You may have noticed the badges appearing on the lapels of football managers, pundits and presenters recently as the return of March for Men draws closer. Setup by Prostate Cancer UK, March for Men is looking to raise over £120m towards better testing, treatments and care with the goal of slashing prostate cancer deaths in half by 2026. It’s been embraced by the footballing world on the basis that whilst men don’t tend to visit their GPs much, they do tune into the football results at the weekend.

What is the prostate?

The prostate is a walnut shaped gland located between the bladder and penis. Surrounding the urethra, the prostate is part of the male reproductive system and its main function is secrete fluid which nourishes sperm.

What can go wrong with the prostate?

An enlarged prostate (sometimes known as benign prostatic enlargement) is by far the most common prostate problem. Because the prostate continues to grow as we age, it’s common in men aged over 50 and can display symptoms such as:

  • Weak flow of urine or difficulty starting to urinate
  • Feeling that the bladder has not emptied properly or dribbling urine after you finish
  • Needing to get up in the night often to urinate or a sudden urge to urinate

It’s important to remember however that an enlarged prostate is not prostate cancer and has no bearing on whether you’re more likely to get prostate cancer in the future.

Prostatitis is the second most common issue with the prostate and is a collective name given to symptoms caused by inflammation or infection. It’s more commonly seen in men aged 30 to 50 but is not the same thing as enlargement. Symptoms vary widely between individuals but more common symptoms are difficulty passing urine, and pain or discomfort around your testicles, back passage or lower abdomen. To help minimise inflammation and infection there are things you can do to help yourself. Try to not sit for long periods – especially on hard surfaces – and avoid cycling which can worsen symptoms. Using a diary to record your food, fluids and exercise can also help pinpoint any behaviours that could contribute to the problem. For example, drinking too much caffeine and alcohol can contribute to the problem.

Despite it now being the most common type of cancer in men1 and the second most common cause of cancer related deaths in males, prostate cancer is the least common of the three problems. There are around 182 diagnoses per 100,000 men in the UK2. It typically affects men over the age of 65 and you’re 2.5 times more likely to get prostate cancer if you have a family history3 and Afro-Caribbean men are at 3 times higher risk4.

Family history

Lifetime risk

No history

8%

Father with prostate cancer at ≥ 60 years

12%

One brother affected at ≥ 60 years

15%

Father affected before 60 years

20%

One brother affected before 60 years

25%

Two male relatives with prostate cancer*

30%

Three or more affected male relatives

35 to 45%

The rates of growth vary greatly between individuals but most cases the cancer is slow growing. Symptoms can be very similar to those observed in other prostate problems, which can make it harder to accurately diagnose. But if you are having to urinate more frequently, getting up in the night to urinate more frequently, having trouble starting or stopping it’s advisable to talk with your doctor.

It’s also important to remember that although incidence of prostate cancer increases with age it does not necessarily mean that it will cause any significant problems or shorten life. 88% of men aged over 80 have prostate cancer but only 3% died as a results of it. 

PSA testing and prostate health

Prostate Specific Antigen (PSA) is an enzyme produced by the prostate and if levels are high it can cause PSA to leak the fluid into the bloodstream and is therefore detectable through blood testing. Raised PSA levels do not mean that you have prostate cancer however – as the three common prostate issues are all closely related in their symptoms – and it’s important to remember that further testing would be required in order to confirm if the cause was due to cancer.

The benefits of PSA testing are that it may lead to prostate cancer detection before symptoms develop and at an earlier stage when the cancer could be successfully treated.

However, the disadvantages of PSA testing can be seen to outweigh the positives. It’s not diagnostic and further testing via digital rectal examination, biopsy, ultrasound and MRI scan are likely to be required to make a positive diagnosis. This can therefore mean that many men are put through medical procedures and caused anxiety unnecessarily. This is because PSA testing is not tumour specific – raised levels can be caused by factors such as age and prostatitis – and it’s not able to identify how aggressive a tumour is. Ejaculation can also cause PSA levels to rise temporarily as can riding a bike – so it’s important to avoid these prior to undergoing a test. Equally, obese men tend to have lower levels of PSA and drugs like aspirin and statins can also cause PSA levels to be lower. All these factors mean that PSA testing may present ‘false-positives’ or ‘false-negatives’. In other words, men without prostate cancer may have a positive result and men without prostate cancer given a positive result – around 75/100 men with raised PSA have a false-positive result.

Despite these factors, PSA testing does have a role. A 2013 study found that the annual changes in PSA levels over time are better indicator of the presence of prostate cancer than a single test 6. The European Randomized Study of Screening for Prostate Cancer (ERSPC) (the largest randomised trial of PSA testing for prostate cancer) also found a significant reduction in risk of death from prostate cancer by 21% after 13 years of follow-up 5.

What’s the answer?

Prostate cancer is a growing problem but perhaps the first challenge to overcome is for men to understand more about their risks and to talk more about the problem. In many cases issues with the prostate are not caused by cancer and PSA testing (despite limitations) remains the best test currently available provided individuals understand it within the context of their health and the limitations of the testing.

For more information about PSA, visit PHE Prostate Cancer Risk Management Programme.

Article References

1 https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/common-cancers-compared#heading-One

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005081/

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955666/

4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154945/

5. Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised ; Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 2014;384(9959):2027-35

6 https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1464-410X.2012.11651.x