Today marks the start of EAU17 congress in London, bringing together urologists from across the world to share their latest research and ideas in the field of urology and its subspecialties. We will be keeping an eye on the latest news from the event and tweeting the most interesting developments, particularly in prostate cancer, which affects 1 in 8 men in the UK and has recently seen great strides forward in terms of treatment and diagnostic techniques.
In the UK, over 40,000 new cases of prostate cancer are diagnosed every year. It is the most commonly diagnosed type of cancer in men in the UK and the sixth leading cause of cancer death worldwide. Despite this, it is curable if diagnosed early, in contrast to many other types of cancer.
Generally, men over the age of 50, those of African Caribbean or African origin and those with a first-degree relative who has had prostate cancer are at higher risk compared with other men.
Typical symptoms of prostate cancer include an increased need to urinate (often during the night), difficulty in starting to urinate and weak flow and straining while urinating. However, these symptoms are also associated with other conditions such as benign prostatic hyperplasia or lower urinary tract infection. Prostate cancer may also go undetected for many years without symptoms, so an accurate diagnosis is essential to avoid unnecessary treatment. The main symptoms suggestive of advanced prostate cancer is bone pain (if the cancer has spread to the bone), but neurological dysfunction and weight loss may also occur if the cancer has spread elsewhere.
Currently available diagnostic tests include the prostate-specific antigen (PSA) blood test, a digital rectal examination or an ultrasound-guided biopsy.
In the UK, the reliability of the PSA blood test has been the subject of recent debate. In fact, the reliability of the test is the reason why the NHS does not offer a screening programme, but instead offers a free informed choice programme outlining the pros and cons of a PSA test, to all men 50 years of age or older.
Recently, the PROMIS study found that using MRI to triage men with suspected prostate cancer could allow 27% to avoid unnecessary biopsy. In addition, the study suggests that MRI could allow a 5% reduction in the number of men who are diagnosed with a prostate cancer that does not go on to cause them harm in the remainder of their lifetime – and thus avoid invasive and unnecessary biopsy and curative therapy.
Patients are advised to consult with clinical specialists (urologist, medical radiologist and oncologist) not only to discuss available treatment options, but also to decide their desired course of action. Typically, the patient has to choose between three approaches after diagnosis: ‘watchful waiting’, ‘active surveillance’ or immediate treatment.
‘Watchful waiting’ allows the cancer to progress until symptoms arise, at which point hormone therapy together with radiotherapy are given to prolong life expectancy (but do not cure). Irrespective of the cancer type (e.g. slow- or fast-growing), this may be a desired course of action for men with a life expectancy of <10 years, so as to avoid the side effects of erectile dysfunction and urinary incontinence, which usually occur within 3–5 years of treatment. Palliative therapy can also be given to reduce cancer pain. ‘Active surveillance’ is usually the desired course of action if the cancer-type is slow-growing. ‘Active surveillance’ involves regular monitoring (usually annually) to assess the progression of the cancer and treatment is begun only when the risk of metastasis is significant. As with ‘watchful waiting’, the advantage of deferring treatment is the delay in the onset of side effects, but with the ‘active surveillance’ approach the aim is to eventually provide curative treatment. Surgical removal of the prostate (radical prostatectomy) and radiotherapy are both curative treatment options if applied before the cancer spreads to other organs.
Immediate curative treatment is usually suggested in two circumstances. Firstly, if the cancer has not been detected early enough and the risk of metastasis is substantial and secondly, if the cancer type is aggressive, in which case the ‘active surveillance’ approach would be risky. For more information, visit www.pcf.org where you can read more about prostate cancer (including personal experiences of patients) and make donations to fund research for better screening tests and treatments with fewer side effects.
1. Ahmed HU, El-Shater Bosaily A, Brown LC, et al.; PROMIS study group.. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 25;389:815-822; 2017. doi: 10.1016/S0140-6736(16)32401-1.