Prostate cancer is a form of cancer that affects the gland that produces some of the fluid in semen and plays a role in urine control in men. This gland is called prostate gland which is part of the male reproductive system.
The American Cancer Society predicts in 2017 that there will be around 161,360 new diagnoses of prostate cancer, and that around 26,730 death rate will occur because of it.
Prostate cancer can be successfully treated if it is diagnosed before metastasis, but if it spreads, it is more dangerous. It most commonly spreads to the bones.
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Regular testing for early detection is vital as the cancer needs to be diagnosed before it spreads.
Symptoms of Prostate Cancer
During the early stages of prostate cancer, there are usually no symptoms. However, if symptoms do appear, they usually involve one or more of the following:
- blood in urine
- frequent urges to urinate, including at night
- difficulty starting and maintaining urination
- painful urination and ejaculation (though painful ejaculation is less common)
- difficulty achieving or maintaining an erection
Advanced prostate cancer can involve the following symptoms:
- bone fractures
- bone pain in the spine, femur, pelvis, or ribs
If the cancer spreads to the spine and compresses the spinal cord, there may be:
- urinary incontinence
- leg weakness
- fecal incontinence
Treatment is different for early and advanced prostate cancers.
Treatment for early stage prostate cancer
If the cancer is small, contained, and has not spread, it is usually managed by one of the following treatments:
Watchful waiting or monitoring: PSA blood levels are frequently checked. The risk of side-effects sometimes overshadows the need for immediate treatment for this slow-developing cancer.
Radical prostatectomy: This involves surgically removing the prostate. Traditional surgery requires a hospital stay of up to 10 days, with a recovery time of up to 3 months. Robotic keyhole surgery involves a shorter hospitalization and recovery period, but it can be more costly.
Brachytherapy: This is when radioactive seeds are implanted into the prostate to deliver targeted radiation treatment.
Conformal radiation therapy: In this approach, radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment. This minimizes the risk of exposing healthy tissues to radiation.
Intensity modulated radiation therapy: Beams with variable intensity are used. This is an advanced form of conformal radiation treatment.
Patients may receive radiation therapy combined with hormone therapy for 4-6 months in early treatment.
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Treatment for advanced prostate cancer
Advanced cancer is more aggressive and will have spread further through the body.
Chemotherapy: may be recommended, as it can destroy cancer cells around the body.
Androgen deprivation therapy (ADT): or androgen suppression therapy, is a hormone treatment that reduces the effect of androgen. Androgens are male hormones that can stimulate cancer growth. ADT can slow down and even stop cancer growth by reducing androgen levels. The patient will likely need long-standing hormone treatment.
Since the prostate is directly involved with sexual reproduction, removing it will affect semen production and fertility. Radiation therapy affects the prostate tissue and often reduces the ability to impregnate a woman. The sperm can be damaged and the semen not enough for transporting sperm.
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Non-surgical options can severely obstruct a man’s reproductive capacity.
Alternatives for preserving these functions may include donating to a sperm bank before surgery, or having sperm extracted directly from the testicles for artificial insemination into an egg. However, the success of these options is not 100% guaranteed.
What causes prostate cancer?
The prostate is a walnut-sized exocrine gland. It produces the fluid that nourishes and transports sperm on their journey to fuse with a female ovum, or egg, for fertilization to occur. The prostate contracts and forces these fluids out during orgasm.
The protein excreted by the prostate, prostate-specific antigen (PSA), helps semen maintain its liquid state. An excess of this protein in the blood is one of the first signs of prostate cancer.
The urethra is tube through which sperm and urine exit the body. It also passes through the prostate, hence, the prostate is also responsible for urine control. It can tighten and restrict the flow of urine through the urethra using thousands of tiny muscle fibers.
How does it start?
It usually starts in the glandular cells. This is known as adenocarcinoma. Tiny changes occur in the shape and size of the prostate gland cells, known as prostatic intraepithelial neoplasia (PIN). This tends to happen slowly and does not show symptoms until further into the progression.
Nearly 50 percent of all men over the age of 50 years have PIN. High-grade PIN is considered pre-cancerous, and it needs further investigation. Low-grade PIN is not a cause for alarm.
Stages of prostate cancer considers the size and extent of the tumor and the scale of the metastasis (whether it has traveled to other organs and tissues). At Stage 0, the tumor has neither spread from the prostate gland nor invaded deeply into it. At Stage 4, the cancer has spread to distant sites and organs.
A doctor will carry out a physical examination and enquire about any ongoing medical history. If the patient has symptoms, or if a routine blood test shows abnormally high PSA levels, further tests may be required including:
- a digital rectal examination (DRE), in which a doctor will manually check for any abnormalities of the prostate with their finger
- a biomarker test checking the blood, urine, or body tissues of a person with cancer for chemicals unique to individuals with cancer
If these tests show abnormal results, further tests will include:
- a PCA3 test examining the urine for the PCA3 gene only found in prostate cancer cells
- a transrectal ultrasoundscan providing imaging of the affected region using a probe that emits sounds
- a biopsy, or the removal of 12 to 14 small pieces of tissue from several areas of the prostate for examination under a microscope
These will help confirm the stage of the cancer, whether it has spread, and what treatment is appropriate.
To track any spread, or metastasis, doctors may use a bone, CT scan, or MRI scan.
The exact cause of prostate cancer is unclear, but there are many possible risk factors.
Prostate cancer is unusual among men under the age of 45 years, but more common after the age of 50 years.
Prostate cancer occurs most frequently in North America, northwestern Europe, on the Caribbean islands, and in Australia. The reasons remain vague.
Certain genetic and ethnic groups have an increased risk of prostate cancer. In the U.S., prostate cancer is more common among black men than non-Hispanic white men. A man also has a much higher risk of developing cancer if his identical twin has it, and a man whose brother or father had prostate cancer has twice the risk of developing it compared to other men.
According to studies, a diet high in red meat or high-fat dairy products may increase a person’s chances of developing prostate cancer, but the connection is neither confirmed nor clear.
Some research has suggested that non-steroidal anti-inflammatory drug (NSAID) use may reduce the risk of prostate cancer. Others have linked NSAID use with a higher risk of death from the disease. This is a provocative area, and results have not been established. There has also been some study into whether statins might slow the progression of prostate cancer. One study in 2016 concluded that results were inconsistent.
It is often believed that obesity is connected to the development of prostate cancer, but the American Cancer Society upholds that there is no clear link.