Prostate Cancer

For many, prostate cancer is a slow growing cancer and in some cases the cancer remains undiagnosed and hidden within the prostate as there are no symptoms or problems. However, this is not the case for all men. Some types of prostate cancer cells can grow rapidly and spread outside the prostate – and so become a serious threat.

The symptoms that may indicate you have a problem with your prostate include:

  • Feeling the need to urinate more often during the day and night
  • Experiencing a feeling of urgency and in some cases leaking before getting to the toilet
  • A weak urine flow
  • Difficulty urinating with pain
  • Feeling that your bladder is not totally empty
  • Continuous pain in the pelvic region
  • Pain or discomfort on, or immediately after, ejaculation.

If you have any of the symptoms described above, visit your GP. These symptoms could be an indication of a different prostate or bladder problem but it is important that you seek medical help.

The risk factors associated with prostate cancer include:

  • Age – the risk of developing prostate cancer increases as you age
  • Genetic – if you have a family history of prostate cancer there is a higher risk that you will develop prostate cancer. Asians and Africans have a statistically higher chance of having prostate cancer than Caucasians
  • Diet – there has been some research which suggests that the typical western diet of high fat and lots of red meat may be linked to the high rates of prostate cancer in western countries

Diagnosing prostate cancer

Once you have made an appointment to see your GP, your GP will want to discuss your family history, investigate your symptoms and may also carry out some tests.

You will likely be asked for a urine sample to investigate whether your symptoms are associated with a urine infection. The GP may then perform a digital rectal examination and perform some blood tests.

Following this initial investigation, your doctor may send you for some tests which would take place at a hospital. These tests may include:

Trans-rectal Ultra Sound (TRUS) guided biopsy – the biopsy will take a number of small pieces of prostate tissue to be looked at under the microscope. Trans Rectal Ultrasound Scans work by using sound waves to make an image of the prostate. The scan allows the health care professional to measure the size of the prostate and will help them to guide the biopsy needles.

CT scan – a CT scanner takes X-rays of your pelvis, which are fed into a computer to create an image of the prostate and the surrounding tissues. The doctor will investigate whether if present, the cancer has spread.

MRI scan – an MRI scan uses magnets rather than X-rays to create a detailed picture of your prostate and surrounding tissues including the lymph nodes.

Bone scan – a bone scan will show whether any cancer cells if present, have spread from the prostate to the bone.

There are two main treatment options for prostate cancer; radical prostatectomy and radiotherapy.

Radical prostatectomy is the most common surgery performed when cancer is confined to the prostate. The surgery involves removing the whole gland along with the tumour. This operation will involve a hospital stay of approx a week and will entail some months of convalescence after the operation.

Radiotherapy – if the cancer is confined to the prostate, beams of radiation can be targeted accurately at the tumour in an attempt to kill the cancerous cells.

If cancer is in early stages, and there are no symptoms caused, you may consider delaying possible treatment and waiting to see whether any symptoms of progressive cancer develop. This is sometimes recommended for older men when it is unlikely that the cancer will impact on their natural life span.

Bladder problems following prostate surgery

After surgery on your prostate a catheter will be left in place for a while. A catheter is a thin flexible tube which is passed through the urethra and into your bladder, where it is kept in place by a small balloon at its tip inflated with water. Its job is to drain urine into a collection bag, normally worn on the leg, in order to keep your bladder empty. The catheter may only be in place for a day or two following some procedures while for others it may remain in place for several weeks.

After the catheter is removed it may take several more weeks for things to settle down before your bladder returns to normal. During these weeks, or maybe months, it might be a good idea to use a form of absorbent pad or collection device in case of leakage. For more information about the products available visit our products pages. You can help your recovery by slowly returning to a normal diet and by making sure you are drinking enough fluids. It may be best not to drink too much tea, coffee or alcohol as these can all irritate the bladder. Over 3 or 4 weeks you can gradually return to normal, gentle exercise. However, you should avoid heavy lifting during this time.

Constipation should also be avoided as this can cause straining which would be bad for the area that has been operated on. It is not unusual for traces of blood to be present in the urine for a week or so after surgery on the prostate or for the urine to appear a little cloudy. However, if you experience burning or pain when passing water or if your urine is very cloudy or smells strongly, it is possible that you have urinary infection – you should consult your doctor and you will probably be prescribed a course of antibiotics.

Longer term incontinence

For a small percentage of men, problems with bladder control may last longer. The urinary system is a complex one and it can be affected by many factors. Any surgery on or near the bladder can result in bladder control problems. These problems can happen as the result of the surgery itself which may alter the way the bladder works.

Sometimes, however, slight changes in the way the bladder works may have been caused by the illness which lead to the surgery but they may not have been apparent until now because they were hidden by more serious symptoms which the surgery has addressed. Before deciding what to do to treat an ongoing problem, your doctor may assess what the exact nature of the problem is.

There are a few types of incontinence which typically may occur following prostate surgery including:

Stress incontinence – you may experience a leakage of urine when you cough, laugh or move suddenly. This happens because the sphincter and other muscles which keep your bladder from leaking have become weakened and they are unable to cope when coughing and other sudden movements put pressure on the bladder. This problem can often be cured by pelvic floor exercises although in rare cases further surgery may be necessary.

Urgency and urge incontinence – before your operation the muscles of your bladder had to struggle to force urine past the enlarged prostate. Now that the obstruction has been removed it may take months for your bladder muscles to get used to the new situation. The muscles can be overactive, resulting in sudden urges to pass water and they can contract suddenly without warning, resulting in incontinence and bed wetting. This problem usually disappears after a number of months, but in the meantime pelvic floor exercises, bladder retraining and anticholinergic drugs which calm the overactivity of the bladder muscles can help.

Mixed incontinence –  this is a combination of stress and urge incontinence.

Total incontinence – occasionally the sphincter that keeps your bladder outlet closed no longer functions at all, so that urine continually leaks in a steady, slow flow. Your bladder is always empty and there is no way for you to control it. This is not a common problem. It usually occurs only where the more extensive surgeries have been performed and even then only rarely.

Further help

For further information about prostate cancer contact Cancer Research UK – the UK’s leading charity dedicated to cancer research. You can phone them on tel: 020 7242 0200 or visit the website at www.cancerresearchuk.org

You can also contact Prostate Cancer UK, their Helpline number is 0800 074 8383, or visit the website at www.prostatecanceruk.org

If you are concerned about your problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.