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What is the prostate?

The prostate is a gland that is only found in men. It is wrapped around the tube (urethra) that carries urine from the bladder to the penis. The prostate produces a thick white fluid which mixes with sperm to form semen. The prostate gland is surrounded by an outer layer, often called the prostate capsule.

What is cancer?

Cancer is a disease that affects the body's cells. Cells are the building blocks of the body that make up organs and tissues. In healthy tissues as cells die or become damaged they are repaired or replaced with new cells. This process happens all the time. When cells become cancerous they do not behave as usual, and they continue to grow and multiply even when they do not need to.

Cells that grow abnormally can form a tumour which is a mass or lump. Tumours can be benign (not cancerous) or malignant (cancerous). Benign tumours do not spread to other parts of the body, so they are not considered to be cancer. Malignant tumours can spread and cause damage to organs and tissues elsewhere in your body. When a tumour spreads to other parts of the body, the cancer is called metastatic cancer.

What is prostate cancer?

Prostate cancer is a cancer that affects the prostate gland. It usually occurs in men over the age of 50, and is very rare in men under 45.

Small areas of cancer in the prostate are very common in older men. The cancer cells can be there for some time before they begin to grow. Prostate cancer may grow very slowly so, particularly in elderly men, it may never cause any problems. In other cases, the cancer can grow much more quickly and can spread to other areas of the body, such as the bones.

What are the stages of prostate cancer?

Prostate cancer is described by how much the disease has progressed. Each level of progression is known as a "stage". These stages are described below:

  • Localised prostate cancer: When prostate cancer first develops, all of the cancer cells are inside the prostate capsule
  • Locally advanced prostate cancer: Some of the cells have now spread outside the prostate capsule to other local tissues surrounding the prostate gland
  • Metastatic prostate cancer: Cells from the prostate have spread to other, more distant, areas of the body, such as the bones, to form secondary tumours

What causes prostate cancer?

The exact cause of prostate cancer is still unknown. In some cases, prostate cancer may run in families. Prostate cancer is not infectious and cannot be passed on to other people.

What treatments are available?

The treatment for prostate cancer depends on whether or not the cancer has spread (i.e. its stage), and how fast growing the cancer cells are (i.e. its grade). In some patients with a slow growing cancer, one option might be to keep a close watch on the cancer before starting to treat it.

Treatments that can be used include surgery, radiotherapy, and hormone therapy.

What is hormone therapy?

Hormones are substances that are produced naturally by the body, for example testosterone and oestrogen. They act as chemical messengers and help control many of our bodily functions. Testosterone is involved in a number of different functions in the body, especially in the health and function of a man's reproductive system.

To grow, prostate cancer needs testosterone. Testosterone is produced by the testicles. Testosterone acts as a fuel for the tumour cells. By reducing the amount of testosterone in the body, it is possible to slow down, or stop, the growth of the cancer cells. The size of the tumour can shrink, and symptoms will usually improve or disappear.

The amount of testosterone in the body can be reduced in two ways; by surgical removal of the testicles, or by using drugs. Treatments that affect testosterone are called "hormone therapy", which is the standard treatment for patients who have locally advanced or metastatic prostate cancer.

One type of hormone therapy is a class of drugs called LHRH agonists (sometimes called GnRH agonists, which means the same thing). LHRH stands for Luteinising Hormone Releasing Hormone.

LHRH is a naturally occuring hormone produced and released in one part of the brain, to stimulate the production and release of other brain hormones which themselves control the production of oestrogen and testosterone.

An "agonist" is something that triggers the body to do something. It does this by binding to a particular receptor in the body. In the case of LHRH agonists, they bind to the same receptors in the brain as naturally occurring LHRH.

How do LHRH agonists work?

LHRH is a hormone that is produced naturally by your body. LHRH agonists are a man-made form of this hormone.

Normally LHRH tells the brain to send a signal (called LH) to the testicles to produce testosterone.

If you give an LHRH agonist the amount of LH in the body goes up. For the first 2 weeks after treatment this causes the body to make more testosterone and the amount of testosterone in the body goes up. This could make any cancer-related symptoms worse during this time. To stop the extra testosterone from causing a problem, most patients are prescribed tablets for the first couple of weeks when they start an LHRH agonist.

After this time the LHRH agonist overwhelms the LHRH receptors in the brain and they stop responding. This means that no LH is sent to the testicles to produce more testosterone. The result is that the amount of testosterone in the body falls to very low levels. This may result in the tumour shrinking, or its growth slowing down.

Hormone therapy side effects

Most of the side effects of LHRH agonists are caused because they work by lowering the levels of testosterone in the body. These side effects are very similar for all drugs that work by reducing testosterone levels.

Side effects include hot flushes, impotence (difficulty in getting or keeping an erection), reduced sex drive, bone pain, back pain, numbness or tingling in the lower limbs, pain or difficulty passing urine. These side effects usually start during the first month of treatment.

As with any medical treatment, you may experience unwanted side effects. If any side effect is troublesome, or worries you, you should speak to your doctor. You should also tell your doctor if you think your symptoms have worsened or changed, particularly if you are having more pain or if you have difficulty passing urine during the course of your treatment. Your doctor will then review whether your treatment needs to be changed.

You should also report side effects online at www.yellowcard.gov.uk

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to the Ipsen Medical Information department on 01753 627777 or medical.information.uk@ipsen.com

Is there anyone I can talk to about my condition and its treatment?

Prostate Cancer UK

The charity provides free information tailored to the needs of men with prostate cancer and their families.

The charity also offers a prostate cancer helpline staffed by prostate cancer specialist nurses. They can offer information and support to anyone affected by prostate cancer.

You can contact the helpline on 0800 074 8383.
Lines are open Monday - Friday 9am-5pm plus Wednesday 7pm-9pm.

Alternatively you can contact the helpline nurses by email via the website: www.prostatecanceruk.org

Macmillan Cancer Support (including Cancerbackup)

Macmillan Cancer Support has merged with Cancerbackup. Macmillan helps with all the things that people affected by cancer want and need, from specialist healthcare and information, to practical, emotional and financial support. Cancerbackup are a specialist cancer information charity providing high-quality information on every sort of cancer.

Helpline: 0808 808 00 00
Lines are open Monday - Friday 9am-8pm.

An interpreting service is available for people whose first language is not English. The charity offers free of charge publications to families and health and social care professionals.

Website: www.macmillan.org.uk www.cancerbackup.org.uk