The prostate is a tiny walnut shaped gland in the pelvis of men. It is situated next to the bladder and can be analyzed by getting a digital rectal scan. Prostate cancer is a type of cancer the forms in the prostate gland.
It is most common types of cancer in men. Usually it grows slowly and is initially confined only to the prostate gland, where it may not cause serious risk. Growths in the prostate can be malignant (cancer) or benign (not cancer). While some types grow slowly and may need minimal treatment, other types are aggressive and can metastasize quickly.
As per date available from various cancer registries, prostate cancer in India ranged 5.0-9.1 per 100,000/year.
Types of prostate cancer
Mostly all prostate cancers are adenocarcinomas. These cancers develop from the gland cells (the cells that make the prostate fluid which is added to the semen).
Some other types of cancer that can start in the prostate are:
- Transitional cell carcinomas
- Small cell carcinomas
- Neuroendocrine tumors (other than small cell carcinomas)
Few prostate cancers grow and spread quickly, but most grow slowly. In fact, autopsy studies reveal that many older men (and even some younger men) who died of other causes also had prostate cancer that never affected them during their lives. In a lot of cases, neither they nor their doctors even knew they had it.
Prostate cancer may cause no symptoms in the early stages. Cancer that’s more advanced may result in some signs and symptoms like:
- Blood in the semen
- Trouble urinating
- Decreased force in the stream of urine
- Bone pain
- Discomfort in the pelvic area
- Erectile dysfunction
You should make an appointment with a doctor at the earliest if you have any signs or symptoms that worry you.
Causes and diagnosis
It is not yet clear what results in prostate cancer. Doctors know that it begins when some cells in the prostate become abnormal. Mutations in the abnormal cells’ DNA result in the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when the other cells would die. The accumulating abnormal cells form a mass that can grow to invade nearby tissue. Some abnormal cells can also break off and metastasize elsewhere in the body.
If a man has symptoms that may indicate prostate cancer, the doctor will likely:
- ask about medical and personal history
- ask about symptoms
- carry out a urine test to look for other biomarkers
- conduct a blood test to assess PSA levels
- carry out a physical exam, which may include a digital rectal exam (DRE)
During a DRE, the doctor will check manually for any abnormalities of the prostate with the finger.
If a doctor suspects prostate cancer, he may recommend further tests, which include:
- A transrectal ultrasound – It involves inserting a probe with a camera into the rectum.
- A PCA3 test – It looks for the PCA3 gene in the urine.
- A biopsy – A doctor will take a small tissue sample for analyzing under a microscope. Only a biopsy can confirm the presence and type of prostate cancer.
A person who needs monitoring rather than treatment may need a routine CT scan or MRI.
Stages and treatment options
Knowing the stage of prostate cancer can help a person understand what to expect, and it will also inform decisions about the treatment. The stages are as below:
- Stage 0 – Precancerous cells are present, however they only affect a small area and are slow growing.
- Localized (stage 1) – Cancer is only present in the prostate gland. Also, effective treatment is possible at this stage.
- Regional (stages 2-3) – Cancer has spread to the nearby tissues.
- Distant (stage 4) – Cancer has spread elsewhere in the body, such as the bones or lungs.
Treatment will depend on the stage of prostate cancer, among many other factors.
Early stage prostate cancer
If the cancer is small and localized, the doctor may recommend:
- Watchful monitoring or waiting – The doctor may check PSA blood levels regularly but take no immediate action. As discussed earlier, prostate cancer grows slowly and the risk of side effects may outweigh the need for immediate treatment.
- Surgery – A doctor may carry out a prostatectomy. He can remove the prostate gland using either open surgery or laparoscopic.
- Radiation therapy – Some of the options include:
- Conformal radiation therapy – This targets a specific area, minimizing the risk to the healthy tissue. There is another type, called intensity modulated radiation therapy, which uses beams with variable intensity.
- Brachytherapy or prostate seed implantation – It is a type of therapy where the doctor will implant radioactive metallic seeds into the prostate gland permanently.
Advanced prostate cancer
As cancer grows, it can spread throughout the body. If it spreads, the treatment options will change. Some of these include:
- Chemotherapy – This can kill cancer cells around the body, however it can cause adverse effects.
- Hormonal therapy – Androgens are male hormones. The main androgens are dihydrotestosterone and testosterone. Reducing or blocking these hormones appears to stop the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most of your body’s hormones. Many drugs can also help.
Some newer treatments aim to treat prostate cancer without the side effects that other treatment options can bring. Some of these include:
- High intensity focused ultrasound
After the surgery, the doctor will continue to monitor PSA levels.
Effects on fertility
The prostate gland plays an important role in sexual function and reproduction. Prostate cancer and its treatments may affect fertility in several ways. For example, if a man has surgery to remove either the testicles or the prostate gland, it will affect fertility and semen production.
Additionally, radiation therapy can affect the prostate tissue, damaging sperm and reducing the amount of semen for transporting it. Hormonal treatment may also affect fertility.
There are some options for preserving these functions:
- Extracting sperm directly from the testicles for artificial insemination.
- Banking sperm before surgery.
There is no guarantee that fertility will remain intact after treatment for prostate cancer. People who would like to have children after treatment should discuss fertility options with the doctor when they decide their treatment plan.
Side effects of treatment
Because the prostate is so close to several vital parts, prostate cancer and its treatments can disrupt normal bowel, urinary, and sexual functioning. Some of the other side effects may include:
- Incontinence (loss of bladder control)
- Reduced sexual desire
- Impotence (erectile dysfunction)
- Changes in orgasm
Survivorship and prevention for prostate cancer
After a prostate cancer diagnosis, a man’s priorities regarding career, relationships, or lifestyle may change. Few people with a history of cancer say that they appreciate life more and have gained a greater acceptance of their self. At the same time, some survivors become anxious and worried about their health and uncertain of how to cope with life after treatment, especially when regular visits to doctors stop. Survivorship is about creating strategies to help you diagnosed with prostate cancer to live with, through, and beyond a diagnosis.
From the time you are diagnosed with cancer, you can start to take charge of your health and take steps to maintain or improve the health. Cancer treatment can be hard on the body and many of the side effects of prostate cancer treatment may stay with you for a long time. It is very important to follow up on all the appointment with the doctor. Create a solid support system so you can share your feelings and discuss moments of anxiety whenever you feel like.
There are some risk factors for prostate cancer, such as age, that you cannot control. But, there are some factors you can control. For example – quitting smoking can reduce the risk of prostate cancer. Exercise and diet are also important factors that can influence the risk of prostate cancer.
- Diet – Certain foods may help reduce the risk of prostate cancer, such as:
- Cruciferous vegetables such as broccoli, Brussels sprouts, and kale
- Oils that contain omega-3 fatty acids, like olive oil
Studies also suggest that certain foods may increase the risk of prostate cancer, which include:
- Saturated fat that is found in animal products
- Milk and dairy products
- Grilled meat
- Red meat
- Exercise – Exercise can help reduce the risk of developing advanced prostate cancer, and of dying of the same. It can also help you to lose weight. This is important because research shows that obesity is a high risk factor for prostate cancer. With a doctor’s approval, aim for at least 30 minutes of exercise most days of the week.
A diet rich in fish and vegetables and low in red meat and full-fat dairy, paired with daily exercise, could help reduce the risk of prostate cancer, as well as boost the health overall. So always stay healthy, stay safe!