Prostate Cancer

Overview

Prostate cancer is one of the most common cancers among men. It develops in the prostate gland, a small gland involved in the reproductive system. Prostate cancer often grows slowly and can be detected early through regular screening. Early detection offers the best chance for successful treatment, making it essential for men to understand their risks and the importance of routine screenings.

What is Prostate Cancer?

Prostate cancer occurs when cells in the prostate gland start to grow uncontrollably. The prostate is a walnut-shaped, small, gland located in front of the rectum in men, right below the bladder.

The prostate gland primarily produces produce seminal fluid, which nourishes and transports sperm. Most prostate cancers are diagnosed at an early stage, where treatment often leads to positive outcomes. However, grades and stages of prostate cancer can also grow and spread quickly, making it a potentially life-threatening disease if you do not treat it promptly.

Types of Prostate Cancer

There are several types of prostate cancer, with adenocarcinomas being the most common. Adenocarcinomas originate in gland cells, such as those in the prostate, that produce fluid. Prostate cancer rarely develops from other cell types. Different types include:

Small Cell Carcinomas

A rare and aggressive form of neuroendocrine cancer, small cell carcinoma represents less than 2% of prostate cancer cases. Small cell carcinoma may grow and spread more rapidly, often requiring specialised treatment.

Transitional Cell Carcinomas (Urothelial Carcinomas)

This type starts in the urothelial cells that line parts of the urinary system, including the bladder, ureters, and urethra. Transitional cell carcinoma may start in the bladder and spread to the prostate or begin in the prostate itself.

Neuroendocrine Tumours (NETs)

These tumours originate in neuroendocrine cells, which have properties of both hormone-producing and nerve cells. NETs are rare in the prostate but can be aggressive and difficult to treat.

Sarcomas

Sarcoma is a type of cancer that can develop in different parts of the body. It is an umbrella term for a diverse group of cancers that originate in the bones as well as in soft tissues, which are often referred to as connective tissues. This includes conditions known as soft tissue sarcomas.

Symptoms of Prostate Cancer

Prostate cancer symptoms often do not appear until the disease has advanced, making regular screening crucial. As the cancer progresses, symptoms may include:

• Persistent Pain in the Back, Hips, or Chest: This could suggest that the cancer has metastasised (spread) to bones or other tissues.
• Frequent Urination: Especially at night, an increased urgency to urinate can be an early sign as the cancer affects the bladder and urinary tract.
• Blood in Urine or Semen: Known as haematuria or haematospermia, blood in bodily fluids can indicate more advanced cancer.
• Pain or Burning During Urination (Dysuria): Though less common, it may indicate cancer's spread or infection.
• Urinary and Bowel Incontinence: Loss of bladder or bowel control can occur if cancer spreads to nearby nerves.
• Weak or Interrupted Urine Flow: This occurs when the tumour grows and obstructs urine flow.
• Erectile Dysfunction (ED): Advanced prostate cancer may impact sexual function, leading to painful ejaculation or difficulty achieving an erection.

Causes of Prostate Cancer

While the precise reasons for prostate cancer are still unknown, various risk factors contribute to the development of the disease. Men between 75 to 79 years old are at a higher risk of developing prostate cancer. African American men have a significantly higher risk of prostate cancer and often experience more aggressive forms of the disease.

Additionally, a family history of prostate cancer can increase risk. Certain genetic mutations, such as BRCA1 and BRCA2, are associated with an increased likelihood of prostate cancer. Also, some studies suggest that a high-fat diet and low intake of fruits and vegetables may increase the risk. Obesity and smoking may also play a role in the development or progression of prostate cancer.

Diagnosis of Prostate Cancer

Diagnostic procedures for prostate cancer often begin with screening tests followed by confirmatory tests if abnormalities are found:

Screening Tests
Prostate-Specific Antigen (PSA) blood test measures the level of PSA in the blood. Elevated PSA levels may indicate towards prostate cancer, although other conditions, like infections or benign enlargement, can also raise PSA. Other than that, the Digital Rectal Exam (DRE) can also detect prostate cancer. In this test, a healthcare provider through the rectal wall examines the prostate gland to feel for abnormalities in size, shape, or texture.

Imaging Tests
In the Transrectal Ultrasound (TRUS, a probe inserted into the rectum uses sound waves to create images of the prostate. Also, Magnetic Resonance Imaging (MRI), provides detailed images, especially useful for guiding biopsies or assessing the extent of cancer spread.

Biopsy
If screening and imaging suggest prostate cancer, a biopsy is performed, where a sample of prostate tissue is taken and examined for cancer cells. The biopsy is crucial for confirming a cancer diagnosis.

Treatment for Prostate Cancer

The choice of treatment depends on the cancer’s stage, the patient’s age, health status, and personal preferences. Common prostate cancer management and treatment include:

Surveillance: Watchful waiting is appropriate for older patients or those with other serious health conditions, where active treatment is unnecessary unless symptoms arise. Whereas, in active surveillance, regular testing and monitoring are done without immediate treatment. Treatment is initiated only if signs of cancer progression appear.

Surgery: A radical prostatectomy involves the removal of a prostate gland that has been diseased. This procedure can often remove prostate cancers that have not spread. In some cases, a nerve-sparing technique can be used to preserve the nerves responsible for penile erection. However, this approach may not be feasible for men with large tumours or tumours that are very near these nerves.

Radiation therapy: In radiation therapy cancer treatment, high-energy X-rays or other forms of radiation are used to kill cancer cells or inhibit their growth. The method of radiation therapy administered depends on the type and stage of the cancer. For prostate cancer, there are three main types of radiation therapy: external radiation therapy, internal radiation therapy, and radiopharmaceutical therapy.

Hormone therapy: Hormone therapy helps to remove hormones or block their function to stop cancer cells from growing. There are different types of hormones that are made by different glands in the body and circulated in the bloodstream. In the case of men, sex hormones can cause prostate cancers to grow. Androgen deprivation therapy (ADT) uses drugs, surgery, or hormones to reduce or block male hormones.

Chemotherapy: Chemotherapy is a treatment for cancer that uses medication to halt the growth of cancer cells. This can be achieved either by killing the cells or by preventing them from dividing. When chemotherapy is inserted orally or injected into a vein or muscle, the drugs that enter the stream of blood reach cancer cells throughout the body and eradicate them.

Preventive Measures for Prostate Cancer

Though prostate cancer prevention is not guaranteed, there are certain steps that may reduce risk:

• Routine Screening: Men at high risk should discuss PSA screening with their healthcare provider.
• Healthy Weight and Diet: Maintain a balanced diet high in fruits, vegetables, and whole grains while limiting red meat and processed foods.
• Exercise: Regular physical activity can improve overall health and potentially reduce cancer risk. 150 minutes of moderate exercise per week is recommended for the prevention of prostate cancer.
• Quit Smoking: Smoking can increase cancer risk and worsen prognosis, so quitting is beneficial.

Myths and Facts Related to Prostate Cancer

There are various myths regarding prostate cancer. Following are some of the most popular myths and facts related to the disease:

Myth 1: No Symptoms Mean No Cancer.
Fact: Prostate cancer often does not cause symptoms in its early stages, making screening essential.

Myth 2: All Prostate Cancer Treatments Cause Impotence or Incontinence.
Fact: Not all cases require aggressive treatment. Side effects depend on the treatment type and individual response.

Myth 3: Prostate Cancer is Always Fatal.
Fact: With early diagnosis, the survival rate is significantly high. Hence, it is recommended to start early treatment.