Prostate Cancer

What is prostate cancer?

Prostate cancer is indeed one of the most prevalent cancers among males worldwide. The prostate gland, located beneath the bladder and surrounding the urethra, plays a crucial role in male reproductive function. It is regulated by testosterone and produces seminal fluid, which carries sperm during ejaculation. When abnormal and malignant cells begin to grow uncontrollably in the prostate gland, they form a tumour, leading to prostate cancer. This cancer can potentially metastasise, spreading to other parts of the body. Even when it spreads, the cancerous cells retain their origin from the prostate, hence still classified as prostate cancer.

Early detection through screening tests like prostate-specific antigen (PSA) tests and digital rectal exams can help diagnose prostate cancer at its initial stages when treatment is more effective. Treatment options include surgery, radiation therapy, hormone therapy, chemotherapy, and immunotherapy, depending on the stage and aggressiveness of the cancer. Regular medical check-ups and maintaining a healthy lifestyle are essential for managing prostate health and reducing the risk of prostate cancer progression.

What are some misconceptions associated with prostate cancer?

Not all diseases of the prostate are prostate cancer. Prostate enlargement, or Benign Prostatic hypertrophy, is a fairly common prostate disease. However, it is essential to visit a doctor for assessment and correct diagnosis if you have symptoms of prostate disease.

Who is at risk of getting prostate cancer?

Various risk factors influence prostate cancer, though its exact cause remains unknown. Understanding these factors can help individuals assess their risk and take proactive measures for early detection and management. Here are the key risk factors associated with prostate cancer:

• Age: The risk of prostate cancer increases with age, particularly after 50 years old. It is rare in men under 40.
• Family History: Having a family history of prostate cancer increases the likelihood of developing the disease. This risk is higher if a close male relative (father, brother) has been diagnosed with prostate cancer, especially if they were diagnosed at a younger age.
• Family History of Breast and Ovarian Cancer: Men with a family history of breast cancer or ovarian cancer (particularly if linked to BRCA gene mutations) may have an increased risk of prostate cancer.
• Race/Ethnicity: Prostate cancer occurs more frequently in certain ethnic groups, with African American men having the highest incidence rates. Asian American and Hispanic/Latino men have lower rates compared to Caucasian men.
• Obesity: Obesity, especially in adulthood, has been associated with an increased risk of aggressive prostate cancer.
• Genetic Changes: Inherited gene mutations, such as BRCA1, BRCA2, and others, can increase the risk of developing prostate cancer.
• Dietary Factors: Some studies suggest that a diet high in red meat or high-fat dairy products and low in fruits and vegetables may be associated with a higher risk of prostate cancer. However, more research is needed to understand the impact of diet on prostate cancer risk fully.
• Chemical Exposure: Exposure to certain chemicals, such as those used in pesticides or industrial settings, may increase the risk of prostate cancer. However, the evidence linking specific chemicals to prostate cancer is still limited and requires further investigation.

What are the symptoms of prostate cancer?

Prostate cancer can present with various symptoms that can affect urinary function sexual health, and even cause pain and numbness in advanced stages. Early detection through screening tests is crucial for effective treatment. Here’s a detailed overview of the symptoms and screening methods for prostate cancer:

Urinary problems

• Frequent Urination: You may feel the need to urinate more often, especially at night.
• Weak Stream: The flow of urine may be slower or weaker than usual.
• Blood in Urine: Hematuria, or blood in the urine, can sometimes occur.

Sexual problems

• Erectile Dysfunction: Difficulty achieving or maintaining an erection can be a symptom.
• Blood in Semen: Hematospermia, or blood in the semen, may also indicate prostate issues.

Pain and numbness

• Leg and Back Pain: Pain, numbness, or weakness in the legs or feet may occur if cancer spreads and affects the spinal cord or nerves.
• Bowel and Bladder Dysfunction: In advanced cases, loss of bowel or bladder control can happen due to pressure on the spinal cord.

Early detection of prostate cancer

Prostate-Specific Antigen (PSA) Test: This test measures the level of PSA in the blood, which can indicate prostate conditions, including cancer. Elevated PSA levels may prompt further investigation, but they can also be elevated due to non-cancerous conditions.

Digital Rectal Exam (DRE): This involves a physical examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities in the prostate gland. It helps detect abnormalities like lumps, enlargement, or irregularities in the prostate gland.

Prostate Imaging:  Includes MRI (Magnetic Resonance Imaging) or ultrasound scans, which provide detailed images of the prostate gland to detect abnormalities or suspicious areas. It is often used to investigate findings from PSA tests or DREs further.

Prostate Biopsy: involves taking a small tissue sample from the prostate gland using a thin needle and analysing it under a microscope for cancerous cells. It confirms the presence of cancer and helps determine its aggressiveness and spread potential.

Prostate cancer screening by age

Age 40: Recommended for men at very high risk, such as those with multiple first-degree relatives (father, brother, son) diagnosed with prostate cancer before age 65.
Age 45: Recommended for men at high risk, including African American men and those with a first-degree relative diagnosed with prostate cancer before age 65.
Age 50: Recommended for average-risk men expected to live at least ten more years as part of routine health check-ups.

Regular screening allows for early detection, potentially leading to better treatment outcomes and quality of life for individuals diagnosed with prostate cancer.

What is the treatment for Prostate cancer?

When prostate cancer is diagnosed, the treatment plan is tailored based on several factors, including the patient’s age, overall health, and the stage of the tumour. Treatment options for prostate cancer can vary widely and may include:

Prostatectomy

A prostatectomy is a surgical procedure performed to remove the prostate gland. The prostate gland is a small, walnut-sized organ located below the bladder and in front of the rectum. It surrounds the urethra, the tube through which urine and semen pass out of the body.

Types of Prostatectomy

• Radical Prostatectomy:  This procedure involves the complete removal of the prostate gland along with surrounding tissues, including seminal vesicles. It is typically recommended for prostate cancer that is localised within the prostate and has not spread beyond its borders.

Radical prostatectomy can be performed through different approaches:

• Open Surgery: A large incision is made in the lower abdomen to access and remove the prostate gland.
• Minimally Invasive Surgery: This includes techniques like laparoscopic surgery and robot-assisted laparoscopic surgery (da Vinci system), in which smaller incisions are used, and robotic arms assist the surgeon in performing precise movements.

Simple Prostatectomy: This procedure involves removing only the part of the prostate that is causing urinary symptoms due to enlargement (benign prostatic hyperplasia, BPH). Simple prostatectomy is not typically used for treating prostate cancer but rather for relieving urinary symptoms caused by BPH.

Early-Stage Cancer: Radical prostatectomy is often recommended for localised prostate cancer that has not spread beyond the prostate gland.

Advanced Cancer: In cases where cancer has spread beyond the prostate (metastatic prostate cancer), other treatments such as radiation therapy, hormone therapy, chemotherapy, or immunotherapy may be considered alongside or instead of surgery.

Side Effects

Potential side effects can include urinary incontinence (difficulty controlling urine) and erectile dysfunction (difficulty achieving or maintaining an erection). These side effects can improve over time with proper management and rehabilitation.

Radiation Therapy: Radiation therapy uses high-energy beams to kill cancer cells or inhibit their growth. There are two types: External beam radiation therapy (EBRT) targets the prostate from outside the body, while brachytherapy involves placing radioactive seeds directly into the prostate gland.

Cryotherapy: Cryotherapy involves freezing and destroying cancerous tissue within the prostate gland. It may be considered for localised prostate cancer that has not responded to other treatments or for men who are not candidates for surgery or radiation.

Hormone Therapy (Androgen Deprivation Therapy, ADT):  Hormone therapy reduces levels of male hormones (androgens), such as testosterone, which can fuel the growth of prostate cancer cells. It may be used as a primary treatment for advanced prostate cancer or in combination with other therapies to shrink tumours before surgery or radiation.

Chemotherapy: uses drugs to kill cancer cells throughout the body.  It is typically used for advanced prostate cancer that has spread to other parts of the body (metastatic prostate cancer) and may be combined with hormone therapy.

Stereotactic Radiosurgery: This precise form of radiation therapy delivers high doses of radiation to small, specific targets within the body. It can be used to treat metastases, including those in the bones, providing localised treatment to reduce tumour size and alleviate symptoms.

Immunotherapy: Immunotherapy uses medications that enhance the body’s immune response to fight cancer cells. It is being studied in clinical trials for prostate cancer, particularly for advanced cases that do not respond well to other treatments.

Management of Bone Metastases

• Bone-Directed Therapy: If prostate cancer has spread to the bones (bone metastases), additional treatments may include:
  • Bone-targeted agents: Medications such as bisphosphonates or denosumab can help strengthen bones and reduce the risk of complications from bone metastases.
  • Radiopharmaceuticals: Drugs like radium-223 can specifically target and deliver radiation to areas of bone affected by metastatic prostate cancer.