All You Need To Know About Prostate Cancer
Prostate cancer is the second most common cancer among men but it can often be treated successfully. Due to lack of awareness, men often tend to ignore their prostate problems. If you have prostate cancer or are close to someone who does, knowing what to expect can help you weather the storm. Here we tell you all about prostate cancer, including risk factors, symptoms, diagnosis and treatment. Read on!
Prostate cancer occurs in a man’s prostate. The prostate is located below the bladder in front of the rectum and surrounds the upper part of the urethra. The prostate regulates bladder control and produces the seminal fluid that nourishes and transports sperm. Prostate cancer usually grows slowly and initially remains confined to the prostate gland. It usually affects men above the age of 50 and all men are at risk for prostate cancer. However, some men are at an increased risk for prostate cancer.
These following factors may increase a man’s risk of developing prostate cancer:
- Race: Research shows that African American men are approximately 70 % more likely to develop prostate cancer in their lifetime than Caucasian or Hispanic men.
- Age: With age, the risk of developing prostate cancer increases. Research suggests 1 in 15 men in their 60s will be diagnosed with prostate cancer.
- Family history: Men with close family relatives such as a father or brother, who has or had prostate cancer are twice as likely to develop the disease.
- Diet: A diet high in saturated fat and preserved food has shown to increase the risk of prostate cancer.
- Obesity: Obese people are at a higher risk of developing prostate cancer.
- High testosterone levels: Men using testosterone therapy are at a higher risk of developing prostate cancer as an increase in testosterone stimulates the growth of the prostate gland.
Prostate cancer may not cause signs or symptoms in its early stages but at an advanced stage they may cause signs and symptoms such as:
- Trouble urinating
- Decreased force in the stream of urine
- Blood in the urine
- Blood in the semen
- Pain in the lower back, thighs or hips
- Discomfort in the pelvic area
- Bone pain
- Erectile dysfunction
The exact cause of prostate cancer is still unclear. Researchers are trying to learn how the risk factors of prostate cancer influence prostate cells to become cancerous. However, on a basic level, prostate cancer is caused by changes in the DNA of a normal prostate cell.
Cancer is partly caused due to DNA changes (mutations) that turn on oncogenes (genes that have the potential to cause cancer) or turn off tumour suppressor genes. DNA changes are either inherited from a parent or can be acquired during a person’s lifetime.
The initial screening involves two tests:
- Prostate-specific antigen (PSA) test: A blood sample is drawn from a vein in your arm and analysed for PSA, a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, a higher than normal level is indicative of prostate enlargement, infection, inflammation or cancer.
- Digital rectal exam (DRE): A DRE involves the examination of your prostate by the doctor. The doctor inserts a gloved, lubricated finger into your rectum to examine your prostate. If he/she finds any abnormalities in the texture, shape or size of your gland, they will recommend further tests.
If an abnormality is detected on a PSA test or DRE test, your doctor may recommend tests to determine whether or not you have prostate cancer. These include:
- Ultrasound: A transrectal ultrasound helps your doctor to further evaluate your prostate. A small probe is inserted into your rectum, which uses sound waves to make a picture of your prostate gland.
- Biopsy: In a prostate biopsy, a thin needle is inserted into the prostate to collect tissue. The tissue sample is then analysed in a lab to determine whether cancer cells are present.
Determining whether prostate cancer is aggressive
If a biopsy confirms the presence of cancer, the next step, called grading, helps determine the aggressiveness of cancer. The tissue samples are studied to compare the cancer cells with healthy prostate cells. The more the cancer cells differ from the healthy cells, the faster cancer will grow and spread. More-aggressive cancer cells have a higher grade.
The scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Scoring can range from 2 (non-aggressive cancer) to 10 (very aggressive cancer).
The different stage indicates how advanced the cancer is. There are 4 prostate cancer stages from 1 to 4, with 4 being the most advanced.
The stages are based on the following:
- the size or extent of the tumour
- the number of lymph nodes involved
- whether or not the cancer has spread to other sites or organs
Prostate cancer treatment depends on several factors. These include how fast the cancer is growing, how much it has spread, one’s overall health, as well as the benefits and the side-effects of the treatment. The treatments options of prostate cancer are as follows:
Active surveillance is recommended as an option for any man with prostate cancer that is low risk and not very aggressive. It is the preferred strategy for men with the least aggressive type of prostate cancer. Active surveillance involves having repeated blood testing for prostate-specific antigen, prostate biopsy, rectal examinations, and sometimes magnetic resonance imaging (MRI) of the prostate to monitor the size and spread of prostate cancer. If cancer grows or becomes more aggressive, then curative treatment with either surgery or radiation therapy is offered.
Radiation therapy doesn’t kill the cancer cells immediately but damages its DNA and diminishes its capacity to reproduce. The body then gets rid of the damaged DNA cells. Meanwhile, although normal cells are affected by radiation therapy, too, they are able to repair themselves. Radiation therapy is of two types:
- External beam radiotherapy: It involves directing high-energy X-ray beams at the prostate gland from outside the body. These beams damage the cells and stop them from dividing and growing.
- Brachytherapy: It involves placing many rice-sized radioactive seeds in your prostate tissue inside the body. These implanted seeds release radiation eventually stop giving off radiation and don’t need to be removed.
Side-effects of radiation therapy can include painful urination, frequent urination and urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur.
Early in their development, prostate cancers need high levels of hormones called androgens to grow. Hormone therapy for prostate cancer works by either preventing the body from making hormones called androgens or by blocking off their effects. As the hormone levels drop, the cancer’s growth is reduced.
Hormone therapy works for:
- Men who have had prostate cancer which has metastasized (spread to other sites in the body)
- Men who want to shrink a tumour to enhance the effectiveness of surgery but have already had primary treatment (surgery\radiation) and the prostate cancer has returned.
Side effects of hormone therapy include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain.
Surgery for prostate cancer (called radical prostatectomy) aims to remove the whole prostate and consequently, the prostate cancer cells inside it. It is offered as an option if cancer hasn’t spread outside the prostate.
There are different types of surgery – Manual or Robot-assisted Keyhole surgery and Open surgery.
- Manual or Robot-assisted Keyhole surgery: Keyhole or laparoscopic prostate surgery is a type of minimally invasive surgery performed with the aid of a small camera. During robotic laparoscopic surgery, the instruments are attached to a mechanical device (robot) and inserted into the abdomen through small incisions.
- Open surgery: During open surgery, the surgeon makes a single cut in the lower abdomen, below the belly button, to reach the prostate and perform the necessary procedures.
Chemotherapy refers to the use of drugs to kill rapidly growing cancer cells. It can be administered through a vein in your arm or in pill form or both.
Chemotherapy can be a treatment option for men with prostate cancer that has spread to different parts of the body. It may also be used for prostate cancers that do not respond to hormone therapy.
Immunotherapy involves taking some of your own immune cells and genetically engineering them to fight prostate cancer. It is then injected back into the cells of your body through a vein. Some people do respond to this therapy with some improvement in their cancer. However, this treatment option is very expensive and requires multiple visits for the treatment.
Getting diagnosed with prostate cancer doesn’t mean the end of the world. Prostate cancer can be cured when detected and treated early. More than 90% of prostate cancer cases are detected in the early stages, making the tumours more likely to respond to treatment. Knowing the symptoms and risk factors that cause prostate cancer can help you identify cancer early on when treatment is most effective.