HEALTH MATTERS: Expert support is here for prostate cancer journey
By Emma Peacock
Myself and my senior colleague Brian work in the Highland urology unit of Raigmore Hospital.
Our primary role is to coordinate the diagnostic pathway for men referred with a suspicion of prostate cancer from the point of referral through to decision to treat.
We are part of a much larger urology team who work with different urological cancers and non-cancerous conditions.
Prostate cancer is the most common cancer in men. Figures published in 2021 by Public Health Scotland state 4265 men were diagnosed with prostate cancer that year.
In recent years there has been an increase in media coverage due to high profile celebrities such as Kenny Logan, Bill Turnbull and, most recently, Sir Chris Hoy being diagnosed. They have helped promote awareness by openly discussing their diagnoses.
Prostate cancer can have no symptoms. Urinary issues can be a symptom, but it is quite common for these to be unrelated to cancer, even if it is present.
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It is important to consider various factors before investigating, such as age and other comorbidities as, in some cases, prostate cancer may not actually affect a man's life expectancy, therefore investigations may not be necessary.
Risk factors such as family history and ethnicity do play a role in an increased likelihood of developing the disease.
Investigations such as the PSA (Prostate specific antigen) blood test and digital rectal examinations are part of the assessment process.
The prostate cancer risk management programme, available online, states that any man aged 50 and over who decides to have a PSA test based on balanced information can do so for free on the NHS. Please discuss this with your GP.
It also outlines the benefits and risks of this test as levels can be raised for a number of reasons other than cancer. Younger men can also be tested if they have clinical concerns or a strong family history.
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A PSA could:
• Indicate prostate cancer at an early stage wher treated could provide a cure or extend life
• Suggest some men have a prostate cancer when they don't
• Instigate investigations which find a slow growing cancer that may never cause symptoms or shorten life, resulting in unnecessary treatments with side effects that can affect daily life
That is why, together with a PSA test, we often perform a digital rectal examination (DRE) to assess the size of the prostate gland and any irregularities. Depending on the outcome an MRI might be the next step. Multiparametric MRI scans, where several techniques are combined into a single scan session, are now considered the gold standard investigation if a man has either an abnormal feeling prostate and/or or a raised PSA.
An abnormal MRI does not necessarily mean prostate cancer but it does justify investigating further. We have a superb radiology and pathology team who work quickly to allow men to have timely investigations and results. If we diagnose a cancer we have our own Urology cancer support worker Ashely and we also work closely with the Maggies Centre who can offer advice and support. For those who are diagnosed with low grade, low volume disease and are being monitored, Kayleigh is our dedicated team member managing that caseload.
Currently, there is no national prostate cancer screening program but significant research is being done around this. Further information regarding this can be found by reading information on the prostate cancer risk management program website. Charities such as Prostate Scotland and Prostate Cancer UK also have websites and phone lines that can offer support and information.
