Men’s Health Month – Prostate Cancer, It’s no joke
A study discovered that 86% of patients surveyed believed appropriate humour was important during their cancer journey, 79% of them stated it helped to relieve some of the anxiety associated with their cancer and 4% of them said it was the most important quality in their interactions with healthcare professionals1. Prostate cancer, the most common form of cancer in men, can be a difficult topic and one many men would rather avoid. So, in this spirit, before getting into the nuts and bolts of this sensitive topic, we thought we’d crack the ice by mentioning a few of the funniest things heard by real doctors during prostate exams:
“Any sign of my car keys?”
“Hey Doc, can you tell I’ve been doing my squats?”
“Are we there yet? Are we there yet? Are we there yet?”
“I always knew that someday I’d be the butt of one of your jokes”.
What is the Prostate?
The prostate is a small, walnut-sized gland located below the bladder, between the penis and rectum, that surrounds the urethra. Its primary role is to produce the white fluid that, when mixed with sperm, creates semen2. This is essential to keep the sperm cells alive on their journey to find and fertilise an egg. Running along each side of the prostate is the neurovascular bundle, a collection of nerves and blood vessels responsible for controlling erectile function3.
The prostate itself is divided into zones or anatomic regions. Prostate cancer most commonly forms in the peripheral region, the one at the back or closest to the rectum. In these cases, the doctor may request a digital rectal exam (DRE)3. This is an examination that involves the doctor inserting a gloved finger into the rectum to examine the prostate first-hand. This examination can’t be used alone as a definitive diagnosis; therefore, it will normally be accompanied by a PSA test3.
The reproductive tract is a hostile environment for sperm, filled with bacteria and pathogens. Therefore, it must be well protected to reach the finish line. This is the role of the semen4. The semen contains a variety of components, some for energy, others are enzymes, like prostate-specific antigen (PSA). The job of this enzyme is to liquefy the semen, keeping it mobile to allow the sperm to reach the egg4. When PSA leaks into the blood, it can be measured and used to give an indication of prostate cancer status. We’ll look at this in more detail later.
What is Prostate Cancer?
Prostate cancer is the most common form of cancer in men. In the UK, 1 out of 8 men will receive a prostate cancer diagnosis within their lifetime. It is estimated that 12,000 men die every year from prostate cancer… that’s 1 death every 45 minutes5.
Cancer typically arises when cells start multiplying rapidly, leading to the formation of a tumour. This abnormal growth often occurs due to the absence of a ‘stop’ signal that typically restrains cell proliferation when necessary6. Once established, certain cancers utilise androgens (sex hormones influencing male development) as a source of sustenance, fuelling further expansion. Some types of prostate cancer progress slowly and are often identified before spreading beyond the prostate. Yet, this delayed growth pattern poses a challenge as prostate cancer commonly exhibits no distinct symptoms, complicating its detection and potentially allowing it to metastasise (spread) beyond the prostate6.
Risk factors
Prostate cancer is mostly diagnosed in European men over 50 years old. Unlike some other cancers, it is not strongly associated with a wide range of modifiable risk factors, but there are a few factors that are known to increase risk:
| Risk Factor | Description |
| Ethnicity | PSA levels are significantly higher in black men. However, prostate cancer incidence is around 40x higher in African American men than in African men suggesting there are some important environmental factors7. A similar trend is seen in Chinese American men when compared with those in China7. Another explanation for these trends may be increased levels of testing and diagnosis in those regions with lower prevalence.
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| Family History | It is estimated that 20% of prostate cancer patients report a family history of the disease7. This may be the result of genetic factors, environmental carcinogens, and common lifestyle habits. |
| Vitamin D | It has been shown that there is an inverse correlation between sunlight or UVB exposure and the diagnosis of prostate cancer, suggesting vitamin D deficiency may increase the risk of prostate cancer7. |
| Folate & Vitamin B12 | These nutrients are involved in DNA synthesis and repair. Low levels of folate and B12 may result in changes to DNA and the development of cancer7. |
Prostate Specific Antigen and Prostate Cancer Diagnosis
Normal PSA levels vary in the population and increase with age, however, men aged between 50-69 are expected to have a PSA level of <3 nanograms per ml8. Serum PSA levels can be elevated due to several mechanisms:
- When prostate cancer eliminates certain cells, it can disrupt the structure of the prostate, allowing more PSA to enter the bloodstream.
- The increased number of cells caused by prostate cancer tumours express PSA in addition to that produced by healthy prostate cells, driving the increase in PSA .
Monitoring for prostate cancer with PSA can be tough as elevations are not specific to prostate cancer. High PSA levels might mean an enlarged prostate, prostatitis, or a urinary infection. Furthermore, research shows that 3 out of 4 men with high PSA won’t have prostate cancer8. However, PSA testing is a useful indicator and is used throughout the world to estimate risk and supplement diagnosis. In the UK, there isn’t a definitive diagnostic pathway for prostate cancer; it often takes a combination of PSA testing, DRE, and MRI scans, considered alongside risk factors and symptoms to achieve a positive prostate cancer diagnosis2.
Myths about Prostate Cancer
In the age of misinformation, deciphering fact from fiction can be a hard nut to crack. Here, we will take a quick look at some of the myths swimming around in relation to prostate cancer.
“Only old men get prostate cancer.”
While it’s true that prostate cancer mostly affects men over 502 (you can judge for yourself if you think that’s old), if you fall into one of the high-risk groups we discussed before and are under 50 you could still be at risk.
“Getting a vasectomy causes prostate cancer.”
This myth has been around for a while, there’s no strong evidence that this is the case. A meta-analysis showed that there was a link between vasectomy and prostate cancer. However, when only considering the most robust and high-quality analysis, this association becomes weaker and less significant. In other words, it may be the case that there is some link, but it is unlikely that vasectomy directly causes prostate cancer9.
“Sexual activity increases the risk of developing prostate cancer.”
It was rumoured that lots of sexual activity or frequent ejaculation increased the risk of prostate cancer. Another myth! Scientists have found no evidence of this. In truth, researchers at Harvard discovered the exact opposite, a decreased risk for men with high ejaculation frequency10.
Genetic Screening at Randox Health
At Randox Health we believe in an initiative-taking approach to your health. There are 3 main contributing factors to risk of prostate cancer: age, family history and ethnicity. This is why we have developed our Prostate Cancer Risk test. This test investigates the genome at 12 distinct sites, to identify potentially harmful variants in the genetic code. Having one of these genetic variants does not mean that a person will develop prostate cancer but does suggest that they are at increased risk. You can read about some of these genetic variants below:
| Gene | Description |
| BRCA1/BRCA2 | These tumour suppressor genes, BRCA1 & BRCA2 are found on chromosomes 17 and 13 respectively. Mutations in these genes are associated with prostate cancer as well as ovarian cancer and particularly their namesake, breast cancer. BRCA1 mutation is associated with a 1.35x increased risk of developing prostate cancer. BRCA2 mutations are associated with a slightly higher increased risk, 2.64x risk11. |
| HOXB13 missense variant G84E | This variant is associated with a higher-than-average risk of developing prostate cancer11,12, however, the variant accounts for a small fraction of all prostate cancers12. |
| TP53 | The gene TP53 is responsible for producing the protein known as p53. This protein has earned the nickname ‘guardian of the genome’ because of its critical involvement in essential functions like regulating the cell cycle, initiating programmed cell death (apoptosis), managing metabolism, and repairing DNA. Those who harbour TP53 mutations are thought to be predisposed to a particularly aggressive form of prostate cancer13. |
These mutations, along with the others included in our Prostate Cancer Risk Test, are used in combination to estimate risk of prostate cancer. However, there’s a lot to consider before deciding to go ahead with genetic screening.
Genetic counselling is crucial for informed decision-making on genetic testing. These experts meticulously review the individual’s and their family’s medical history, pinpointing possible genetic concerns. This holistic approach determines the appropriateness of genetic testing.
After opting for genetic testing, counsellors provide invaluable assistance in interpreting the results. They elucidate the implications for the individual’s health and their family members and discuss strategies for managing any emerging issues. This could involve recommending closer monitoring or preventive measures.
With all genetic screening at Randox Health, you can book an appointment with a genetic counsellor who will help empower you with the knowledge to navigate genetic risks and make informed choices for your well-being. If you or someone you know would like to find out about risk of prostate cancer, information on how to book an appointment is available here: https://randoxhealth.com/prostate-cancer-risk and don’t forget to book a consultation with one of our Genetic Counsellors.
Prostate Health Risk at Randox Health
At Randox Health, we also offer advanced Prostate Health testing for those who wish to investigate their risk of prostate disease. As we’ve mentioned, PSA isn’t specific to prostate cancer; it may indicate prostatitis, an enlarged prostate, or a urinary tract infection. This is why, in addition to PSA, our new Prostate Health test includes analysis of a novel combination of biomarkers including EGF, IL-8, and MCP-1 to generate a prostate cancer risk score, which can significantly improve the predictive potential of PSA alone in identifying individuals at risk of prostate cancer. Appointments can be booked online for a time and date that suits, during which we’ll take a blood sample. Then, our laboratorians will get to work running the test and determine whether results show a high or low risk of prostate cancer. Once testing is complete, a personalised and comprehensive report detailing results will be provided. Don’t forget, remote GP appointments to discuss results are also available.
Men’s Mental Health
While we are here to help promote physical health and wellbeing, it is crucial that we look after our mental health. Only 36% of referrals to NHS talking therapies are men14. It’s also well known that the biggest killer of men under 50 is suicide. Men can find it much harder to open up about how they feel and are more likely to develop potentially harmful coping mechanisms such as drugs or alcohol14.
If you or someone you know is struggling with their mental health, speak to someone you trust, a partner, relative or friend. You can contact The Samaritans in confidence. They provide emotional support, 24 hours a day. To speak to someone, Call 116 123 for free or email jo@samaritans.org.uk. You can also visit a Samaritans branch to talk to someone in person. You can find your local branch here https://www.samaritans.org/branches/.
Alternatively, speak to your GP who can give you advice on the next steps. We’ll leave some additional contact information below, if you’re struggling, please reach out to someone.
You are not alone.
National Suicide Prevention Helpline UK: 0800 689 5652 (6pm to midnight every day).
Shout – Offers a confidential 24/7 test service for those seeking mental health support: Text SHOUT to 85258.
References
- Samant R, Balchin K, Cisa-Paré E, et al. The importance of humour in oncology: a survey of patients undergoing radiotherapy. Curr Oncol. 2020;27(4):e350-e353. doi:10.3747/co.27.5875
- NHS. Prostate Cancer. Health A to Z. Published October 18, 2021. Accessed October 23, 2023. https://www.nhs.uk/conditions/prostate-cancer/
- Prostate Cancer Foundation. Prostate Gland. What is Prostate Cancer. Published 2023. Accessed October 23, 2023. https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-gland/
- Harvard Health. PSA: Prostate-Specific Antigen, Persisting Scientific Ambiguities. Harvard Health Blog. Published July 1, 2009. Accessed October 23, 2023. https://www.health.harvard.edu/newsletter_article/PSA-Prostate-Specific-Antigen-Persisting-Scientific-Ambiguities
- Prostate Cancer Foundation. About prostate cancer. Prostate Cancer UK. Published 2023. Accessed October 23, 2023. https://prostatecanceruk.org/prostate-information-and-support/risk-and-symptoms/about-prostate-cancer
- Prostate Cancer Foundation. How Prostate Cancer Grows. What is Prostate Cancer. Published 2023. Accessed October 23, 2023. https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/how-it-grows/
- Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10(2):63-89. doi:10.14740/wjon1191
- NHS Choices. Should I get a PSA test? NHS. Published 2019. Accessed October 23, 2023. https://www.nhs.uk/conditions/prostate-cancer/should-i-have-psa-test/
- Baboudjian M, Rajwa P, Barret E, et al. Vasectomy and Risk of Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Open Sci. 2022;41:35-44. doi:10.1016/j.euros.2022.04.012
- Havard Health. Ejaculation frequency and prostate cancer. Men’s Health.
- Nyberg T, Tischkowitz M, Antoniou AC. BRCA1 and BRCA2 pathogenic variants and prostate cancer risk: systematic review and meta-analysis. Br J Cancer. 2022;126(7):1067-1081. doi:10.1038/s41416-021-01675-5
- Ewing CM, Ray AM, Lange EM, et al. Germline mutations in HOXB13 and prostate-cancer risk. N Engl J Med. 2012;366(2):141-149. doi:10.1056/NEJMoa1110000
- Maxwell KN, Cheng HH, Powers J, et al. Inherited TP53 Variants and Risk of Prostate Cancer. Eur Urol. 2022;81(3):243-250. doi:10.1016/j.eururo.2021.10.036
- Mental Health Foundation. Men and mental health. Explore Mental Health. Published October 1, 2021. Accessed October 24, 2023. https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/men-and-mental-health
