Medicines for Prostate cancer

What it is

Prostate cancer is the most common cancer in men, in which cells in the prostate (a small gland below the bladder that helps make semen) grow in an uncontrolled way. It mainly affects older men, and the risk increases with age; other factors that increase risk include a family history of prostate cancer, being of Black ethnicity, and being overweight. A key feature of prostate cancer is that it often grows slowly, and many prostate cancers may never cause problems in a man’s lifetime — but some are more aggressive and can spread, so it varies a great deal. In its early stages, prostate cancer often causes no symptoms, particularly because it usually begins in the outer part of the gland. When symptoms do occur, they are often urinary — such as needing to urinate more often (especially at night), difficulty starting or a weak flow, straining, or a feeling of not fully emptying the bladder — but these symptoms are very commonly caused by a non-cancerous enlargement of the prostate (which is very common with age) rather than cancer. Symptoms that may suggest more advanced disease include blood in the urine or semen, and, if it has spread, bone pain, unexplained weight loss, or tiredness. Because early prostate cancer often has no symptoms, awareness of risk and discussing testing (including the PSA blood test) with a GP is important, particularly for men at higher risk. Diagnosis and treatment are individualised: options range from monitoring (active surveillance or watchful waiting) for slow-growing cancers, through to surgery, radiotherapy, and hormone therapy, and outcomes for prostate cancer are often good, especially when it is caught early or is slow-growing.

How it is treated

Prostate cancer is assessed and managed by specialist teams, and because it varies so much — from slow-growing cancers that may never cause harm to more aggressive ones — the approach is carefully individualised. Assessment may involve a PSA blood test, an examination of the prostate, an MRI scan, and a biopsy, which help determine whether cancer is present and, if so, how aggressive it is and whether it has spread; this guides decisions. Management options include: active surveillance or watchful waiting — closely monitoring a slow-growing, localised cancer and only treating if it changes, which avoids unnecessary treatment and its side effects; surgery to remove the prostate; radiotherapy (external or internal); and hormone therapy (which lowers the male hormones that fuel prostate cancer), often used for more advanced disease or alongside other treatments; with chemotherapy and other treatments used in certain situations. The choice depends on the stage and aggressiveness of the cancer, the man’s age and general health, and his preferences, including weighing up the benefits against the possible side effects of treatment (such as effects on urinary, bowel, and sexual function). Because early prostate cancer often causes no symptoms, and because the PSA test has benefits and limitations, men — particularly those over 50, or younger if at higher risk (family history, Black ethnicity) — are encouraged to discuss their risk and the pros and cons of PSA testing with their GP, so they can make an informed choice. The reassuring messages are that prostate cancer is common and often slow-growing, that outcomes are frequently good (especially when caught early), and that there is a range of effective options — including simply monitoring some cancers. The key action is awareness: knowing the risk factors, discussing testing with a GP, and getting urinary symptoms or other concerns checked.