Prostate cancer occurs when the cells of your prostate gland grow in an abnormal way. Early prostate cancer is also called localised prostate cancer. This means the cancer is found within the prostate only. It has not spread outside your prostate gland. The tumour may be too small to be felt during an exam of your back passage and your doctor may only suspect it after doing a PSA test. Often men with early prostate cancer do not have any symptoms at all.

The exact cause of prostate cancer is unknown. Research continues to study possible causes. But there are certain things called risk factors that can increase your chance of getting the disease. These include::

Age: The risk of prostate cancer increases with age. It is rare in men under the age of 50.

Family history: If you have a brother or father with the disease, your risk is higher. The risk is also higher if your relative developed prostate cancer at a younger age or if you have more than one relative with the disease.

Race: Afro-Caribbean men are at a higher risk of developing prostate cancer.

Symptoms may include the following:

Because prostate cancer often grows slowly, symptoms may not occur for many years. It is very common for a man with early prostate cancer to have no symptoms at all.

Surgeon/Urologist

• Mr Richard Power

Beaumont Hospital : 01 8093046 rpower@rcsi.ie

Private Practice :01 8374805

• Mr Gordon Smyth

Beaumont Hospital: (01)8092339 gordonsmyth@beaumont.ie

Private Practice: (01) 8065622 Mary Lawlor gordonsmythurology@bonsecours.ie

• Mr Ijaz Cheema

Beaumont Hospital: (01) 8093406  ijazcheema@beaumont.ie

Private Practice: (01) 6459459

• Ms Liza Mc Lornan

Beaumont Hospital: (01)8093485 lizamclornan@beaumont.ie

Rapid Access Prostate Clinic

Referrals to the Rapid Access Prostate Clinic can be made electronically by your GP via www.healthlink.ie Telephone: (01) 809 3485

Prostate Cancer Specialist Nurses: Sara White, Clodagh Sharpe, Eimear Dunne

Telephone: 01) 8528377

Urology Nurse Specialist: Rachael Swords

Medical Oncologist: Prof Grogan

Radiation oncologist: Dr Brian O’Neill

Physiotherapist: A therapist who treats injury or illness. You may be taught pelvic floor exercises by a physiotherapist if you have surgery for prostate cancer.

Medical social worker: A person specially trained to help you and your family with all your social issues and practical needs. They are skilled at giving emotional support. They can also give advice on benefits, entitlements and services available to you when you go home.

There are a number of tests used to diagnose and stage prostate cancer. Staging is where we determine Your Doctor and Nurse will explain these tests in detail with you at the clinic and why you are having them. You can also CLICK HERE for more information about these tests.

PSA blood test: Prostate specific antigen (PSA) is a protein that can rise due to disease in your prostate.

Digital rectal exam: The digital rectal exam (DRE) is where your doctor feels your prostate gland through your back passage (rectum) using a gloved finger. He or she can check if your prostate has enlarged or has abnormal tissue, such as hard or lumpy areas.

Transrectal ultrasound (TRUS) and biopsy: A biopsy of your prostate tissue is taken (biopsy) and examined under a microscope.

Template biopsy: A template biopsy takes more samples than a TRUS biopsy and is done through the skin between your testicles and back passage. It may be done when a TRUS biopsy has not shown any prostate cancer and your doctor feels there is a need for further tests.

MRI scan: This special scan uses magnetic energy to build up a picture of the tissues inside your body. It is used to determine the extent of your cancer.

CT scan: This is a special type of X-ray that builds up a detailed picture of the tissues inside your body. It is used to check if your cancer has spread anywhere else in the body.

Bone scans: Prostate cancer can sometimes spread to your bones. Bone scans can find cancer spots before they show up on an ordinary X-ray.

Early prostate cancer can be treated in a number of ways. Both you and your doctor together will decide which treatment suits you best. It is common for you to be asked to make a decision about which treatment suits you best. In making your decision, your doctor and nurse will support and advise you.

Many things can affect which treatment options are suitable for you. These include::

• The stage and grade of your cancer.
• Your PSA level.
• The size of your prostate gland.
• If you have urinary symptoms or not.
• Your general health.

The following treatment options are available:

• Active surveillance
• Brachytherapy
• External beam radiotherapy
• Surgery
• Watchful waiting

Types of treatment

Active surveillance: This is a treatment option for low-risk prostate cancer, which can be very slow growing and often does not cause symptoms or cause problems. Active surveillance aims to avoid or delay treatment if your cancer is likely to be slow to change and unlikely to threaten your health. It allows you to avoid the side-effects of treatment. It also aims to find cancers that change and start to behave more like fast-growing ones, and to offer treatment before the cancer spreads. During active surveillance you will be checked (monitored) with repeat blood tests and biopsies. If there is any sign of activity in your cancer, you will be offered treatment to cure the cancer. Active surveillance can carry on for many years if your cancer shows no signs of changing.

Radiotherapy: Radiotherapy is a treatment that uses X-rays to kill cancer cells. It can be given externally or internally. When given internally, it is called brachytherapy. When given externally, it is called external beam radiotherapy.

• Brachytherapy: In this form of internal radiotherapy, radioactive seeds are placed in your prostate gland. They release radiation slowly over the following months. The seeds are very small, about the size of a grain of rice. The number of seeds implanted depends on the shape and size of your prostate gland. Not all men are suitable for brachytherapy.
• External beam radiotherapy: This uses high-energy X-ray beams to destroy the cancer cells. Radiotherapy can also be used together with hormone therapy, if needed. It is suitable for most men, although it may not be the best option if you have urinary symptoms.

Surgery: The operation to remove your entire prostate gland is called a radical prostatectomy. There are several ways of doing it. For example, traditional open surgery, keyhole surgery, and robotic keyhole surgery.

Watchful waiting: Prostate cancer often grows slowly and does not cause symptoms. For some men with early prostate cancer who have other health issues this may be a reasonable option. Watchful waiting is different from active surveillance. It involves PSA testing but no repeat biopsies. Also, it may suit you if your prostate cancer changed but you were not suitable for either surgery or radiotherapy.

Deciding on treatment

At this time you may be anxious about what is going to happen next. Do not be afraid to ask your doctor or nurse. They will discuss your treatment options with you. Many men find making a decision about which treatment they should have difficult. Do remember that your doctor will tell you if one treatment is better than another at getting rid of your cancer. But often they cannot because the treatment options are all thought to be equally good at treating early prostate cancer.

Very often there is no rush to make up your mind about which treatment to have. It is good to take time to talk to a urologist and a radiation oncologist before you make up your mind. Taking time to talk things through with doctors and nurses, family and friends can help you to reach the right decision for you. You will need to think about what the treatment involves for you, the impact on work or daily activities, and which side-effects you feel you can live with.

Asking questions: Do ask your doctor and nurse as many questions as you like, no matter how small or trivial you think they are. All questions are important. If you forget to ask a question or would like more explanations, call the specialist nurses on 01-8528377.

National Cancer Helpline Phone: 1800 200 700

ARC Cancer Support

Phone: 01) 215 0250

Gary Kelly Cancer Support Centre

Phone: 041) 980 5100

Beaumont Hospital Daffodil Centre

Phone: 01 7974880

Email: daffodilcentrebeaumont@irishcancer.ie

For more information on prostate cancer click the link to download a copy of The Irish Cancer Society booklet for Understanding Prostate Cancer