Prostate (or prostatic) cancer starts in the prostate gland. The prostate gland is one of two male sex glands that produce fluids (prostate-specific antigen (PSA), seminal fluid) and semen (the second is the seminal vesicles). The prostate is about the size and weight of a walnut and weighs about 1 kg. It is at the base of the penis and about 2.5 cm (1 in) from the penis’ opening.
Cancer is one of the most common types of cancer in men, and the American Cancer Society has estimated that there were about 268,new cases of prostate cancer in 2021. Some studies indicate that the incidence of the disease may be declining. Other studies have found that it is increasing.
The most common form of prostate cancer is the slow-growing hormone-sensitive prostate cancer. The most common signs and symptoms of prostate cancer are difficulties urinating, blood in the urine, back and leg pain, and fever. Diagnosis is with a digital rectal examination or blood tests. PSA testing monitors if the disease has progressed to the more advanced forms.
There are many treatments for prostate cancer are available. These include drugs, radiation, prostatectomy, and watchful waiting. Several preventive measures are also available. Many men choose to lower their risk of getting prostate cancer, such as stopping smoking, maintaining a healthy weight, eating a diet rich in fibre and vitamin D, and not drinking alcohol.
For people with cancer, symptoms can usually be detected early. However, it cannot be cured once prostate cancer progresses, and it often kills its victims. Many prostate cancer patients live a few years, while others may live just a few weeks. Half of those who survive longer than ten years die from prostate cancer.
Signs and symptoms
Cancer of the prostate, called prostate cancer, is the most common non-skin cancer in men and second most common in women.
Symptoms can include:
- Difficulty with urination (obstruction, frequent urination, hesitancy, weak stream, and dribbling), frequent urge to urinate, painful urination, urinary infection
- Pain and swelling in the prostate area Back or groin pain
- Difficulty passing urine
- An enlarged prostate (usually measured using digital rectal exam)
An enlarged prostate may cause blood in the urine, semen abnormalities, and may cause painful urination and discomfort, or urinary tract infections.
What are the Warning Signs of Prostate Problems?
The vast majority of cases of prostate cancer are an overgrowth of cells in the lining of the prostate gland. Some cases of prostate cancer appear to be triggered by inherited genetic mutations. However, in most cases, it is unclear how the mutated genes cause the overgrowth of cells in the prostate. Some inherited gene mutations are associated with increased risks of prostate cancer, while other gene mutations are associated with increased risk of different cancer types.
Environmental factors cause most prostate cancer. These factors include dietary changes, which may result from lifestyle, diet and nutritional supplements; infections, which may be associated with specific strains of sexually transmitted infections; and certain medications. Some studies have found that obesity, frequent drinking of alcoholic beverages, and a high intake of processed meat may increase the risk of prostate cancer.
Diagnosis Cancer of the prostate is diagnosed by digital rectal exam and the results of a blood test called the prostate-specific antigen (PSA). In most cases, the prostate-specific antigen (PSA) levels in the blood are normal until a man is in the mid-50s, but the PSA levels begin to increase gradually with age. For this reason, PSA levels in men older than 50 are not helpful in determining whether cancer has developed. The normal level of PSA in young men is usually higher.
Cystoscopy and Sigmoidoscopy
A digital rectal examination is done to examine the prostate gland, check for nodules or tumors, feel the edges of the prostate gland, and measure its size. A cystoscopy (a procedure in which a physician looks inside the urinary tract using a scope) and a sigmoidoscopy (which is done in the lower end of the colon) are sometimes done to see whether there are tumors or enlarged lymph nodes in other parts of the body. A bone scan may also be done to look for bone metastases.
PSA Blood Test
A blood test called the prostate-specific antigen (PSA) test is used to screen for prostate cancer. The PSA level is a screening tool that measures the amount of a substance, called prostate-specific antigen (PSA), in a man’s blood. PSA levels in men older than 50 are not helpful in determining whether cancer has developed. The normal level of PSA in young men is usually higher.
Once prostate cancer is detected, it can be examined through various imaging tests, including MRI and CT scans, to assess its size and spread. In addition, biopsies can be performed through a local anesthetic to diagnose cancer. Biopsies are to obtain a sample of the tumor cells and ensure that cancer has not spread to other parts of the body.
Other tests may be done in order to determine the stage of cancer or its specific characteristics, or whether the cancer has been treated successfully. For example, to see if the cancer has spread to other parts of the body, a bone scan may be done. For women, the ovarian Papanicolaou (Pap) smear is often done to check for signs of ovarian cancer.
Although the exact role of PSA testing in the early diagnosis of prostate cancer is unclear, and there is general agreement that it can increase early detection of cancer. PSA screening, which involves checking for abnormal levels of PSA, is now widely used in the United States and most other countries to screen for prostate cancer.
Screening for prostate cancer is controversial, and many experts have criticized PSA screening. Many men choose to have their PSA tested regularly, and many PSA levels will not show signs of prostate cancer. The National Cancer Institute has estimated that screening effectively decreases mortality by 20% to 30%. The U.S. Preventive Services Task Force (USPSTF) recommends that men aged 55–69 should be screened, as long as they discuss the benefits and potential harms of screening with their physicians. However, they note that there is little evidence that screening is cost-effective in the range of ages they recommend. The USPSTF also notes that men who are at low risk for prostate cancer should not be screened for it.
Prevention – Early detection and treatment
Early detection is associated with a better prognosis for prostate cancer, but early detection also has been associated with high levels of over diagnosis. Because early detection makes treatment more likely, many groups recommend against the use of PSA-based screening in asymptomatic men.
Several organizations recommend that men over 50 avoid PSA testing because the positive predictive value is lower for this age group. Men who have a first-degree relative with prostate cancer or a history of prostate cancer are encouraged to have regular screening, but many experts also suggest that the benefit of early detection is unclear.
High levels of over diagnosis also limit early detection for other cancers, so there is also little evidence that men at low risk for other cancer types should be screened routinely.
Possible Preventive Measures Include:
Lowering one’s risk of getting prostate cancer by quitting smoking, keeping a healthy weight, eating a healthy diet, and limiting the amount of alcohol one consumes; A prostate examination every 1 to 2 years starting at age 40.
The United States Preventive Services Task Force recommends that men over age 40 check their PSA levels every 2 years. They recommend that men with a PSA level of 3 ng/ml or lower be followed closely without screening for prostate cancer. PSA testing cannot detect all prostate cancers and it may lead to excessive screening and overtreatment. If a man has an elevated PSA level for more than 3 years, it should be checked to determine whether or not there are any possible causes for it (e.g. enlarged prostate, infection). The American Cancer Society’s (ACS) 2019 recommendations on screening for prostate cancer include the option of delaying the first prostate examination until age 50.
There is some evidence that specific inherited gene mutations have caused some prostate cancers. Genetic screening can identify these hereditary mutations and allow men at high risk to undergo surveillance or early treatment. The American Cancer Society recommends that men at high risk (e.g. those who have a first-degree relative with prostate cancer, a positive family history, or a history of fast-growing cancer in the prostate) discuss genetic testing with their physician.
Men between 40 and 60 years are currently recruiting for a prostate cancer prevention study. Men who have a first-degree relative with prostate cancer, a positive family history, or in the highest prostate cancer risk category (based on a clinical risk calculator) are eligible for the study. The study is a randomized controlled trial (RCT) in which half the men assign to receive a genetic test and the rest to receive an information pamphlet. Participants in the study are not aware of their assigned group. Genetic testing and information from the pamphlets are used to decide the optimal screening frequency for participants in each group.
Various forms of androgen deprivation treatment are used to lower the levels of hormones (prostate-specific antigen, PSA) produced by prostate cancer. Common hormonal therapies include luteinizing hormone-releasing hormone (LHRH) analogs, anti-androgens, and chirogenic medications. Hormonal therapies are used to shrink prostate tumors and to decrease the amount of PSA in the blood before surgery is done.
The most common types of hormonal treatment for prostate cancer are:
The LHRH analogs (leuprolide acetate, goserelin) block the pituitary gland from producing LHRH. As a result, the testicles stop producing testosterone and cause the prostate to shrink. The anti-androgens (flutamide, bicalutamide) block the action of testosterone in the prostate.
The chirogenic medications (methyltrienolone enanthate (Dbol), dihydrotestosterone (DHT)) reduce the amount of testosterone in the prostate. It reduces the amount of testosterone in the blood, which causes the prostate to shrink. While hormone treatment can effectively treat advanced prostate cancer, there are some side effects. It may also delay the spread of prostate cancer to other parts of the body and it can sometimes cause sexual dysfunction. In addition, some men who undergo hormone treatment stop responding to the treatment after a while and need other treatments.
If cancer is detected in the early stages of prostate cancer, surgery is used to remove the prostate gland. Early diagnosis and treatment can lead to a more favorable prognosis. Many men who undergo surgery, radiation, or high-intensity focused ultrasound (HIFU) will no longer require hormone treatment after the surgery or other treatments are complete. In some cases, a surgical procedure called cryosurgery can be used to remove prostate cancer. A cryoprobe is inserted into the prostate, and liquid nitrogen is used to freeze the cancer. This causes the prostate tissue to become dead.
Prostatectomy is surgical removal of the prostate. For most men with early-stage prostate cancer, a prostatectomy is a preferred treatment. Because it is major surgery, people with high blood pressure or some other health problems should not undergo a prostatectomy. Men who undergo surgery for prostate cancer usually have their PSA levels checked at least 3 months after surgery. Prostatectomy will remove cancerous prostates in men who have urine flow or bladder control problems. If the cancer is very advanced, surgeons will use other treatments.
Radiation uses high-energy x-rays to destroy cancer cells. Treatment is given by a linear accelerator machine and can be performed at a hospital or a clinic. Radiation is used to treat prostate cancer that has spread to the lymph nodes, bones, or brain. It may be used in combination with other treatments, such as surgery, hormonal treatment, or chemotherapy.
Radiation is often recommended after surgery to treat the cancer that may have spread to the lymph nodes. It is usually used in combination with hormone and may be used to shrink tumors before surgery. High-intensity focused ultrasound (HIFU) HIFU is used to focus a beam of sound waves on the spot on the prostate. It causes the prostate to heat up and can destroy cancer cells. HIFU is less invasive than other prostate cancer treatments.
For this reason, it is a treatment for early-stage prostate cancer. HIFU is performed in the hospital and is covered by some insurance policies. However, some companies may not pay for HIFU.
Prostate Cancer Hormone Treatment
Many men who undergo radical prostatectomy for prostate cancer will have hormone treatment after surgery. This treatment helps keep the hormone levels down, making prostate cancer less likely to come back. Most men who undergo a radical prostatectomy will not be given hormone treatment.
Hormone treatment will treat a recurrence of prostate cancer. It can be used in combination with radiation or in combination with androgen deprivation treatment. Some men may experience erectile dysfunction after surgery for prostate cancer. It is due to damage to the nerve cells in the penis. This condition is usually permanent. The risk of erectile dysfunction increases as a man ages.
Other Prostate Cancer Treatments
There are three types of treatment for prostate cancer: surgery, radiation and hormonal treatment.