Professor Amit Bahl
Consultant Clinical Oncologist, University Hospitals Bristol NHS Foundation Trust
Earlier diagnosis and interventions of prostate cancer help to keep men living longer.
“It’s a common misconception that all men with prostate cancer die with it, rather than because of it, but that’s only true if the cancer has not spread,” says Professor Amit Bahl, consultant oncologist at University Hospitals Bristol NHS Trust. Prostate cancer is the second most common cancer in men. Prostate cancer is the most common cancer in men in the UK1 and Black African and Caribbean men have double the risk of developing prostate cancer compared to white men2.
If men are diagnosed early, before the cancer has metastasised (spread), curative treatment is possible. Later diagnosis or an advanced stage of prostate cancer sometimes results in clinicians switching treatment focus to that of simply prolonging life, reducing pain and the risk of life-changing events, such as bone fractures.
Spouses and partners are often the ones driving the decision to see a GP
Professor Bahl often hears men say that they only saw their GP because their spouses made them go. “We want this to change,” he says, calling for more men to speak up and openly about prostate cancer with loved ones and their doctors.
Common symptoms of early prostate cancer – particularly in the high-risk group of men aged around 70 years old, include changes in urination – such as an increased need to pee, straining, or a feeling that your bladder has not fully emptied. However, many men delay seeing their GP often because they are afraid of the disease and treatment options, which centre on blocking testosterone – or to use its medical term, chemical castration.
The side effects of hormone therapy (androgen deprivation therapy) can include fatigue, weight gain and sexual problems. As Professor Bahl says: “Hormone therapy is a difficult discussion. Counselling and exercise are both strongly recommended to improve people’s wellbeing during hormonal therapy.”
Watch and wait approach
For patients in early stage prostate cancer, where there are no detectable metastases, clinicians keep a close eye on hormone levels of prostate-specific antigen (PSA) for guidance on how a cancer is progressing. In men with non-metastatic prostate cancer, who are receiving hormone therapy, quickly rising PSA levels are a signal that the current hormone therapy is no longer working and development of metastatic disease is likely.
It is important for men to keep having their PSA checked to manage progression. Recently, there have been developments in this field with treatment options showing a significant delay in development of metastatic disease and improving survival along with maintaining quality of life.
Professor Bahl says: “New treatments can give patients significant hope for increased life expectancy. Aside from COVID-19, the two major causes of death, now, are heart disease and cancer. This makes it a key focus of attention for the industry as greater numbers of people will live to be able to benefit from drug innovation.”
Job code: PP-UN-ONC-GB-0041
 Prostate Cancer UK. Prostate Cancer and Risk. Available at https://prostatecanceruk.org/prostate-information/ are-you-at-risk [Last accessed July 2020] |  Lloyd T. et al. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008– 2010. BMC Medicine. 2015;13(1): 171. Available at https://bmcmedicine.biomedcentral.com/ articles/10.1186/s12916-015-0405-5 [Last accessed July 2020]