Management of Prostate Cancer in Ireland

Written by Helen Forristal, Director of Nursing Services, Marie Keating Foundation

In 2022 3,941 people were diagnosed with prostate cancer, making it the most common cancer in Ireland excluding nonmelanoma skin cancer. Worldwide, more than 1 million men are diagnosed with prostate cancer each year and more than 300,000 die of the disease.

Startling statistics show that 1 in 6 men will be diagnosed with prostate cancer during their lifetime, 1 in 8 up to 75 years of age. However, when detected early, prostate cancer has very promising five-year survival rates of 93%.

But like many other forms of cancer, these survival rates are all dependent on when the cancer is detected, and we know that early detection saves lives and improves survival outcomes. The Marie Keating Foundation encourages men to be more open about their health and to speak to their GP about a PSA test when they turn 50, or 45 with a family history of prostate cancer.

Urology Nurse Specialist and Director of Nursing Services at the Marie Keating Foundation, Helen Forristal explains: “Men typically get a bad rap for not speaking about their health, but when resources and supports are put in place, we see that this is not the case. We have yearly Prostate Awareness campaigns urging men to Stand Up For Their Prostate and become more prostate health aware, we provide a host of resources on our website including our Marie Keating Foundation Talks Cancer podcast where we dedicated a whole series to Prostate cancer. We hope that by initiating more conversations we will incite more men to take action. Our message is a simple one, if you are 50, ask your GP to consider checking your PSA levels. If you are 45 with a family history of prostate or breast cancer, have that conversation. It could save your life.”

A PSA or Prostate-Specific Antigen test is a simple blood test that monitors possible changes in your prostate which may need further investigations and follow up. By having regular PSA levels checked as instructed by your GP or Urologist, it can help to detect prostate problems or cancer in its earliest stages, even if you are experiencing no symptoms and please do remember prostate cancer may have no symptoms or signs at all.

More information on the Prostate and Prostate Cancer

What the prostate is

The prostate is a gland found only in those born as males. In younger men, it is about the size of a walnut, but it can be much larger in older men. The prostate is found below the bladder. It surrounds the first part of the water pipe (urethra), which carries urine from the bladder to the penis. The same tube also carries semen, and the function of the prostate is to thicken the semen for ejaculatory purposes. The prostate gland is divided into 2 lobes, to the left and the right of a central groove.

What the prostate does

The role of the prostate is to make some of the fluid that protects and nourishes sperm cells in semen, making the semen more liquid. The growth and function of the prostate depends on the male sex hormone testosterone, which is produced in the testes. Some treatments for prostate cancer work by lowering the levels of testosterone as prostate cancer is a hormone dependent tumour.

Prostate cancer

Several types of cells are found in the prostate, but almost all prostate cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen).

Prostate Cancer Facts:

• Prostate cancer is the most common male cancer in Ireland.

• Many men with early prostate cancer have no symptoms at all.

• Because you may not have symptoms, if you are a man over the age of 45 it is really important to talk to your doctor about PSA testing if you have a family history of Prostate or Breast cancer. When you reach 50 irrespective of family history you should talk to your GP about the PSA blood test. It is important to note that the PSA blood test is not a screening tool as it is neither sensitive or specific enough to determine a definite cancer diagnosis and may be elevated because the prostate has simply become enlarged and is producing more PSA. It is also important to note that activities such as cycling and sexual activity can stimulate the prostate to produce more PSA, so important not to embrace such activity the night before an impending test.

• There has been a significant increase in the number of men diagnosed in recent years due to the increasing use of the PSA blood test together with a Digital Rectal Examination (DRE).

• Prostate cancer responds well to treatment and, if detected early, it can be treated successfully. When prostate cancer is detected early, over 93% of men have a really good five-year survival rate.

* If your father or brother has had prostate cancer, you are twice as likely to get prostate cancer at some point in your life.

We encourage men to take an active role in their health, and to speak to their GP if they have any concerns or worries about a change in their bodies. Prostate cancer is very treatable when caught early.

Prostate Cancer’s early warning signs (note that there may not be any) can include:

• frequency passing urine

• getting up a night-time to go to the toilet

• pain on passing urine,

• difficulty passing urine

• blood in your urine

• hesitancy when you go to the toilet

• urgency about getting to the toilet

• your flow has become weak or intermittent

Other factors to consider would be blood in the semen, back pain, unexplained tiredness and weight loss.

Know your risk factors too.

The risk of developing prostate cancer increases with:

• Age - men over 50 years

• Family history - You are two and a half times more likely to get prostate cancer if your father or brother had it.

• Inherited genes - BRCA gene mutation especially BRCA 2 and Lynch Syndrome

• Race - African Americans at greater risk

• Being overweight or obese

Having a risk factor doesn’t mean that you will definitely develop prostate cancer.

• If you have any of the discussed symptoms, visit your G.P.

• Tests your G.P. may do include:

 A blood test called a PSA test.

 Digital Rectal Examination (DRE) of your prostate

• Based on the results, your G.P. may refer you to one of the HSE 8 Rapid Access Prostate Clinics (RAPC) where you will be reviewed by a Specialist called a Urologist

• Urologist may repeat the above tests and may take a biopsy of your prostate gland – TRUS biopsy/Transperineal biopsy.

• Further tests may also be required and may include one or more of the following: MRI/ Multiparametric MRI (mpMRI)/ CT scan/Pet-CT scan