing to get the initiatives started (such as the Iconic 8 VIP’s) until the main revenues come on stream. The PR and CSR value to a corporate could be immense in comparison to the cost. Please contact the charity on info@prost8.org.uk or call 0203 858 0848.

Celebrities

The charity is seeking the support of iconic male celebrities to be the face of a very ambitious two-part campaign called The Iconic 8 VIP’s.  The VIP in this instance stands for ‘very important prostates’ thus the male bias.  We are aiming to go live with this phase one of the campaign during August so the search is on and if anyone can open their little black book and help with contact details of potential celebs it would be greatly appreciated.  The ideal scenario would be to go live on 8th August (to capitalise on the 8/8 date to tie in with the 8 in Prost8) but not critical.

The Iconic VIP’s provides the PR fuel for the main initiative which forms phase two. This is an ambitious scheme to create the biggest non-profit crowdfunding campaign ever here in the UK to raise the £10m target and provide the focal therapy equipment to accelerate access to this life changing treatment option.

Events

Volunteers are being sought to help with recruiting people to attend or support events such as the Prost8 UK Black Tie Ball in November, see the website for details.  Suggestions for events anywhere in the UK would be appreciated, especially if it is accompanied by offers to help with organisational activities. More to follow in the coming weeks, and again thank you all for being part of the journey.

Prost8 UK Initiative Launches

Focal Ablation Explained

Focal Therapy, including HIFU (high intensity focused ultrasound) and Cryotherapy, is a relatively new, but highly effective, treatment that uses highly focused heat or extreme cold to destroy cancerous prostate cells in cases where the cancer has not spread beyond the prostate.

Unfortunately, very few NHS trusts offer this treatment yet, but it is becoming more widely used as a non-invasive treatment for those who have early stage prostate cancer.

HIFU is so important because surgeons can target just the cancerous tumour itself, and it minimises damage to the nerves, tissue and organs that surround the prostate.  The nerves are critical as they are responsible for preserving sexual function and maintaining urinary continence.

Donate to Prost8 UK Today

Our current focus and motivation is to raise up to £10m in the next two years. We plan on doing this by running high profile fundraising campaigns that will enable us buy and donate HIFU equipment across each of the 14 NHS Cancer Care regions in the UK, together with promoting more effective screening procedures.

1 in 8 men will be diagnosed with prostate cancer in their lifetime, so it could be you or a loved one next.  Help us to help all men by donating to Prost8 UK today.

 

Prostate Cancer Symptoms Never to Ignore

Prostate cancer, in its early stages, doesn’t usually have any symptoms or warning signs. The cancer only normally raises a concern if the tumour presses against the urethra and causes changes to your urine flow. And, because the cancer typically appears in a different area of the prostate, there are no symptoms in the early stages of the disease developing.

The symptoms of prostate cancer generally become more noticeable as the disease advances. In most cases, prostate cancer symptoms are not actually caused by the cancer itself, but as a result of a blockage caused by an increased growth in the prostate gland. Such a growth can cause urinary tract difficulties and affect sexual performance. This is exactly why it’s so important to have yearly check-ups done in order to catch prostate cancer in its early stage of development where it can be treated more effectively.

The Symptoms To Look Out For

There is no denying that paying close attention to your health can save your life. Here are the prostate cancer symptoms that you should never ignore. Call your doctor as soon as possible if you experience any of the following symptoms.

Difficulty Passing Urine

This symptom might take the form of feeling like you need to go to the toilet, and then nothing actually comes out. Another sign is finding it difficult to stop once you have started. Because the prostate surrounds the urethra, even a small tumour can cause problems with passing urine. The prostate gland can become enlarged as men get older, and even a slight change can cause similar symptoms. If you do experience this, then there might not be a need to worry. But, do visit your doctor to be sure.

Pain While Urinating

Like the previous symptom, blood in your urine could be a sign of a cancerous prostate tumour pressing against the urethra. Although, pain while urinating can also be a sign of infection, which is known as prostatitis and is a non-cancerous enlargement of the prostate gland.

Blood in Your Urine

This symptom is one of the less common ones, but it is a reason to book an appointment with your doctor. It doesn’t need to be a lot; all you might notice is a slight pinkish colour when going to the toilet.

Pain In Your Lower Back or Upper Thighs

The most common areas for prostate cancer to spread to is in the lower back and pelvis. One way to tell the difference from a worrying sign and standard back pain is that it might feel a lot deeper and more like a persistent ache rather than actual pain. However, if you experience this symptom for a prolonged amount of time, then visit your doctor for check-up.

Blood in Your Semen

This symptom doesn’t mean that you will notice a lot of blood in your semen; it’s more like that it will be enough for you to notice a slight pink colour. If you do notice this symptom, then it is important that you reach out to your doctor.

Difficulty Getting or Maintaining an Erection

This symptom is the one that men find the most difficult to discuss. If you are unable to get an erection or maintain one, then it is time to visit your doctor. A cancerous tumour in the prostate can prevent the increase in blood flow that the penis requires in order to become erect. However, do be aware that an enlarged prostate and Benign Prostatic Hyperplasia can also cause this, but still, do visit your doctor.

Symptoms associated with prostate cancer can also be caused by other non-cancerous diseases, such as a urinary tract infection (UTI) or benign prostatic hyperplasia (BPH). The latter is often confused as prostate cancer. Your doctor can help to diagnose your exact condition and address any of the issues we have discussed with treatment.

Talk to Your Doctor If You Are Concerned

If you experience any of the symptoms that we have discussed in this blog post or are concerned about changes you have noticed, then it is important to talk to your doctor. Your doctor will ask a series of questions, including how long and how often you have been experiencing the symptom(s).

It is important to remember that when Prostate Cancer caught early, it is one of the most treatable cancers, but caught too late; it is one of the least.

Why Prost8 UK is Campaigning

At Prost8 UK, we strongly believe in promoting less invasive treatment options for early stage non-metastatic prostate cancer, including Focal Ablation.  The most common version of this is HIFU (high intensity focal ultrasound) which focuses sound waves to create a point of heat which destroys the cancerous cells with minimal damage to surrounding healthy tissue.   We also campaign for earlier awareness of the symptoms through newer simpler and more accurate screening. If you would like to support our cause and help us help all men in the UK, then please visit our donation page today.

 

 

Why High Intensity Focal Ultrasound (HIFU) Is So Important

Conventionally, surgery or radiotherapy have been the only effective methods of removing solid Cancer tumours. However, recent technological advancements have resulted in a shift toward less invasive techniques. High Intensity Focused Ultrasound (HIFU) has promised to deliver the objective of non-invasive, highly targeted tumour ablation, especially in Prostate Cancer cases. Allied with recent technological improvements in imaging, it has emerged as a real clinical treatment option across the United Kingdom.

What is High Intensity Focal Ultrasound (HIFU)?

High Intensity Focused Ultrasound (HIFU) is a relatively new treatment that uses high energy sound waves to heat and destroy cancerous prostate cells in cases where the Cancer has not spread beyond the prostate. Not all NHS trusts offer this treatment yet, but it is becoming more widely used as a non-invasive treatment for those who have Prostate Cancer. This new type of treatment is so important because surgeons can target small amounts of tissue affected by Cancer, minimising damage to the nerves around the Prostate that are responsible for preserving urinary continence and sexual function.

Before Being Treated with HIFU

Before you receive HIFU treatment, you will need to have an MRI scan and, in most cases, biopsies taken from your Prostate. This is to determine the exact location of the cancer. This helps your surgeon and medical team to make sure that they only treat the area of your prostate that is affected by the Cancer. To have a biopsy(s) taken from your Prostate, you will be given a general anaesthetic then have an ultrasound probe inserted in your rectum. This is so your surgeon can have a close look at where to take the biopsy(s) from. After this the surgeon will take some samples of tissue from your Prostate by inserting small needles usually through the perineum, the area between the anus and the scrotum.

During the Treatment

HIFU treatment can last up to three hours per session. Although the exact time depends on the size of your Prostate, together with how much of it is being treated. Once you have been put under a general anaesthetic, your surgeon and medical team will put a small hollow tube known as a catheter into your bladder. The HIFU probe will then be placed in your rectum. This probe releases a highly controlled beam of ultrasound waves that kills the cancerous cells in your prostate by using focused points of heat. During the treatment, your surgeon will use ultrasound scanning to ensure that the HIFU probe is positioned correctly and directed in the right area. The probe only treats small areas at a time so your surgeon will move it around until all the cancerous cells in your prostate have been destroyed.

After Your Treatment

After you have received HIFU treatment, you will need to rest up until you’ve recovered from the anaesthetic. During this recovery period, you might need some pain relief to help you with any discomfort you may experience while the anaesthetic wears off. You can usually go home on the same day that you receive HIFU treatment. Your medical team will help show you how to manage your catheter once you have got home and advise you on when to return to have it removed. The anaesthetic will affect you for 24 hours following your treatment so your co-ordination will be affected. So, you will need someone to assist you and drive you home.

Check Ups

Following your treatment, you will need to have check-ups with your surgeon or medical team at the hospital where you had the treatment, and then with your GP. This is known as a follow-up, and the primary aim of this is to check how the Prostate Cancer has responded to the HIFU treatment. You will have Prostate Specific Antigen (PSA) tests every 3 to 6 months to check how well the treatment has worked.

How to Cope with Prostate Cancer

A prostate cancer diagnosis can change the way you feel about life.  It can make you feel scared, stressed and emotionally overwhelmed. After being diagnosed, there are important treatment choices to make, emotional stress to manage and insurance and paperwork to organise together with any other personal circumstances that might be affected by the illness.

The most important thing you can do is to think positively. Look at all the treatment options that are available to you, along with any side effects, so you know exactly what to expect after you have had your treatment(s). It is also an excellent idea to stay as active as you possibly can; the fitter your body is, the better it will cope with the treatment. Think about your lifestyle and diet; this way, you can make a significant difference in fighting the Prostate Cancer.

Find someone to talk to about Prostate Cancer. It could be a family member or close friend, a counsellor, someone on your medical team or someone you might meet at a Prostate Cancer support group meeting. It is always good to offload what’s on your mind and find answers to the questions you are asking yourself. Try to manage the emotional stress by learning cognitive techniques to help you relax.

Questions to Ask Your Doctor

It’s essential to have honest, open discussions with your doctor or consultant if you are going to receive HIFU. GP’s are becoming more familiar with less invasive treatment options such as HIFU, so feel free to ask any questions, no matter how big or small they might seem. Here are some questions that you might want to ask:

  1. Where is this treatment available?
  2. What are my other treatment options?
  3. What are the advantages and disadvantages of HIFU
  4. Can I see the results of HIFU treatment?
  5. What are the side effects of HIFU?
  6. How will I know if the treatment has worked?
  7. Will I need more treatment after HIFU?
  8. What treatments are available after receiving HIFU?

Donate to Prost8 UK Today

Prost8 UK specialises in promoting less invasive treatment options for early stage non-matastatic prostate cancer as well as early awareness of symptoms. It is important to remember that caught early prostate cancer is one of the most treatable cancers, but caught too late it is one of the least.

Our current focus and motivation is raising up to £10m in the next two years by creating running awareness and high profile fundraising campaigns to enable us to buy, donate and deploy HIFU equipment into each of the 14 NHS Cancer Care regions in the United Kingdom, together with promoting more effective screening procedures. Our primary objective is to improve post prostate cancer lifestyle.

1 in 8 men will be diagnosed with prostate cancer in their lifetime, so it could be you or a loved one next.  Help us to help all men by donating to Prost8 UK today.

Prost8 partners with GoFundMe

Crowdfunding

Prost8 UK announce Major Crowdfunding Campaign

Prost8 have proudly partnered with GoFundMe, the largest non-profit Crowdfunding platform in the world, to launch a major campaign supporting prostate cancer sufferers throughout the UK. 

The aim is to donate equipment to enable the NHS to offer wider coverage of a brand new type of treatment for prostate cancer known as  HIFU, high intensity focal ultrasound, across the UK over the next 3 to 5 years.  This will provide literally 1000’s of men with early stage prostate cancer in England, Scotland, Wales and N.Ireland to benefit from a far less invasive treatment option than those currently on offer. 

HIFU is no more harmful than a traditional ultrasound scan, just like that used to scan babies in the womb. However, the device uses multiple beams of ultrasound which, when focused onto one point in the cancer tumour, generates a tiny point of heat that destroys the cancer cells leaving surrounding tissue  unharmed. 

The procudure takes about 1 to 3 hours and is treated as a day stay with patients returning home the same day to recover in comfort. 

The crowdfunding campaign is really unique in that it has one national umbrella covering the UK but with 14 sub campaigns each focused on the NHS’s geographic regions.  Each Cancer care region will be able to take part by donating to support the deployment of a HIFU device in a stategic hospital in their own region. 

Everyone who donates will receive a new limited edition Prost8 supporters lapel pin and will also be entered into a fun celebrity led draw to win one of three amazing experiences (more details to follow).  Sign up for our email newsletter to ensure you are first in line to take part and to hear about other great events and campaigns.