Prostate cancer

The prostate is a small gland, the shape and size of a chestnut, just below the bladder surrounding the urethra. It is a gland that consists of a number of glandular tubes which produce and secrete prostatic fluid. This fluid keeps sperm alive and transports sperm cells during ejaculation which makes the prostate very important for fertility. 

Prostate cancer is the most common type of cancer found in men and ranks worldwide as the second most common cause of death with regard to carcinomas, otherwise known as malignant tumours. In the Netherlands, approximately 12,000 men are diagnosed with prostate cancer each year, of which about 75% are 65 years or older. Prostate cancer is a disease in which malignant cells develop in the tissue of the prostate gland. In general, prostate cancer is a slow growing malignant tumour. 

• Weak urine flow
• Difficulty in starting to urinate
• Need to urinate in short intervals and passing little urine each time
• Leaking such as a few drops in your trousers
• The feeling that the bladder is not completely empty
• A burning sensation while urinatining
• Continence problems, sometimes even incontinence
• Having to get up frequently in the night to urinate

More often it is older men who experience these symptoms, which are usually caused by a benign enlargement of the prostate. However, if you suffer from the above-mentioned complaints, please contact your (family) doctor.  

PSA represents prostate-specific antigen and is a protein created only in the prostate. A PSA test is a blood test which measures the amount of PSA in the blood.

Button: Read more about PSA values

Normally, this substance is present in your blood in small quantities. An elevated PSA can be an indication of prostate cancer, but usually additional research is needed to make a proper diagnosis.

But even in benign diseases of the prostate, such as inflammation or enlargement of the prostate, the PSA levels may be high. Therefore further research is necessary if the PSA value is elevated or shows a significant increase during a period of time.

As you get older the PSA values increase. Below are the following values per age group:

If your PSA values are high, it is important to find the cause as soon as possible to ensure effective measures can be taken. With a detailed urological check-up, you will get clarity about your symptoms and the possible causes. Read more about a urology check-up.

Button: Read more about a urology check-up

The TNM classification system is based on the size or extent of the primary tumour (T-stage), the amount of spread to nearby lymph nodes (N-stage) and the presence of metastasis (M-stage) or a secondary tumour formed by the spread of cancer cells to other organs or parts of the body. In many types of cancer, the TNM combinations correspond to one of the five stages. Once the T, N, and M categories have been established, this data is used in conjunction with the Gleason-score. This process is known as the grouping of the stages. The stages are indicated by Roman numerals from I (the least severe) to IV (most severe). This categorisation makes it easier to ensure the correct treatment is chosen which offers the greatest chance of survival or cure. The following sections show the various stages of prostate cancer. 

•  In stage 1 the cancer is confined to the prostate only. The cancer cannot be felt during a digital rectal examination and is not visible on plain radiographs. In general, the cancer is found unintentionally during surgery for another condition, such as a benign prostatic hyperplasia. Prostate cancer in stage I is also called prostate cancer in stage A1.
• In stage 2 the cancer is more developed than in stage I, but has not yet spread further than the prostate. Prostate cancer in stage II is also known as prostate cancer in stage A2, B1 or B2.
• In stage 3 the cancer has spread beyond the most outer layer of the prostate to the nearby tissue. The cancer may also have spread to the seminal vesicles. Prostate cancer in stage III is also called prostate cancer in stage C.
• In stage 4 the cancer has spread (metastasised) to the lymph nodes surrounding the prostate, to lymph nodes elsewhere in the body or to other organs of the body such as the bladder, rectum, bones, liver or lungs. Metastatic prostate cancer often spreads to the bones. Prostate cancer in stage 4 is also known as prostate cancer in stage D1 or D2.

An early diagnosis of prostate cancer is extremely important to increase the chances of survival for the patient. On average, men diagnosed with metastatic prostate cancer survive for two years. In comparison, 90% of men diagnosed with prostate cancer in its early stages survive for more than ten years.

Do you have prostate problems or other urological complaints? Then it is advisable to have an extensive urological exmination.

There are three possible methods of treating prostate cancer. The urologist ultimately decides which treatment is most suitable for you. The three possible treatments are:

This is a surgical procedure in which the entire prostate gland and some tissue around it are removed. This prostatectomy removes the complete tumour with assistance of the Da Vinci robot.

Brachytherapy is primarily applied for the treatment of less aggressive tumours. It is a type of internal radiation therapy and is relatively accurate treatment for the prostate. 

If a benign enlargement of the prostate is diagnosed, the prostate will be treated surgically in most cases by means of a TURP (Transurethral resection of the prostate). A part of the prostate is removed through the urethra.