Prostate cancer is one of the most common cancers in men. It develops when abnormal cells grow and divide uncontrollably in the prostate, a small gland that produces seminal fluid in men. This can be caused by both genetic and environmental factors. Age is one of the primary risk factors for prostate cancer; men over the age of 50 are more likely to be diagnosed with it than younger men. Other risk factors include your family history and your race. Lifestyle factors are also key contributors to your risk of getting prostate cancer. This includes diet, alcohol consumption, smoking, obesity, and exposure to certain chemicals. Early diagnosis is key to improve chances for successful treatment outcomes. It's normal to feel worried and anxious after receiving a diagnosis of cancer. It's important to know that there are effective treatments available for prostate cancer. Treatment options include surgery, radiation therapy, hormone therapy and chemotherapy.
At Blackrock Health, our three hospitals have a history of providing fast and easy access to extensive diagnostic facilities and expert medical or surgical care for patients with cancer. We have invested heavily, both in technology, and in an expert oncology team. This ensures that we can deliver cancer care, tailored to the needs of each individual patient. Our expert consultants and dedicated multidisciplinary teams are here for you. We aim to provide the most comprehensive and compassionate treatment possible in your cancer journey. We are committed to the highest standards of care and have earned a reputation as one of the leaders in the field of private oncology care in Ireland.
While learning of your diagnosis is a difficult time, it's important to remember that we can offer many resources and supports to help. Please note that some tests and treatments outlined below are only available in specific hospitals across the Blackrock Health group.
Recognising and responding to symptoms of prostate cancer
Prostate cancer is a disease that affects the prostate gland, which is a part of the male reproductive system. Being aware of the symptoms of prostate cancer is important, as early detection can lead to better treatment outcomes. Some of the most common symptoms of prostate cancer include difficulty in passing urine, a weak stream, and frequent urination. Other symptoms can include blood in the urine or semen, pain in the pelvic area or lower back, and erectile dysfunction. If you are experiencing any of these symptoms, it's important to talk to your GP as soon as possible. They can help determine if further testing is needed to consider a possible diagnosis of prostate cancer.
Diagnostic tests for prostate cancer
Physical Examination
A physical examination is an important step in the early detection of prostate cancer. During a physical examination, your doctor will check your prostate gland. This will be done by inserting a gloved and lubricated finger into your rectum. This may sound uncomfortable, but it's a quick and important procedure. Most importantly, it is a key test to help detect any abnormalities in the prostate gland. Your doctor will be checking for the size, shape, and texture of the gland, as well as any signs of lumps or nodules. The exam can also help detect any changes in the gland that could indicate the presence of prostate cancer. If your doctor detects any abnormalities, they may recommend further testing, such as a PSA blood test or a biopsy.
PSA Test
The PSA test is a simple blood test that can help detect prostate cancer in its early stages. PSA stands for Prostate-Specific Antigen, which is a protein produced by the prostate gland. During the test, a small sample of your blood is taken and tested for PSA levels. Higher levels of PSA can indicate the presence of prostate cancer, although this is not always the case. If your PSA levels are high, your doctor may recommend further testing to confirm a diagnosis of prostate cancer, such as a biopsy or imaging tests. It's important to remember that the PSA test is just one tool in the detection of prostate cancer and is not a conclusive standalone test.
Ultrasound
Ultrasound is a non-invasive, quick, and painless test that can be used as an early step in the detection of prostate cancer. During an ultrasound, a small probe is inserted into the rectum. This probe uses high-frequency sound waves to create images of the prostate gland. This test can help detect any abnormalities in the size, shape, and texture of the gland that could indicate the presence of prostate cancer. It can also be used to guide a biopsy needle to a specific area of the gland for a more accurate diagnosis.
PSMA PET/CT Scans
This test is offered at the Blackrock Clinic to help detect the spread of prostate cancer. PSMA PET/CT scans use a hybrid technique of Positron Emission Tomography (PET) and Computed Tomography (CT) scans together. PET scans use radiopharmaceuticals to create images of targeted areas in the body. In the context of the prostate, PSMA stands for Prostate-Specific Membrane Antigen. It is a protein that is produced in large amounts on the surface of prostate cancer cells, and to a lesser extent on normal prostate cells. During this test, a radioactive isotope of fluorine (Fluorine-18, or 18F) is injected into a vein. This travels through the body and attaches to the antigen (PMSA) on the surface of the prostate cancer cells. This test can identify prostate cancer cells which have spread elsewhere in the body. The low levels of radiation produced by the 18F PSMA are used to generate functional images for the PET scan. The CT scan is an imaging technique that uses X-rays to create detailed anatomical images. The functional scan (PET) and the anatomical scan (CT) images are viewed together to produce the results of the 18F PSMA scans.
Precaution
After administration of the radiopharmaceutical the patient will be slightly radioactive for 8 hours, it is a precaution to stay away from young children and pregnant women during this time.
Biopsy
A biopsy is a common and important step in the diagnosis of prostate cancer. During a biopsy, a small sample of prostate tissue is removed for laboratory testing. This can help confirm or rule out the presence of cancerous cells in the prostate gland. Biopsy is usually performed using a thin, hollow needle that is inserted through the rectum or through the skin between the scrotum and the anus. The procedure typically takes less than an hour. After the procedure, the tissue samples are sent to a laboratory for analysis. Your oncologist will then discuss the results with you and help you understand what they mean for your diagnosis and treatment plan.
Determining the stage of your prostate cancer
Determining the stage of this disease is a critical step in identifying the best treatment plan. To understand the stage of prostate cancer, we will look at factors such as the size and location of the tumour. We will also consider whether it has spread to other parts of the body, and if it has impacted healthy tissues. After understanding these details, a doctor can then diagnose what stage of prostate cancer their patient has.
The stage of prostate cancer describes the size and extent of the cancer and whether it has spread beyond the prostate gland. Most patients are used to hearing about a four-stages system for classifying prostate cancer:
- Stage 1: The cancer is small, localised within the prostate gland, and has not spread to nearby lymph nodes or other parts of the body.
- Stage 2: The cancer is still localised within the prostate gland but is larger and may be growing more aggressively.
- Stage 3: The cancer has spread beyond the prostate gland and may have invaded nearby tissues or organs, such as the seminal vesicles. -
- Stage 4: The cancer has spread to distant parts of the body, such as the bones, lungs, or liver. At this stage, the cancer is described as metastatic.
A more precise staging system for prostate cancer is called the TNM system, which stands for Tumour, Node, and Metastasis.
- The T category describes the size and extent of the primary tumour. This is scored from 1 to 4, with 1 being the smallest. This category is sometimes preceded by the letter P, which means the scoring refers to the primary or first identified tumour.
- The N category describes whether the cancer has spread to nearby lymph nodes. This is scored from 0 to 1, with N-0 meaning no spread, and N-1 meaning nodes are involved
- The M category describes whether the cancer has spread to other parts of the body, such as the bones. This can be scored either as 0 (for no spread) or 1 (for evidence of spread).
- All the above scores can also be shown as "X", which means the classification is uncertain without further investigation.
The stage of prostate cancer is an important factor in determining the best course of treatment. Your Blackrock Health urologist - and / or your oncologist - will use the results of staging tests to develop a personalised treatment plan. This will be tailored to your individual needs and to the stage of your cancer.
Treating your prostate cancer
When prostate cancer is diagnosed, there are a range of treatment options that can be recommended. The specific treatment plan will depend on the stage and aggressiveness of the cancer. It will also depend on your age, your general health, and your personal preferences. Treatment options may include:
- active surveillance (also called watchful waiting)
- surgery to remove the prostate gland
- radiation therapy
- hormone therapy, or
- chemotherapy.
Each treatment has its own benefits and risks. The decision about which treatment to pursue should be made in consultation with your urologist and oncology team at Blackrock Health. It is important to get a clear understanding of your available options, including the potential benefits and side effects. This will allow you to make an informed decision.
Active Surveillance
Active surveillance, also known as watchful waiting, may be recommended if you have low-risk prostate cancer. This treatment option involves closely monitoring the cancer with regular check-ups. This takes place rather than immediately undergoing surgery or radiation therapy. During active surveillance, the Blackrock Health team will carry out regular tests to monitor your cancer. These could include blood tests to measure PSA levels, digital rectal exams, or repeat biopsies. Active surveillance is generally recommended for men who have a low risk of the cancer spreading and who have a life expectancy of at least 10 years. The goal of active surveillance is to avoid the potential side effects of more aggressive treatments. Yet it still offers the ability to respond to the cancer if it becomes more advanced. If the cancer does progress, treatment options such as surgery or radiation therapy may be recommended.
Surgery
Surgery is a common treatment option for prostate cancer. You may have a radical prostatectomy - which removes the entire prostate gland. Or you may have a partial prostatectomy, which only removes the cancerous tissue. Radical prostatectomy is typically recommended for younger, healthier patients with localised cancer. The surgery may be done using an open incision or laparoscopically with robotic assistance. There may be side effects from surgery, such as urinary or erectile problems, and your surgeon will discuss the various risks before your operation. The potential risks of surgery include bleeding, infection, and damage to surrounding tissue. The potential benefits include complete removal of the cancer and reduced risk of recurrence. After surgery, you will need to stay in the hospital for a short period of time and will require several weeks of recovery at home. You will also need to follow up with your healthcare team regularly to monitor your progress and make sure the cancer has not returned.
Radiation Therapy
Radiation therapy is a treatment option for prostate cancer that uses high-energy radiation to kill cancer cells. It may be used as the primary treatment or in combination with other treatments. Radiation therapy may be given externally using a machine that directs radiation towards the cancer. Alternatively, it may be delivered internally with small radioactive pellets (brachytherapy) - see below. Radiation therapy is non-invasive, meaning there is no incision, and it may be performed on an outpatient basis. The side effects of radiation therapy may include fatigue, skin irritation and inflammation of the bladder and rectum.
Brachytherapy Therapy
This treatment is offered at Hermitage Clinic and Galway Clinic. Low Dose Rate Brachytherapy - or LDR Brachytherapy - is a type of internal radiation therapy. It aims to treat cancer by delivering radiation from implanted pellets placed permanently in the affected organ. To minimise side effects, the radiation must be tightly focused on the tumour. LDR Brachytherapy uses radioactive seeds, which emit low levels of radiation for several weeks. After treatment ends, the harmless seeds remain in place permanently. This one-time procedure requires an overnight stay in the clinic and typically takes about an hour. Brachytherapy can provide a faster, more effective form of radiation therapy for some patients. Depending on the cancer type and stage, Brachytherapy may be used in combination with other treatments. This can affect the length of treatment.
SpaceOAR Hydrogel
This compliment to radiation therapy is offered in the Galway Clinic. SpaceOAR Hydrogel reduces side effects during radiation therapy for prostate cancer. It is a water-based gel made from polyethylene glycol that is injected between the rectum and the prostate. The gel creates a temporary space between the rectum and prostate. This pushes the rectum further away from the high-dose radiation beams. This protects the rectum from radiation, which can cause bowel problems and other complications. The procedure to insert SpaceOAR Hydrogel is performed as an outpatient procedure. It takes place under local anaesthesia and only takes about 30 minutes. SpaceOAR Hydrogel does not interfere with cancer treatment, and it is naturally absorbed by the body over time. This product is an important tool in helping to minimise the side effects of radiation therapy for prostate cancer patients.
Hormone Therapy
Hormone therapy, also known as androgen deprivation therapy, is recommended in certain cases. This is usually where the cancer has spread beyond the prostate or is deemed high-risk. This treatment option works by lowering the levels of male hormones in the body, which can slow the growth of prostate cancer cells. Hormone therapy may be given through injections, orally or surgically. Hormone therapy is normally administered for a set period - as prostate cancer cells can adapt and become resistant to this treatment. Hormone therapy may also be used in combination with other treatment options to improve outcomes. While hormone therapy can be effective in controlling prostate cancer growth, it may also cause side effects. These can include loss of libido, hot flashes, and mood changes.
Chemotherapy
Chemotherapy is not usually a first-line treatment for prostate cancer. However, it may be recommended for patients whose cancer has spread beyond the prostate or has not responded to other treatments. It may also be recommended for patients who have a high-risk or aggressive form of the disease. Chemotherapy uses drugs to target and destroy cancer cells. As it can also affect healthy cells in the body, this can cause side effects such as nausea, hair loss, and increased risk of infection. The treatment is typically administered in cycles, with breaks to allow the body time to recover. While chemotherapy can be a challenging treatment, it has the potential to significantly prolong a patient's life. Symptoms and side-effects of chemotherapy can often be managed very effectively. This means it need not impact your quality of life to a significant extent.
Recovering and monitoring after treatment for prostate cancer
After undergoing treatment for prostate cancer, it is normal to experience a period of recovery. Recovery time varies depending on the type of treatment received and the individual patient. During recovery, it is essential to follow the instructions of Blackrock Health team to ensure you have the best possible outcome. Our team will provide guidance on self-care and follow-up appointments. We'll also monitor your recovery and ensure that the cancer has not returned. Monitoring typically involves regular PSA testing and physical exams. You may also undergo additional imaging tests as needed. We're here to support you throughout your recovery and will provide resources to help you manage any side effects or symptoms that may occur.
How do I get this?
You will need a referral letter from your GP or consultant before you make an appointment.
Is this insured?
Not all services are covered by health insurance. To find out if you're covered, please check your health insurance before your visit. You can do this on our health insurance cover check page, or by contacting your health insurer.
How do I pay?
If you do not have health insurance or your health plan does not cover the full cost, you will need to pay the balance due before your treatment or procedure. You may be able to claim back some fees on your insurance. To pay an excess not covered by your insurance or any other inpatient fees, please visit our payment page. If you have any queries about paying for your care, please contact the finance team in your hospital.