Prostate Cancer

Prostate Cancer

Prostate cancer is a type of cancer that occurs in the prostate gland in males. It produces the seminal fluid that transports sperm. It is located below the bladder and in front of the rectum.

It is one of the top leading sites of cancer in men affecting the older population above the age of 40 years.

Prostate cancer when detected early increases the chance of survival rate with the best successful treatments.

Types of Prostate Cancer

There are several types of prostate cancer determined by the type of cancer cell.

1. Adenocarcinoma – It is the most common type of prostate cancer. It occurs in a gland cell that lines the prostate gland and tubes of the prostate gland. There are two types of adenocarcinoma including –

• Acinar adenocarcinoma – It develops in gland cells that line the prostate gland.
• Ductal adenocarcinoma – It starts in the cells that line the tubes of the prostate gland.

2. Squamous cell carcinoma – It covers the prostate. It grows and spreads quickly compared to adenocarcinoma.

3. Small cell prostate cancer – It is a type of neuroendocrine cancer. It spreads more quickly than the other types of prostate cancer.

Prostate Cancer

Causes and Risk Factors

The exact cause of Prostate cancer is yet unknown. However, there are certain risk factors that can increase the chances of getting prostate cancer in men including –

• Age – The risk of prostate cancer increases with age. More likely to happen in men above the age of 40 yrs.
• Race or ethnicity – It is more common in black people than in white people.
• Family history – a family with a history of prostate cancer is at a higher risk of developing prostate cancer.
• Genetic factors – Changes in BRCA1 or BRCA2 hormone can increase the chance of developing prostate cancer. Men with Lynch syndrome also are at a higher risk of prostate and other types of cancer.
• Diet – High-fat diets can increase the risk of prostate cancer.

Symptoms

Prostate cancer may not show any symptoms in men in the early stages, but screening can detect these cancer changes. The screening tests measure the levels of PSA in the blood. If the level of PSA appears higher then it may indicate a sign of prostate cancer in males.

However, here are some common symptoms that may be associated with prostate cancer –

1. Urinary problems – This can include a weak or interrupted urine flow, difficulty starting or stopping urination, or the need to urinate frequently, especially at night.
2. Blood in the urine or semen – This can be a sign of prostate cancer, although it can also be caused by other conditions.
3. Erectile dysfunction -This can be a symptom of advanced prostate cancer that has spread to the nerves or blood vessels that control erections.
4. Pain or discomfort in the pelvic area – This can be a sign that cancer has spread to the bones of the pelvis or lower back.

These symptoms can be caused by other conditions that are not related to cancer. However, if you are experiencing any of these symptoms, it’s important to see a doctor for a proper evaluation and diagnosis.

Diagnosis and Tests

There are several tests and procedures that can be used to diagnose prostate cancer. that includes –

1. Digital rectal exam (DRE) – During a DRE, a doctor inserts a lubricated, gloved finger into the rectum to feel the prostate for any abnormalities.
2. Prostate-specific antigen (PSA) test – This blood test measures the level of PSA, a protein produced by the prostate gland. Elevated levels of PSA may be a sign of prostate cancer or other conditions, such as an enlarged prostate.
3. Transrectal ultrasound (TRUS) – A TRUS uses sound waves to create images of the prostate gland. This test is often used in conjunction with a biopsy.
4. Biopsy – During a biopsy, a small sample of tissue is removed from the prostate gland and examined under a microscope to check for the presence of cancer cells.
5. MRI or CT scan – These imaging tests may be used to help determine the extent and stage of cancer. 

However, all men with elevated PSA levels or abnormalities found during a DRE will have prostate cancer. Additional testing, such as a biopsy, is necessary to confirm a diagnosis. If you are experiencing any of the above symptoms or have concerns about your risk for prostate cancer, it’s important to talk to your doctor about appropriate testing and screening.

Stages

Prostate cancer is typically staged using the TNM system, which stands for Tumor, Node, and Metastasis. This system takes into account the size of the tumor, whether it has spread to nearby lymph nodes, and whether it has metastasized (spread) to other parts of the body. The stages of prostate cancer are as follows:

1. Stage I: The tumor is small and confined to the prostate gland.
2. Stage II: The tumor is larger but still confined to the prostate gland.

• Stage IIA: The cancer is grown outside of the prostate gland, but it is still confined to the area immediately surrounding the prostate.
• Stage IIB: The cancer is grown outside of the prostate gland and into nearby tissues or organs, such as the bladder or rectum.

3. Stage III: The tumor has spread beyond the prostate gland to nearby tissues or organs, such as the seminal vesicles.
4. Stage IV: The tumor has spread to other parts of the body, such as the bones, liver, or lungs.

Within each stage, there may be sub-stages that further describe the extent of the cancer. The stage of prostate cancer is an important factor in determining the most appropriate treatment approach. Early-stage prostate cancer may be treated with surgery or radiation therapy, while more advanced cases may require systemic treatments such as hormone therapy, chemotherapy, or immunotherapy.

Treatments

Prostate cancer treatments depend on the type and stage of cancer. However, some treatment options are determined regardless of cancer stage in men. 

Early-stage prostate cancer 

If the cancer is detected early then the doctors will recommend the following treatment options –

• Surgery – Surgery is performed by a urologist for the treatment of urinary system disorders. A radical prostatectomy will remove the tumor, surrounding tissue, seminal vesicles, and nearby lymph nodes.
• Radiation Therapy – It uses radiation to kill cancer cells in the prostate. It can perform either –
• External beam radiation therapy (EBRT) – It uses a machine outside the body to send radiation to the target cells. It uses computers to guide and target a specific area for minimizing the risk of cancer growth.
• Internal beam radiation therapy (IBRT) – It is also known as brachytherapy. In this radioactive implants are placed near the prostate to stop the growth of cancer cells.

Hormone treatment

This treatment aims to lower the levels of androgens (testosterone hormone) in the body, which can help slow the growth of prostate cancer cells. It reduces or blocks circulating levels of these hormones to temporarily inhibit the growth of cancer cells in the body.

Advanced Prostate Cancer

1. Chemotherapy – This treatment uses drugs to kill cancer cells that have spread beyond the prostate gland.
2. Immunotherapy -This treatment uses the body’s own immune system to target and destroy cancer cells.
3. Bone-targeted therapy – This treatment is used to prevent or treat cancer that has spread to the bones, and may include medications that help strengthen bones or slow the growth of cancer cells in the bones.

The choice of treatment will depend on several factors, including the stage of the cancer, the patient’s age and overall health, and the potential side effects of the treatment. It’s important for patients to discuss the pros and cons of each treatment option with their doctor to determine the best course of action for their individual situation.