Men's Health Week 2024: Prostate cancer and potential management strategies

Understanding prostate cancer

What is prostate cancer?

The prostate is a small walnut-sized gland located below the bladder and in front of the rectum. Only men (or people assigned male at birth) have a prostate, and it plays a vital role in male reproductive health by producing seminal fluid that nourishes and transports sperm.

Prostate cancer occurs when cells in the prostate gland divide and grow uncontrollably. These cells can then invade the surrounding tissue/organs/lymph nodes and spread throughout the body. This can lead to severe health consequences and even death if not identified early and managed promptly.

What are the common signs and symptoms of prostate cancer?

In the early stages, prostate cancer may not cause noticeable symptoms. It can go undetected until it has spread to other parts of the body, which is why men over the age of 50 are advised to get regular prostate exams. If you have a close relative (such as your brother or father) who has been diagnosed with prostate cancer, two extended family members (uncle, grandfather, cousin), or if you are of African descent then it is advised that you start getting regular prostate screenings from the age of 40.

As the cancer progresses, men might experience the following signs:

• Difficulty urinating or a weak urine stream
• Frequent urges to urinate, especially at night
• Blood in urine or semen
• Pain or discomfort in the back, hip, and/or pelvic area
• Erectile dysfunction
• Sudden, unintentional weight loss

It is important to note that these symptoms can also show up with other non-cancerous conditions, such as benign prostatic hyperplasia (BPH). Either way, if you do experience any of the above symptoms for an extended period of time, it is crucial to book an appointment with your GP. While they may not be able to run the required diagnostic tests themselves, they can refer you to a specialist who can.

Early detection and treatment are crucial for not only improving survival rates, but also raising the quality of life of patients.

Prostate cancer statistics

The currently available statistics are from the years 2017 -2019, and show that in the UK:

• Around 55,100 men are diagnosed with prostate cancer every year
• Approximately 12,000 men die from prostate cancer annually
• 28% of all new cancer diagnoses in men are for prostate cancer
• Men aged between 75 and 79 are at most risk, with around a third of all new cases being diagnosed in men aged over 75
• Prostate cancer incidence rates have increased by 48% in males in the UK since the early 1990s

What health screenings are available for prostate cancer?

While prostate cancer is the most common form of cancer for males in the UK, there is unfortunately no current national screening programme. This is due to the lack of a reliable test capable of detecting treatable prostate cancer in its early stages, - but that shouldn't put you off getting checked regularly, especially if you are aged 50 or over.

Prostate-Specific Antigen (PSA) Test

This blood test measures the level of PSA, a protein produced by the prostate gland. Elevated PSA levels can indicate prostate cancer, although other issues, such as urine infections, BPH, and prostatitis, can also cause high PSA levels.

This is not a 'bullet-proof' test and may produce false positives or miss cancer altogether.

Research has shown that 1 in 7 men with a normal PSA level actually have prostate cancer. Even more concerning, 1 in 50 men with a normal PSA level are battling an aggressive, fast-growing form of prostate cancer. These findings underscore the importance of regular screenings and vigilant monitoring, as well as the need for men to combine PSA testing with other diagnostic methods for a more accurate assessment.

Digital Rectal Examination (DRE)

During a DRE, you will be asked to lay on your side with your knees tucked while a nurse or doctor inserts a gloved, lubricated finger into the rectum to feel for any abnormalities in the prostate gland. The prostate is felt through the wall of the rectum, which is why the test is called a digital rectal examination.

Both tests have their limitations, and decisions regarding screening should be made in consultation with a healthcare professional, considering individual risk factors such as age, family history, and ethnicity. DRE exams can show false positives, and there are instances where men with prostate cancer have had normal results from a DRE.

MRI

MRI scans can help assess the size and location of prostate cancer tumours and determine if they have spread to other areas. They are particularly useful when used in conjunction with a DRE or PSA test for better accuracy, but again, they are not always able to pick up on smaller or less aggressive cancers.

Biopsy

A biopsy is the only way to confirm prostate cancer definitively, but once again, there is a chance that cancer may be missed. The biopsy can only determine a cancer prognosis if cancer is present in the collected samples.

It involves taking a small tissue sample from the prostate gland and testing it for cancer cells. If there is prostate cancer present, a biopsy can also help determine how aggressive the cancer is. Biopsies can pick up faster-growing cancer in the initial stages, which can be missed in the other forms of testing, and help with planning treatment options.

What are the conventional treatment options for prostate cancer?

Active surveillance

For low-risk, early-stage prostate cancer, active surveillance may be recommended. This involves regular monitoring through PSA tests, DREs, and biopsies to track the progression of the cancer. Treatment is initiated only if the cancer shows signs of growth or becomes more aggressive.

Surgery

Radical prostatectomy involves the surgical removal of the prostate gland. This procedure aims to eliminate the cancerous tissue entirely. It can be performed using traditional open surgery or minimally invasive techniques such as laparoscopic or robotic-assisted surgery.

Radiation therapy

Radiation therapy uses high-energy beams to target and destroy cancer cells. It can be delivered externally (external beam radiation therapy) or internally (brachytherapy). Radiation therapy is often used for localised prostate cancer or as part of a combined treatment approach.

Hormone therapy

Hormone therapy, also known as androgen deprivation therapy (ADT), aims to reduce the levels of male hormones (androgens) that fuel the growth of prostate cancer cells. This can be achieved through the use of pharmaceutical medications.

Chemotherapy

Chemotherapy involves the use of powerful drugs to kill cancer cells. It is typically reserved for advanced prostate cancer that has spread to other parts of the body or for cases that do not respond to hormone therapy.

Can medical cannabis help men with prostate cancer?

Before we go on, it is important to once again point out that cannabis-based treatment options will not cure prostate cancer, and should never be used as a substitute for conventional cancer treatments. 

Medical cannabis options may help reduce the heavy side effects of chemotherapy, as well as secondary cancer issues like anxiety, depression, pain, and insomnia, helping patients regain quality of life.

One of the few ways that UK patients can receive a medical cannabis prescription through the NHS is when they are suffering from nausea or vomiting caused by chemotherapy. And while it is legal for NHS prescribers to offer cancer patients cannabis-based products, they rarely do so.

Thankfully, medical cannabis is fully legal in the UK, and prescribing specialists working with private medical cannabis clinics have the right to offer cannabis-based medicines when they deem it appropriate, as long as the patient meets certain eligibility criteria.

Limited early research suggests that certain cannabinoids, such as THC and CBD, may have the potential to offer some anti-cancer effects.

What does the research actually state?

The 2020 review paper "Anti-Cancer Potential of Cannabinoids, Terpenes, and Flavonoids Present in Cannabis" found that, in a study on mice,:

"THC has been shown to reduce melanoma cell proliferation and tumor growth in vivo in murine models in other studies. In one study, a preparation of equal amounts THC:CBD was able to decrease tumor growth and increase autophagy and apoptosis in vivo. THC significantly inhibited the tumor growth of transplanted mouse melanoma cells in a cannabinoid receptor-dependent fashion."

These findings are tentatively supported by another review, this time from 2019 and titled "Cannabinoids in cancer treatment: Therapeutic potential and legislation"

"Cannabinoids were able to effectively modulate tumor growth in different in vitro and in vivo cancer models, however, these anticancer effects appears to be dependent on cancer type and drug dose. Understanding how cannabinoids are able to modulate essential cellular processes involved in tumorigenesis, such as the progression through the cell cycle, cell proliferation and cell death, as well as the interactions between cannabinoids and immune system are crucial for improving existing medications and developing new therapeutic approaches."

That last point is important. 

While cannabinoid therapy does seem to show great promise in the fight against cancer, these studies do not meet the rigorous standards required by UK regulatory bodies such as the Medicines and Healthcare Products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE). 

It is still too early to make any concrete claims about the efficacy of medical cannabis in treating tumours. Medical cannabis is best applied as a complementary treatment option alongside conventional methods.

What kind of support is available to UK prostate cancer patients?

Coping with a prostate cancer diagnosis can be challenging, but there are different support options available to help patients and their families:

• Prostate Cancer UK provides a wealth of information, resources, and support services for prostate cancer patients. Specialist nurses working with the foundation offer confidential advice and emotional support through a dedicated helpline.
• Macmillan Cancer Support offers a range of services, including a helpline, online community, and local support groups. They provide practical, emotional, and financial support to individuals living with cancer.
• Many communities have local support groups where individuals can connect with others going through similar experiences. These groups offer a safe space for sharing information, experiences, and emotional support.

Conclusion

Men's Health Week serves as a reminder of the importance of proactive health measures, particularly concerning prostate cancer. By understanding the signs and symptoms, attending regular health screenings, and being aware of available treatment options and support resources, men can take charge of their health and improve their chances of early detection and successful treatment.

Too often, men find talking about their health concerns difficult. The stigma surrounding prostate cancer and its detection/treatment can make it challenging to seek help and advice. But by shedding light on this often misunderstood disease, we hope to break down at least some of these barriers and make it easier for men to seek the support they need. If you or a loved one is affected by prostate cancer, remember that you are not alone. Reach out to healthcare professionals and support organisations for guidance and assistance. 

If you would like to learn more about how cannabis-based therapy options may be beneficial, head over to our blog and education sections, or feel free to reach out at any time to discuss medical cannabis.