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PROSTATE CANCER

Introduction:

Prostate cancer develops in the prostate, a small walnut size gland located below the bladder and in front of the rectum in men. This tiny gland secretes fluid that mixes with semen, keeping sperm healthy for conception and pregnancy.

Prostate cancer is a serious disease.

Fortunately, most people with prostate cancer get diagnosed before it spreads beyond their prostate gland. Treatment at this stage often eliminates the cancer.

WHAT ARE THE TYPES OF PROSTATE CANCER?

If you’re diagnosed with prostate cancer, it’s most likely an adenocarcinoma. Adenocarcinomas start in the cells of glands — like your prostate — that secrete fluid. Rarely, prostate cancer forms from other types of cells.

Less common types of prostate cancers include:

  • Small cell carcinomas.

  • Transitional cell carcinomas.

  • Sarcomas.

 

Incidence of prostate cancer:

Prostate cancer is common, second only to skin cancer as the most common cancer affecting men. For every 100 people with prostates, 13 will develop prostate cancer at some point in their lives. Most will live normal lives and eventually die from causes unrelated to prostate cancer. Some won’t need treatment.

Symptoms and causes

Most prostate cancers grow slowly inside the prostate gland.

 

Early-stage prostate cancer rarely causes symptoms.

These issues may occur as the disease progresses:

  • Frequent, sometimes urgent, need to pass urine, especially at night.

  • Weak urine flow.

  • Pain or burning when you pass urine.

  • Loss of bladder control or incontinence.

  • Painful ejaculation and erection problems.  

  • Blood in semen or urine.

 

However, not all growths in your prostate are cancer.

Other conditions that cause symptoms similar to prostate cancer include:

  • Benign prostatic hyperplasia (BPH): At some point, almost everyone with a prostate will develop benign prostatic hyperplasia (BPH). This condition enlarges your prostate gland but doesn’t increase your cancer risk.

  • Prostatitis: If you’re younger than 50, an enlarged prostate gland is most likely prostatitis. Prostatitis is a benign condition that is due to an infection in your prostate gland. Bacterial infections are often the cause.

RISK FACTORS FOR DEVELOPING PROSTATE CANCER

The most common risk factors include:

  • Age: Your risk increases as you get older. You’re more likely to get diagnosed if you’re over 50. About 60% of prostate cancers occur in people older than 65.

  • Race and ethnicity:. You’re at greater risk if you’re Black or of African ancestry. You’re more likely to develop prostate cancers that are more likely to spread. You’re also at greater risk of prostate cancer forming before age 50.

  • Family history of prostate cancer: You’re two to three times more likely to get prostate cancer if a close family member has it.

 

Some studies have identified other prostate cancer risk factors, but the evidence is mixed.

Other potential risk factors include:

HOW TO DIAGNOSE PROSTATE CANCER

Screenings can help catch prostate cancer early. If you’re average risk, you’ll probably have your first screening test at age 50. You may need earlier screenings if you’re in a high-risk group – start screening at 45.

Screening tests can show whether you have signs of prostate cancer that require more testing.

  • Digital rectal exam: Your doctor can examine you for any bumps or hard areas that may mean cancer of the prostate.

  • Prostate-specific antigen (PSA) blood test: That is a cancer marker for prostate cancer. High PSA levels may indicate cancer – above 4.  Levels also rise if you have benign conditions, such as BPH or prostatitis.

Diagnostic procedures for prostate cancer:

When a high PSA is detected, the next two steps will be MRI of the prostate with possible biopsy when the MRI demonstrates a possible lesion.

  • Imaging: An MRI can show very accurate images of your prostate gland, including suspicious areas that may be cancer. Imaging results can help your doctor decide whether to perform a biopsy.

  • Biopsy: During a needle biopsy, a urologist removes a tissue sample with a special biopsy needle inserted in the lesion in the prostate for testing in a lab for cancer. A biopsy is the only sure way to diagnose prostate cancer. 

 

Grade and staging of prostate cancer.

Urologists use the Gleason score and cancer staging to determine how serious the cancer is and the types of treatments you need.

Gleason score:

The Gleason score allows your provider to rate how abnormal your cancer are. The more abnormal cells you have, the higher your Gleason score. The Gleason score allows your provider to determine the grade of your cancer, or its potential to be aggressive. Gleason 6 and less respond excellent to treatment, Gleason 7 intermediate and Gleason 8 and higher have the more aggressive growth pattern.

Staging prostate cancer:

Cancer staging allows your provider to determine how advanced your cancer is, or how much it’s spread. Cancer may be in your prostate gland only (local), invading nearby structures (regional) or spread to other organs (metastasized). Prostate cancer most commonly spreads to your bones and lymph nodes.

TREATMENT OF PROSTATE CANCER

Your treatment depends on multiple factors, including your overall condition, if the cancer’s spread and how fast it’s spreading. Depending on your treatments, you may work with various healthcare providers, including urologists, radiation oncologists and medical oncologists. Most prostate cancer diagnosed in the early stages can be cured with treatment.

Surveillance:

Your healthcare provider may monitor your condition instead of providing treatment if your cancer grows slowly and doesn’t spread.

Active surveillance:

 

You get screenings, scans and biopsies every one to three years to monitor cancer growth. Active surveillance works best if the cancer grows slowly, is only in your prostate and isn’t causing symptoms. If your condition worsens, your provider can start treatment.

Watchful waiting: 

Watchful waiting is similar to active surveillance, but it’s more commonly used for people who are frailer with cancer that likely won’t go away with treatment. Also, testing is much less frequent. Instead of eliminating the tumour, treatments usually focus on managing symptoms.

Surgery:

A radical prostatectomy removes a diseased prostate gland. It can often successfully eliminate prostate cancers that haven’t spread. Your provider can recommend the best removal method if they believe you’d benefit from this surgery.

  • Robotic radical prostatectomy: Robotic radical prostatectomy allows your provider to perform surgery through several tiny incisions. Instead of operating directly, they operate a robot system via a console for more precision and improved outcomes. 

Radiation therapy:

You may receive radiation therapy as a standalone treatment for prostate cancer or in combination with other treatments. Radiation can also provide symptom relief.

  • Brachytherapy: It involves placing radioactive seeds inside your prostate. This approach kills cancer cells while preserving surrounding healthy tissue.

  • External beam radiation therapy: With external beam radiation therapy (EBRT), a machine delivers strong X-ray beams directly to the tumour. Specialized forms of EBRT, like IMRT, can direct high doses of radiation toward the tumour while sparing healthy tissue.

 
Systemic therapies:

Your provider may recommend systemic therapies if cancer has spread outside your prostate gland. Systemic therapies send substances throughout your body to destroy cancer cells or prevent their growth.

  • Hormone therapy: The hormone testosterone boosts cancer cell growth. Hormone therapy uses medications to combat testosterone’s role in cancer cell growth. The medication works by preventing testosterone from reaching cancer cells or by reducing your testosterone levels. Alternatively, your provider may recommend surgery to remove your testicles (orchiectomy) so they can no longer make testosterone. This surgery is an option for people who cannot afford expensive medication.

  • Chemotherapy: Chemotherapy uses medicines to destroy cancer cells. You may receive chemotherapy alone or with hormone therapy if your cancer has spread beyond your prostate.

Side effects of prostate cancer treatment:

  • Incontinence: You may leak urine when you cough or laugh or feel an urgent need to pass urine. This problem usually improves over the first few months provided you exercise the muscle controlling your bladder.

  • Erectile dysfunction: Surgery, radiation and other treatments can damage the erectile nerves in your penis and affect your ability to get or maintain an erection. It’s common to regain erectile function within a year or two (sometimes sooner). In the meantime, medications like Viagra or Cialis can help by increasing blood flow to your penis.

THE PROGNOSIS FOR PEOPLE WITH PROSTATE CANCER

Your survival is excellent if prostate cancer is detected early. Almost everyone  diagnosed with cancer that hasn’t spread outside of their prostate has a normal life expectancy.

Prostate cancer survival rates aren’t as good when the cancer’s metastasized, or spread outside of your prostate. Thirty-two percent of people with metastatic prostate cancer are alive five years later.

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