Don’t you think understanding prostate cancer will be helpful? This discourse will cover the meaning, symptoms, causes, prevention, diagnosis, and treatment of prostate cancer.
What is prostate cancer?
Prostate cancer is common in men, with more than 75% of men over 65 years being affected.
It affects the prostate gland, a walnut-sized organ that surrounds the urethra and is vital for reproduction. It occurs due to the multiplication of cells in the soft tissues of the prostate.
Types of prostate cancer
Understanding the type of cancer sheds light on the kind of cell cancer that started it, which helps your doctor choose the appropriate treatment for you.
There are different types of prostate cancer.
- Acinar adenocarcinoma: Adenocarcinomas develop in the gland cells that line the prostate gland. It is the most common type.
- Ductal adenocarcinoma: Begins in the cells that line the tubes of the prostate gland. It grows and spreads faster than acinar adenocarcinoma.
- Transitional cell (or urothelial) cancer: Starts in the cells of the urethra. Usually, it begins in the bladder and spreads into the prostate, and may spread to nearby tissues.
- Squamous cell cancer develops from flat: Cells covering the prostate grow and spread more quickly than adenocarcinoma cancer.
- Small cell prostate cancer: A type of neuroendocrine cancer that is rare and grows more quickly than other types. It mainly affects men with advanced cancer. The Prostate-specific antigen (PSA) level in men with small cell prostate cancer is often average, slightly higher than usual, even if cancer has spread.
- Neuroendocrine tumours (NETs): A rare tumor that starts in neuroendocrine cells and occurs in different types. The type you are diagnosed with depends on the type of cell that cancer started in. Most NETs develop slowly over some years and may not cause symptoms in the early stages.
- Soft tissue sarcoma: These are cancers that develop in the bodies of supporting tissues such as the blood vessels, muscle, fat, and nerves. The two most common prostate sarcomas include rhabdomyosarcomas and leiomyosarcomas, affecting younger men between ages 35 and 60, with rare cases in children. Prostate sarcomas are hard to detect since they do not change PSA levels.
Symptoms of prostate cancer
Prostate cancer hardly displays symptoms during the early stages, but doctors can detect changes through screening.
Some of the symptoms you may experience in the early stages may include:
- A frequent urge to urinate, especially at night
- Difficulty starting and maintaining urination
- In some cases, pain on ejaculation
- Blood in the urine or semen
- Painful urination
- Erectile dysfunction
Symptoms of advanced prostate cancer include:
- weight loss
- Oedema, or swelling in the legs or feet
- Bone pain, especially in the thighs, hips, or shoulders
- Changes in bowel habits
- Back pain
Recurrent prostate cancer symptoms
There are possibilities of prostate cancer returning after treatment. When it returns to the prostate area, the disease is referred to as a local recurrence.
If found in another part of the body, the recurrent cancer is considered metastatic, which most often spreads to the bones, liver, and lungs.
Symptoms of recurrent cancer include:
- Rise in the PSA level
- Blood in the urine
- Difficulty urinating
- Lower back pain
- Difficulty breathing
Causes of prostate cancer
Prostate cancer starts when prostate cells change in their DNA. The changes cause cell growth and make the cells divide faster than normal cells.
Abnormal cells continue living when other cells die, and they form a tumour that can grow to invade nearby tissue. Some abnormal cells can mutate and spread (metastasize) to other parts of the body.
Risk factors of prostate cancer
With age, especially after age 50, the risk of prostate cancer increases. Around 60% of men diagnosed with prostate cancers are 65 or older.
Young men are at a lower risk of getting prostate cancer even though they are not excluded.
Though reasons are not concrete, Black people are said to have a greater risk of prostate cancer than other races. In Blacks, it is also more likely to be aggressive.
If a blood relative such as a sibling or parent has been diagnosed with prostate cancer, chances are you are at risk.
A type of cancer called familial prostate cancer runs in the family and it makes up about 20% of all prostate cancers. It develops because of a combination of shared genes and a shared environment or lifestyle.
Hereditary prostate cancer is rare and accounts for about 5% of all cases. It can be suspected if a family history includes any of the following characteristics:
- Two or more close relatives, such as a sibling, uncle, parent, nephew, child, or grandparent, in the same family, are diagnosed with prostate cancer before age 55.
- Prostate cancer in three generations of the family.
- Three or more first-degree relatives with prostate cancer.
Though research has not clearly been defined, cigarette smoking may increase prostate cancer risk through exposure to carcinogens or by affecting circulating hormone levels.
The exact impact of diet on prostate cancer is not clear. Discussions put it that men who eat a lot of dairy products and calcium present a slightly higher chance of getting prostate cancer.
Some studies suggest that men who have had a vasectomy have a slightly increased risk for prostate cancer.
Inflammation of the prostate
Some research has suggested inflammation of the prostate gland may be associated with an increased risk of prostate cancer.
Sexually transmitted infections
Sexually transmitted infections (like gonorrhea or chlamydia) might increase prostate cancer risk since they can cause inflammation of the prostate.
Diagnosis of prostate cancer
Diagnosing cancer at its early stages is often best for a cure.
Screening is testing for cancer in people before they have symptoms. For every 1,000 men in the ages of 55 and 69 who are screened, about one death is prevented and will prevent three men from getting prostate cancer that spreads to other places in the body.
Who should get screened?
Men between the ages of 55 to 69 should be screened for prostate cancer with a Prostate-specific antigen (PSA) test.
Before making a decision, you should talk to your doctor about the pros and cons of screening for prostate cancer.
Men above 70 should not screen for prostate cancer routinely. This recommendation applies to men who:
- Are at average risk for prostate cancer.
- Do not have symptoms of prostate cancer.
- Are at increased risk for prostate cancer.
- They have never been diagnosed.
What are the benefits of screening?
- It helps prevent cancer by finding changes in your body that would become cancerous if left untreated
- Good for knowing your results
- Cancer screening helps in early diagnosis
- Early detection may mean less treatment and less time spent recovering
The possible harms include harms from screenings, diagnosis, and treatment.
Possible harm from screening
False-positive test results occur when a man has an abnormal PSA test but does not have prostate cancer. They often lead to unnecessary tests, like a biopsy of the prostate, which may cause men to worry about their health.
Possible harms from diagnosis
There is a phenomenon commonly known as over-diagnosis when some men are screened for prostate cancer yet they never had symptoms.
Harm from treatment
The most common treatments are surgery to remove the prostate and radiation therapy. Most of the time, they cause complications like urinary incontinence (accidental leakage of urine), erectile dysfunction (impotence), and bowel problems including fecal incontinence (unintentional leakage of bowel movements) and urgency.
Stages and grades of prostate cancer
It is essential to know the stages of prostate cancer to help you understand what to expect and inform treatment decisions. The stages include:
- Stage 0: Precancerous cells are present but are slowly growing and only affect a small area.
- Stage 1: Localized cancer is only present in the prostate gland, and successful treatment is possible.
- Stages 2-3: Regional stage: Cancer has spread to nearby tissues.
- Stage 4: Distant: Cancer has spread to other parts of the body such as the lungs or bones. A cure is almost impossible.
Tests for prostate cancer
Digital rectal exam (DRE)
The doctor puts a finger into the rectum to test for any hard areas or bumps on the prostate that might have cancer. This can be uncomfortable (especially for men who have hemorrhoids) but it is painless.
PSA Blood test
The PSA test is used for detecting early-stage prostate cancer, especially in those with many risk factors, which helps treat cancer before the tumor grows and spreads.
However, PSA screening may find very slow-growing prostate cancers that would never threaten someone’s life.
For this reason, screening for prostate cancer using PSA may lead to treatments that are not needed, which can cause side effects and affect a person’s life.
Imaging tests use sound waves, x-rays, magnetic fields, or radioactive substances to create pictures of the inside of your body.
This helps the doctor to look for cancer and see the prostate during specific procedures (such as a prostate biopsy or certain types of prostate cancer treatment) and also to see how much it has spread to other body parts.
A biopsy is a procedure where small samples of the prostate are removed and then examined under a microscope.
It is the only way to get assurance if a man has prostate cancer. The test can also help tell the probability that cancer will grow and spread quickly.
Complications of prostate cancer
The condition can result from prostate cancer or its treatment. Averagely two out of every three men who have prostate surgery become impotent.
However, there are medications and vacuum devices that assist in achieving an erection.
Cancer that spreads to other parts
Prostate cancer can spread to organs such as the bloodstream, bones, and the lymphatic system and cause an effect on these organs.
Once it has spread to other areas, it may be controlled or respond to treatment but can hardly be cured.
- Urine incontinence: About one out of every five men who have prostate surgery loses bladder control. Prostate cancer and its treatment can cause urinary incontinence. Treatment options may include medications, surgery, and catheters.
- Bowel incontinence: About one out of every six men who have radiation therapy has bowel problems.
- Fecal incontinence: (accidental leakage of bowel movements)
Prevention of prostate cancer
You can keep prostate cancer at bay by:
Maintaining a healthy weight
Obese men with a body mass index (BMI) of more than 30 are prone to prostate cancer. If you are overweight, work on losing weight.
You can do this by doing exercises and reducing the number of calories you consume daily.
If you are healthy, work to maintain it by eating a healthy diet and exercise frequently.
Prevention of prostate cancer through healthy eating has not been proved. Still, some evidence shows that eating a healthy diet with various fruits and vegetables can improve your health and help your body fight disease.
You might consider choosing a low-fat diet, increasing the number of fruits and vegetables you eat daily, and exercising. Exercise improves your overall health and helps you maintain your weight.
Choosing healthy foods over supplements
Supplements are not proven to play a role in reducing the risk of prostate cancer. Instead, choose foods rich in vitamins and minerals.
Lycopene, a nutrient found in tomatoes, is associated with helping to prevent cancer. Also, consider feeding on legumes that can maintain healthy levels of vitamins in your body.
Drinking water is also part of a healthy diet.
Consulting your doctor about increased risks of prostate cancer
It is advisable to consult a doctor concerning your prostate health. Early screening may reduce the overall risk of developing prostate cancer.
Treatment of prostate cancer
This involves monitoring prostate cancer in its localized stage until the doctor recommends further treatment if needed.
Patients with slow-growing tumors or low-grade tumors confined to the prostate gland may consider active surveillance.
Below are the qualifications for active surveillance:
- Your cancer is limited to the prostate.
- you can live with cancer without worrying about reducing your quality of life.
- your tumor is small and is expected to grow slowly
- you aren’t experiencing any symptoms.
- you have a long life expectancy and may benefit through curative therapy if your cancer progresses.
Watchful waiting is a form of managing prostate cancer through monitoring the condition. It may be effective for men with limited life expectancy, low-risk disease, and slow-growing cancer.
Patients observe their symptoms and inform their doctor if changes occur. The goal is to follow prostate cancer until it has started to cause symptoms such as pain or blockage of the urinary tract or metastasized.
Doctors recommend that patients who are too sick or too old with other life-threatening illnesses should be the ones to benefit from local therapy.
Surgery (radical prostatectomy)
This is the surgical removal of the entire prostate and the seminal vesicles, which has the risk of affecting sexual function. Urinary incontinence is a possible side effect of radical prostatectomy.
Radiation therapy is the use of high-energy rays to destroy cancer cells. A specific number of treatments are administered over a set period such as external beam radiation therapy and extreme hypofunction radiation therapy.
Cryotherapy uses below-room temperatures to freeze and kill prostate cancer cells and most of the prostate.
It involves freezing cancer cells with a metal probe inserted through a small incision in the area between the rectum and the scrotum.
Cryotherapy is sometimes used if cancer has recurred after radiation therapy. It may be an option to treat low-risk early-stage prostate cancer patients who cannot have radiotherapy or surgery.
Focal therapies are less invasive treatments that destroy small prostate tumors without treating the rest of the prostate gland.
They use heat, cold, and other methods to treat mostly low-risk or intermediate-risk prostate cancer.
Systemic therapy/ hormonal therapy
They are also referred to as androgen-deprivation therapy (ADT). Since prostate cancer growth is driven by male sex hormones called androgens, lowering these hormones can help slow cancer development.
The most common androgen is testosterone. Hormonal therapy is used to reduce testosterone levels in the body.
It is reduced by either using drugs that stop the function of the testicles (called medical castration) or surgically removing the testicles (surgical castration).
Types of hormonal therapy include:
- Bilateral orchiectomy;
- LHRH agonists;
- LHRH antagonist;
- Androgen receptor (AR) inhibitors;
- Androgen synthesis inhibitors;
- Combined androgen blockade; and
- Intermittent hormonal treatment.
It is performed using drugs to destroy cancer cells by inhibiting the cancer cells from dividing, growing, and making more cells.
Chemotherapy may help those with newly diagnosed or castration-sensitive metastatic prostate cancer or advanced prostate cancer.
The chemotherapy side effects depend on the individual, the dose used, the type of chemotherapy received, and the length of treatment. They usually go away after treatment.
However, some side effects may come back, continue, or develop later.
They can include nausea and vomiting, fatigue, appetite loss, sores in the mouth and throat, diarrhea, constipation, sexual and reproductive issues, pain, and hair loss.
It is the use of medicines to stimulate a person’s immune system for recognizing and destroying cancer cells.
Some immunotherapy used includes a cancer vaccine.
What to expect after the prostate is removed
Men diagnosed with prostate cancer face a unique emotional issues. Guilt for not being able to have intimate relationships due to anxiety and fear, increased risk of depression, anxiety, fatigue, irritability and fear of disease progression.”
- Erectile dysfunction: It occurs because the nerves and blood vessels that control the physical aspect of an erection are delicate and stressful to the area.
- Urinary incontinence: Nearly all men will have some form of leakage immediately after the surgery, but this will improve over time and strengthen exercises.
- Bowel function: It is rare (less than 1%) for men to have altered bowel function after surgery. In rare cases of locally advanced prostate cancer where cancer invades the rectum, surgery may damage the rectum.
- Infertility: During prostatectomy, both the prostate and the nearby seminal vesicles that provide semen and carry the sperm through the urethra and out the penis during ejaculation are removed. The loss of semen following surgery makes ejaculation impossible, so the sperm cannot physically make it out of the body to reach the woman’s egg for fertilization.
Prostate cancer has become the most common cancer affecting men, especially those above 65 years.
However, the number of people it kills can be reduced through early screening and treatment once diagnosed.
It can be prevented through healthy lifestyle practices like healthy diets and exercises. Be in charge and see a doctor for advice and help on prostate cancer.
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- Cancer Research UK (Dec. 12, 2018). Prostate cancer incidence. cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/incidence
- Cheng HH, Nelson PS.(March 19,2019). Genetic risk factors for prostate cancer. uptodate.com/contents/genetic-risk-factors-for-prostate-cancer.
- John Hopkins Medicine (n.d). Active Surveillance for Prostate Cancer. hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/active-surveillance-for-prostate-cancer
- Mayo Clinic Staff. Prostate Cancer (Nov. 12, 2020). mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087
- National Cancer Institute (March 21, 2019). Physician Data Query (PDQ). Prostate Cancer Prevention. cancer.gov/types/prostate/hp/prostate-prevention-pdq
- National Comprehensive Cancer Network(May 29, 2020) .Prostate cancer. nccn.org/professionals/physician_gls/default.aspx