a patient’s guide to prostate cancerprostatecancercentre.co.uk/downloads/booklets/prostate...a...

A Patient’s Guide toProstate Cancer

Professor Stephen Langley MS FRCS(Urol)Mr John Davies BSc FRCS(Urol)

Mr Christopher Eden MS FRCS(Urol)

Prostate Cancer Centre, Guildford

This booklet is intended to help you understand your prostate and what your operation will involve

This booklet is written by leading urologists for men and their familieswho would like to know more about prostate cancer. It is notintended to be a definitive textbook, but aims to provide a basicunderstanding of the disease, its diagnosis and treatment. Otherbooklets in this series explore the treatment options described in thisgeneral guide in more detail. These more specialist booklets may begiven to you by your doctor or they can be viewed and downloadedthrough the internet at: www.prostatecancercentre.com

© 2005 ISBN: 1 898763 13 5

This book is copyright under the Berne Convention. No reproductionwithout permission. All rights reserved.

First published in 1998Revised 1999, 2002, 2003, 2005

Written by:

Professor Stephen Langley, Mr John Davies and Mr Christopher EdenThe Prostate Cancer CentreStirling Road, Guildford, Surrey GU2 7RF

www.prostatecancercentre.comTel: 0845 370 7000 (local rate)

ContentsIntroduction 1

What is the Prostate and Where is it? 1What Does the Prostate Do? 2What Controls the Growth of the Prostate Gland? 3What is Prostate Cancer? 3How Does Prostate Cancer Spread? 4How Common is Prostate Cancer? 5Why Does Prostate Cancer Occur? 6

Symptoms and Diagnosis 7What are the Symptoms of Prostate Cancer? 7Who Treats Prostate Cancer Patients? 7How is Prostate Cancer Diagnosed? 8What Does the Stage of a Prostate Cancer Mean? 12What Does the Grade of a Prostate Cancer Mean? 13

Treatment 15How is Prostate Cancer Treated? 15What are the Treatment Options in Prostate Cancer? 16

Conclusion 28How Does One Cope with the Diagnosis of Prostate Cancer? 28Are There any Organisations for Patients with Prostate Cancer? 2910 Questions You Need Answered when Choosing Your Prostate Treatment 30Useful Addresses and Websites 31

Introduction

A Patient’s Guide to Prostate Cancer 1

What is the prostate and where is it?The prostate is a small gland, about the size of awalnut, which lies just below the bladder. The tubedraining the bladder, called the urethra, passesthrough the centre of the gland, to the penis.

Anatomy.

Vas deferens

Bladder

Pubic bone

Urethra

Penis

Testis

Adrenal gland

Kidney

Ureter

Rectum

Seminal vesicle

Prostate gland

Anus

A Patient’s Guide to Prostate Cancer2

The valve mechanism, or sphincter, maintainscontinence and stops urine leaking out of thebladder. It is located below the prostate gland andencircles the urethra.

What does the prostate do?The prostate gland is a part of the male reproductivesystem. It develops at puberty and continues toenlarge throughout life.

The prostate acts ratherlike a junction box. Itallows the tubes thattransport sperm fromeach testicle and thetubes that drain from theseminal vesicles to meetand then empty theircontents into theurethra. The seminalvesicles consist of twopouches that providenutrients for the spermand lie immediatelybehind the prostate.

At the point of orgasm, sperm, seminal vesicle fluidand prostatic secretions enter the urethra and mixtogether, forming semen. This is then ejaculated outthrough the penis by rhythmic muscularcontractions.

Vas deferens

ProstateSphincterUrethra Seminal vesicle

Bladder


What controls the growth of theprostate gland?The growth of the prostate is controlled bytestosterone, the male sex hormone. Mosttestosterone is made by the testicles, although asmall amount is also made by the adrenal glands,which lie on top of each kidney.The hormone goesinto the bloodstream and finds its way to theprostate. Here, it is changed into dihydro-testosterone(DHT), a more active form which stimulates growth ofthe gland.The prostate gradually enlarges withageing, resulting in symptoms such as reduced urineflow and a feeling of incomplete emptying of thebladder, having passed urine.This enlargement isusually benign (non-cancerous).

What is prostate cancer?Normally in the prostate, as in the rest of the body,there is a continuous turnover of cells, with newones replacing old, dying ones. In a cancer, thebalance between the new and old cells is lost, withmany more new ones being made and older cellsliving longer, as the process of planned cell deathhas been disrupted.

The malignant growths are known as prostatecancer. They differ from benign enlargements in thatthe cancerous cells can spread (metastasise) toother areas in the body. However, sometimes thecancer can be detected before it has spread outsidethe prostate.

How does prostate cancer spread?Cancer cells can spread by directly growingoutwards through the capsule (outer covering ofthe gland) into the neighbouring parts of the body,such as the seminal vesicles or bladder. They mayoccasionally spread through the bloodstream andimplant and grow in the bones of the spine. Finally,cells can spread through lymph vessels. Thesevessels are like a second system of veins, except


that, instead of blood, they contain a milky fluid thatis made up of the cells’ waste products. Lymphvessels drain via lymph nodes (special bean-shapedfilters), to finally empty back into the bloodcirculation, and it is these lymph nodes that can alsobecome invaded by cancerous cells.

How common is prostate cancer?Prostate cancer is now the most common cancer inmales in the UK, with nearly 20,000 men beingdiagnosed with the disease and 10,000 men dyingfrom it each year. However, there have been manyrecent advances in detecting and treating prostatecancer, and patients who are diagnosed early cannow have a high chance of cure.

Prostate cancer rarely occurs before 50 years ofage and is most commonly diagnosed in men intheir 60s and 70s. Indeed, it seems almost inevitable


��that, if one lives long enough, prostate cancer willoccur. However, this does not mean that all men willbe aware of the cancer, need any treatment, or evendie because of the disease.


Why does prostate cancer occur?The real answer to this question is not known.Nevertheless, there are a number of factors that canincrease the chance of developing prostate cancer.Relatives of patients with prostate cancer have anincreased risk of developing the disease themselves,especially if their father or brother were affected.The disease is more common in the Afro-Americanpopulation and rarer in the Chinese. There alsoappears to be a link with people living in urbanareas exposed to pollution and those consuminglarge quantities of dietary fat.

✗


Symptoms and Diagnosis

What are the symptoms of prostate cancer?There are often no symptoms associated with earlystage prostate cancer. As the disease progresses andthe tumour enlarges, it may press on the urethra,which runs through the gland, and obstruct the flowof urine during urination. In this situation, thepatient may notice a weak, interrupted stream ofurine that requires straining to produce and, oncompletion, he may still feel that the bladder is notempty. However, these symptoms are not specific toprostate cancer and are most commonly found inbenign (non-cancerous) enlargements of the gland.

Blood in the semen may be a sign of prostatecancer, although again this is a common finding andnot normally related to malignancy. If the tumourhas spread to the bones, it may cause pain. Thespine is the most common site for this to occur.

Who treats prostate cancer patients?This is the job of a specialist team of hospitaldoctors and nurses, including a Urologist (surgeon)and an Oncologist (physician specialising inradiotherapy and chemotherapy for the treatmentof cancers). Usually, following an examination bythe patient’s General Practitioner (GP), the GP willmake arrangements for the patient to see the

Urologist, so that a full range of tests can be carriedout and an assessment of the prostate made.

How is prostate cancer diagnosed?The doctor will initially ask the patient questions tocheck their general medical health and see if theyare experiencing any symptoms associated withprostate cancer (although, as has been mentioned,such symptoms are not specific to prostate cancer).

Physical examinationHaving made a general examination, the doctor willthen need to perform a rectal examination to feelthe gland. A gloved, lubricated finger is inserted intothe back passage (rectum) to check the size andshape of the prostate gland.



Blood testThe prostate can be evaluated by testing for thelevel of a particular protein in the blood called PSA(prostate-specific antigen). Prostate enlargementtends to cause an increase in the level of PSA, withmalignant tumours (cancers) producing a greaterincrease than benign enlargements. However, otherconditions can also cause PSA to rise, such as aurinary infection. Therefore, although a slightelevation in the PSA may indicate prostate cancer, itis by no means definite.

Digital rectalexamination.


Ultrasound examination and biopsyThe prostate can be imaged with ultrasound, adevice often used to scan pregnant women. Tovisualise the prostate, a well-lubricated probe,similar in size to a finger, is inserted into the rectum,and images of the prostate appear on a screen. Thistechnique also provides pictures of the seminalvesicles and the tissues surrounding the gland. Theimages produced help to identify areas within thegland that may be malignant, but the only way toprove there is cancer present is to take a biopsy (asmall piece of tissue obtained by a special needle).

If a biopsy is to be performed at the time of theultrasound scan, the patient will be forewarned. Asmall needle is inserted alongside the ultrasoundprobe, which can then be moved to the area of thegland in question. The procedure is no more painfulthan giving blood, due to the use of local anaesthetic.The doctor will give the patient an antibiotic to helpprevent any infection occurring.

Typically, 10 biopsies are normally taken, which arethen analysed in the laboratory, and a diagnosisobtained. After the procedure, it is quite common forthe patient to see some blood in his urine, semenand stools, but this usually settles over a week ortwo.

Bone scanOnce a diagnosis of prostate cancer has been made,if spread is suspected (usually by the level of PSA), abone scan can be used to see if the tumour hasinvaded bone. For this painless test, a tiny, harmlessquantity of a radioactive agent is injected into avein. This makes its way to any cancer deposits


within the skeleton and sticks to them.After a few hours, the patient isscanned by a special camera, similar toan x-ray machine, which detects thesedeposits, if present.

Other testsTwo other types of scanning machines are available.A computer tomography (CT) scan or a magneticresonance imaging (MRI) scan are sometimes usedto obtain detailed pictures of the prostate and thesurrounding tissue. Both are quite painless. The CTscanner uses x-rays and MRI uses magnetic fields toproduce their images.

All of these tests will help the doctor to assess thestage and grade of the prostate cancer.


Stage

1 Earliest stage, where the cancer is sosmall that it cannot be felt on rectalexamination, but is discovered in aprostate biopsy or in prostate tissuethat has been surgically removed to‘unblock’ the flow of urine (as in atransurethral resection of theprostate – TURP).

2 The tumour can now be felt onrectal examination, but is stillconfined to the prostate gland andhas not spread.

3 The tumour has spread outside thegland and may have invaded theseminal vesicles.

4 The tumour has spread to involvesurrounding tissues such as therectum, bladder or muscles of thepelvis.

What does the stage of aprostate cancer mean?The stage of a prostate cancerrefers to how far the cancer hasspread. The classificationcommonly used to stage prostatecancer in the UK is shown here ina simplified form. (The prefix T isused by convention to identify thetumour stage, i.e. T1 or T2).

It is very important to rememberthat although all prostate cancershave the potential to progress, itusually takes years to pass fromStage 1 to 4.

T1

T3

Seminal vesicle

Rectum

External urinarysphincter muscle

T4

T2

What does the grade of a prostatecancer mean?The grade of a cancer is the term used to describehow aggressive the disease is and whether it willprogress quickly (months) or slowly (years). Thegrading assessment is made by a Pathologist in thelaboratory, looking at the prostatic cells under themicroscope. The grading system used for prostatecancer is known as the Gleason Scoring system,named after the Pathologist Donald Gleason, andranges from 2-10.

The Pathologist will identify several of the prostatecancer cells in the biopsy. Having identified thelargest and second largest areas of cancerous cells,he or she will assign each area a number known asthe Gleason grades. These grades range from 1-5,with Grades 1-3 tumours least likely to spread andGrades 4 and 5 most likely.


Grade 1 (Gleason score 2-4)

Least aggressive


Moderatelyaggressive

Gleason Scale – Appearance of Tissue


Most aggressive

The Gleason score is calculated by adding the twoGleason grade numbers together – thus, the scoreranges from 1+1=2 to 5+5=10. Therefore, a Gleasonscore of 3+2=5 suggests that most of the cancer isGleason Grade 3, with a smaller amount of GleasonGrade 2. Prostate cancers with a Gleason score of 7or greater will always contain at least some Grade 4tumour and hence have a worse prognosis.

Understanding of the pathological grading is ofgreat importance for both the clinician and thepatient, as it will determine which treatment optionsare available, as well as their likely success. Manyregional cancer centres will arrange for a specialistPathologist to review the microscopic slides of apatient’s prostate cancer cells to confirm thediagnosis before treatment begins.


How is prostate cancer treated?At present, there is no definite evidence as to whichis the best treatment for prostate cancer, especiallyfor early stage T1 or T2 tumours, and differentUrologists may have differing views. One of thereasons for this is that some patients with earlystage disease may live 10 years or more if notreatment at all is used. Therefore, more involvedtherapies have a hard act to beat. However, in otherpatients, the disease can be much more serious.Unfortunately, whilst it is possible to generalise, itcan be difficult to predict what course the prostatecancer will take in any individual.

Also, the side-effects of treatment must bebalanced against the overall benefit of therapy. Forexample, there is little point in undergoing majorsurgery to take out the prostate if the tumour hasspread to areas where it cannot be removed.

The treatment of prostate cancer is determinedby the stage and the grade of the disease as well asthe PSA. There are a number of treatment optionsfor every stage, each with their own advantagesand disadvantages. Thus, the therapy needs to betailored to suit each individual patient. It is possibleto cure patients with prostate cancer at an earlystage, but even if cure is not a possibility, thedisease can normally be kept in check for a numberof years.

Treatment



What are the treatment options inprostate cancer?The different treatment options available to patientsdiagnosed with prostate cancer are described below.It is important that any patient with such a diagnosisis aware of the different treatments, and they shouldfeel free to discuss these with their Urologist andOncologist. Some patients feel surprised that they arebeing offered a choice of different treatments andnaturally feel inadequately prepared to make such animportant decision.This is a common feeling, whichthe information in this and the related bookletsshould help to dispel. One of the prime reasons forincluding patients in the decision-making process oftheir treatment is that there is little evidence thateither surgery or radiotherapy is more or less likely tocure an individual, or indeed that curative treatmentis always necessary, even when possible.

Whatever therapy is undertaken, the patient willneed regular follow-up examinations, which willinvolve a PSA blood test and possibly scans or x-rays, for a number of years.

Active surveillanceIf their cancer has been diagnosed accidentally,during an operation to remove prostatic tissueblocking the urinary stream or by a PSA blood testand biopsy, and the patient has no symptoms, a“wait and see” policy may be chosen.

This does not mean “do nothing”, but the patientwill be regularly monitored by the doctor and ifproblems develop, appropriate action taken. Duringthis observation period, seeing how quickly the PSArises can assess the severity of the condition.

Frequently, patients opting for such a treatmentstrategy will be offered a repeat prostate biopsy 2years after diagnosis, to ensure the grade of thecancer has not worsened. If treatment is ultimatelyrequired, curative therapies may still be offered,although often hormone therapy (see page 25) is thetreatment of choice.With such a regimen, patientscommonly live for a number of years and this optionis frequently chosen by patients with low gradecancers and/or who are elderly.

Prostate surgery: Radical prostatectomyRadical (curative) prostatectomy is an operation toremove the entire prostate and seminal vesicles. Thisoperation can be performed through an incision inthe lower abdomen (a radical retropubicprostatectomy) or through an incision made between



Prostatectomy.

the anus and scrotum (a radicalperineal prostatectomy). Inspecialist centres, the prostatecan also be removed by akeyhole or laparoscopictechnique. These are complex,major operations that usuallyrequire a hospital stay ofbetween 1 week for openoperations to 2 days withkeyhole surgery. Such proceduresshould not be confused withconventional prostate surgery –transurethral resection of theprostate (TURP) – where onlythe tissue blocking the urinaryflow is removed, leaving partof the gland behind.

The advantage of surgery isthat it is a one-off procedureand provided the cancer isconfined to the prostate, willhopefully cure the disease. Itavoids the side-effects ofradiotherapy and is thoughtby some to be the mosteffective form of treatmentfor early prostate cancer.

However, there are risksassociated with radicalprostatectomy. It is a majoroperation and involves a numberof weeks of convalescence to make afull recovery. Unfortunately, the prostate lies very close

Vas deferens

Vas deferens (cut)

Bladder

Testis

External urinarysphincter muscle

Rectum

to both the sphincter that controls urinary continenceand the nerves that produce penile erections. In thepast, removal of the gland often caused damage tothese structures, resulting in a significant risk ofpostoperative urinary incontinence and impotence(inability to achieve an erection).

Newer surgical techniques have reduced therecurrence of impotence and severe incontinence isnow uncommon. Furthermore, there are a number ofnew therapies to treat such side-effects, should theyoccur. Radical prostatectomy, more than any otherprostate cancer treatment, is highly dependent on theexperience and skill of the surgeon. Few Urologists inthe UK are currently trained in the keyhole technique,due to the lack of training opportunities and thelengthy learning curve of the procedure.

For more information on radical prostatectomy,please read A Patient’s Guide to RadicalProstatectomy, which should be available at yourhospital or may be viewed and downloaded fromthe internet at: www.prostatecancercentre.com

Radiotherapy:External beam or brachytherapyRadiotherapy involves directing high-energy radiationrays at the tumour, aiming to destroy the cancerouscells and leave the healthy ones intact. It may be usedin two situations: firstly, to treat early cancers confined tothe gland or the surrounding tissues (so-called radicalradiotherapy); and, secondly, to treat tumours that havespread to the bone and which are causing pain(palliative radiotherapy). Radiotherapy is a painlessprocedure, like having an x-ray, although there can betroublesome side-effects associated with the treatment.



Radical radiotherapy for a tumourlocalised to the prostate may beeither given by external beamradiotherapy or by brachytherapy.

External beamradiotherapyRadical (curative)external beamradiotherapy involvesbeams of radiationpassing through thebody to be targetedonto the prostate,which is a process similar to x-rays. The treatment isgiven on an out-patient basis with the patientsattending their local cancer centre for five days aweek for 4–7 weeks. At each visit, the patient willreceive a small fraction of the radiation dose untilthe therapy is complete.

For more information on radiotherapy, please readA Patient’s Guide to External Beam Radiotherapy,which should be available at your hospital or maybe viewed and downloaded from the internet at:www.prostatecancercentre.com

BrachytherapyRadical (curative) radiotherapy can also be givenusing radioactive seeds that are approximately halfthe size of a grain of rice.These seeds, typically 80-100in number, are inserted directly into the cancerousprostate gland through delivery needles underultrasound control. The needles are passed throughthe skin behind the scrotum and in front of the anus

to reach the prostate.The procedure isperformed under an anaesthetic. It hasthe advantage of being either a day caseor overnight stay procedure, with patientsrapidly returning to normal activities.

This procedure is relatively new, the firstpatients being treated in the late 1980s.The results of this technique in curing

patients with prostate cancer seemto be as good as for radicalprostatectomy or external beamradiotherapy.

The advantage of radicalradiotherapy is that it can cure early


I125 Brachytherapy implant.

Catheter in urethra

Needle, delivering seeds into prostate

Template to aid accurate placementof the needles delivering the seedsUltrasound probe in rectum

for needle guidance

Cross-sectionaldiagram oftheimplantationprocess.

Post-implant x-ray of seeds in prostategland, with the ultrasound probe in therectum.

prostate cancer without the need for a majoroperation. It rarely causes loss of urinary control, andimpotence is less common than with surgery.

The side-effects of radiotherapy, in general, arenormally limited to patients having radical rather thanpalliative treatment. External beam radiotherapy islengthier than surgery and often causes tiredness,nausea, and diarrhoea, as well as frequent and painfulurination. Although most of these side-effects settle intime,some will occasionally persist. With brachytherapy,the side-effects are usually confined to the urinarysystem, with patients temporarily experiencing a slowflow and urinary frequency. Some patients may evenexperience difficulty in passing urine at all after thetreatment and require a catheter (tube draining thebladder through the penis) for a short period, normallya week or two, before their urinary symptoms settle.However, incontinence and impotence seem leastcommon with this form of treatment.


Bladder

Prostategland

Radioactiveseeds

Urethra

Illustrationshowing theseeds lying inthe prostategland afterimplantation.


For more information on brachytherapy, pleaseread A Patient’s Guide to Prostate Brachytherapy,which should be available at your hospital or maybe viewed and downloaded from the internet at:www.prostatecancercentre.com

CryosurgeryCyrosurgery uses extreme cold to destroy theprostate tissue. Using transrectal ultrasound in afashion similar to brachytherapy, fine cryoneedlesare inserted into the prostate gland. Underanaesthetic, argon and helium gases are used tofreeze, then thaw, the prostate, causing destructionof the tumour. Temperature can be as low as -140°C.A warming device and temperature sensors protectProstate

gland

Cryoneedle

Argon/heliumgas supply

Transrectalultrasound

Ice balldeveloping inprostate gland

Cryosurgery.

vital neighbouring structures, such as the rectum,bladder and sphincter muscles.

Patients typically stay in hospital overnight and aredischarged home with a urinary catheter for 2 weeks, toallow the swelling of the prostate to reduce.Cryosurgeryis a newer technique being investigated in only a smallnumber of specialist centres in the UK. The impotencerate is higher than with other treatments and incontinencecan occasionally occur. Although it has been used totreat men with newly-diagnosed prostate cancers, it iscurrently primarily reserved for patients with recurrentprostate cancer after treatment by radiotherapy.

For more information on cryotherapy, please readA Patient’s Guide to Prostate Cryotherapy, whichshould be available at your hospital or may beviewed and downloaded from the internet at:www.prostatecancercentre.com

High intensity focused ultrasound (HIFU)HIFU treatment involves focusing highintensity sound waves on the prostate,which generate high temperatures over80°C and cause tissue destruction.These sound waves are generated by aspecial transrectal ultrasound probethat allows the prostate gland to bevisualised and targeted. The aim of thetreatment is to obliterate the canceroustissue, whilst preserving neighbouringorgans.

The procedure is performed under anaesthetic andtakes approximately 3 hours. Some centres routinelyperform a telescopic prostate operation to rebore theprostate,TURP, before treating with HIFU. When used


HIFU probe in rectum

Catheter

with curative intent, the success rate is uncertain andrisk of impotence seems high. Whilst the concept ofthe device is appealing, its real place and value in thetreatment of prostate cancer has yet to be establishedand, at present, the technique is consideredexperimental.

For more information on HIFU, please read APatient’s Guide to HIFU, which should be available atyour hospital or may be viewed and downloadedfrom the internet at: www.prostatecancercentre.com

Hormone therapyWhen the cancer has spread beyond the prostate,going to either the lymph nodes or bones, hormonaltherapy may be very effective at shrinking thetumour and reducing the side-effects of the disease.It does not provide a cure, but will often keep thecancer in check for a number of years.

Some patients are given a course of hormonetherapy before having radical radiotherapy.

This is useful if the cancer has spreadoutside the confines of theprostate gland, but has not yetreached the lymph nodes orbone.

As mentioned earlier, theprostate gland and prostatecancer are under the influenceof testosterone, the male sexhormone, which drives thetumour to grow and spread. Byblocking the body’s productionof testosterone, or blocking its

action, the growth of the tumour


may be greatly reduced.There are a number of ways toadminister such hormonal therapy (see below).Whatever technique is chosen by the patient, certainside-effects are common, such as hot flushes, a loss ofsexual desire, impotence and occasionally breasttenderness, or more occasionally breast enlargement.

Surgical orchidectomyThe parts of the testicles that produce testosteronemay be surgically removed by a smalloperation, called an orchidectomy,which can be performed as a daycase procedure. This has theadvantage of being a one-offtreatment, which does not relyon the patient rememberingtheir medication, and tends tocause less breast problems.However, the operation isirreversible and an option thatsome men find unacceptable. Itis not true that men develop ahigh-pitched voice after such aprocedure!

Injection therapyInjection of an agent, known as anLHRH analogue, has a similar effect toremoving the testicles, but isreversible and doesn’t involve anoperation. The injection is given everyone or three months by either adoctor or nurse, or the patients can betaught to inject themselves. This new



approach to injection therapy has proven verypopular with some patients who have been able tomaster the technique without any difficulty.

Because there can be an initial rise in testosteroneafter the first injection, a two week course of anti-androgen tablets (see below) are normallyprescribed to stop this effect. Hot flushes, breasttenderness and impotence are common side-effectswith this form of medication.

Anti-androgen tabletsThis therapy involves taking tablets to block theaction of testosterone. They work by either loweringthe level of testosterone in the body, or by blockingits action on the prostate gland. The tablets, whichare taken each day, may be used alone to treatprostate cancer, or in combination with an LHRHanalogue (see previous page). All of the availablemedications have side-effects such as breasttenderness or enlargement, although some havefewer effects on sexual desire and potency.

ChemotherapyChemotherapy involves powerful drugs to attackthe cancer cells and try to prevent them growing. Itis a second line of defence for patients withadvanced stage prostate cancer that is no longercontrolled by hormonal therapy. There are a numberof different agents currently available, with newdrugs having recently been launched which appeareffective in controlling the disease in its later stages.


Conclusion

How does one cope with thediagnosis of prostate cancer?The diagnosis of prostate cancer maychange the lives of both the patientand his family. It is quite normal attimes for patients or their lovedones to feel frightened, angry ordepressed.These are naturalreactions, which for mostpeople are helped by sharingtheir concerns and feelings.Patients may find comfortin discussing theirproblems with otherprostate cancer patients.They should bear in mind,however, that no twoindividuals or tumours are the same.Thepatient’s doctor is the best person to discuss theirown condition – to avoid a little knowledge being aworrying thing!

Whilst prostate cancer is a serious disease, it canbe very effectively managed – or, indeed, cured – iftreated early.


Are there any organisations forpatients with prostate cancer?The hospital looking after the patient, or the patient’sGP, are the best initial sources of further informationand guidance. Pages 31-32 list some addresses andwebsites of organisations that specialise in treatingand supporting patients with prostate cancer andthe associated side-effects that may occur.


10 questions you need answered whenchoosing your prostate treatment

1. What is my PSA?

2. What is my clinical stage?

3. What is my Gleason score?

4. Do I need a bone scan, CT or MRI?

5. Has the cancer spread outside the prostate gland?

6. Is the prostate cancer curable?

7. Am I young and fit enough to attempt curative treatment, or isthe condition not life-threatening?

8. Which of the treatment options are suitable for me?

9. How many patients has your doctor treated using this techniqueand what are their success and complication rates?

10. Does this hospital specialise in prostate cancer treatments?


Useful addresses and websitesThe Prostate Cancer Charity www.prostate-cancer.org.uk3 Angel Walk, Hammersmith, London W6 9HXTel: 020 8222 7622 Helpline: 0845 300 8383For information about prostate cancer.

Prostate Cancer Centre prostatecancercentre.comStirling Road, Guildford, Surrey GU2 7RFTel: 0845 370 7000 (local rate)Providing a single point of referral to specialists at the forefront of the treatment of localisedprostate cancer.Mr John Davies - Cryotherapy and high intensity focused ultrasound (HIFU).Mr Christopher Eden - Laparoscopic radical prostatectomy.Professor Stephen Langley - Brachytherapy.

The Prostate Project www.prostateproject.org

PCaSo Prostate Cancer Network www.pcaso.comPO Box 66, Emsworth, Hampshire PO10 7ZPHelpline: 0845 650 2555To improve the diagnosis, treatment, care and support to those troubled by this cancer.

Macmillan Cancer Relief www.macmillan.org.uk89 Albert Embankment, London SE1 7UQTel: 020 7840 7840 Macmillan Cancerline: 0808 808 2020Provides information on Macmillan nurses and the help that they can provide for patients and their families.

The British Association of www.cancerbacup.org.ukCancer United Patients (BACUP)3 Bath Place, Rivington Street, London EC2A 3JRAdministration line: 020 7696 9003 Information line: 0808 800 1234Provides information on all aspects of cancer care and details of local organisations; staffed by cancer nurses.

The Continence Foundation www.continence-foundation.org.uk307 Hatton Square Business Centre, 16 Baldwin Gardens, London EC1N 7RJTel: 020 7404 6875 Fax: 020 7404 6876 Incontinence information helpline: 0845 345 0165Helpline for people with bladder and bowel problems. Open 9.30am – 1pm weekdays.

Irish Cancer SocietyInformation Officer, 43-45 Northumberland Road, Dublin 4Tel: 00 353 1 2310 500 Helpline: 1 800 200700 (available only in Eire)Helpline service, staffed by nurses, to give information and advice on all aspects of cancer care.Open 9am – 5pm weekdays.

Everyman www.icr.ac.uk/everymanEveryman, The Institute of Cancer ResearchFreepost LON922, London SW7 3YYTel: 020 7878 3810 Fax: 020 7153 5313 e-mail: [email protected] to male cancers, promoting awareness and raising money for research.Has opened the UK’s first male cancer research centre.

British Prostate Groupc/o BAUS, 35-43 Lincoln’s Inn Fields, London WC2A 3PETel: 020 7869 6950 Fax: 020 7404 5048An interest group around prostate disease, involving both clinical and scientific research,particularly in prostate cancer.

CancerBACUPwww.cancerbacup.org.uk‘Helping people live with cancer.’

CancerSupport UKwww.cancersupportuk.nhs.uk‘Coping with cancer at home.’

The Sexual Dysfunction Associationwww.impotence.org.uk‘To help sufferers of impotence (erectile dysfunction) and their partners.’

Other useful websitesBrachytherapy www.prostatespecialist.co.uk

www.seattleprostateinst.com

Radical prostatectomy www.laparoscopicradicalprostatectomy.co.uk

Cryosurgery www.cryosurgery.co.uk


Published by:

Eurocommunica LtdCaxton House, 51 Barnham Road, Barnham, West Sussex PO22 0ER

Patient Information

Hospital Details: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Consultant: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urology Nurse Specialist: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PSA: Clinical Stage: Gleason Score:

. . . . . . . . . . . . . . ng/ml T . . . . . . . . . . . . . . . . + . . . . . . = . . . . . .

Imaging Results:

Bone scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MRI/CT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Next Hospital Appointment:

Next PSA level test:

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The views and opinions contained in this book are those of theauthors and not necessarily those of Eurocommunica Ltd.

Date of preparation: May 2005

a patient’s guide to prostate cancerprostatecancercentre.co.uk/downloads/booklets/prostate...a...

Documents