Source: United Kingdom – Executive Government & Departments
Scientists comment on the symptoms, diagnosis and treatment of prostate cancer, following Joe Biden’s diagnosis.
Ben Lamb, Consultant Urological and Robotic Surgeon, Barts Health and UCLH NHS Trusts, and Clinical Senior Lecturer, Barts Cancer Institute, Queen Mary University of London (QMUL), said:
“Most prostate cancer (around 4/5) in the UK is diagnosed before it is metastatic, with 1/5 diagnosed with metastatic disease. There is regional variation with the highest rates of diagnosis of metastatic disease in parts of Scotland, and the lowest in London and southeast of England. Late stage cancer can also include stage 3, where the cancer has broken out of the prostate, but not yet spread to other organs. Late diagnosis is linked to deprivation, ethnicity and older men.
“Diagnosis for most men is triggered by urinary symptoms causing them to seek help from their GP. In later stage disease, some men may have symptoms from metastatic disease, such as fatigue, bone pain or weight loss. Lymph node spread can cause blockage of the kidneys with renal failure and leg swelling. If the prostate tumour is large, it can cause bladder symptoms, though in most men in general, these are from benign enlargement of the prostate as men age.
“To diagnose, GPs will usually undertake a PSA test and refer to hospital care if it is elevated. Many men then get an MRI scan and if suspicious, they are recommended to have a prostate biopsy. Some men, particularly those with suspicion of metastatic disease may need other scans such as a bone scan, CT scan or PET scan to stage the disease (understand if there is spread from the prostate).
“An aggressive cancer means it is more likely to develop and spread, more likely to need treatment, and less likely to be cured by treatment.
“The Gleason score is a grading score given by pathologists to prostate biopsy samples under the microscope. It is strongly liked to the ‘aggressiveness’ of the cancer and the chance of dying of prostate cancer. The lowest score is 6 and the highest 10. We have recently shifted to using the ISUP grade group scoring, which goes from 1-5, and is easier to understand. Gleason 9 translates to ISUP grade group 5.
“Metastatic prostate cancer is primarily treated with hormone therapy. Prostate cancer depends on testosterone to grow, and by blocking testosterone production and action, the cancer can be effectively treated but not cured. Additional modern hormone drugs (known as ARTA’s) are given in addition, and these are known to prolong survival. Chemotherapy can also be given.”
Declared interests
None received.