Prostate Cancer

Prostate cancer is a disease in which prostate cells divide abnormally and destroy that tissue permanently. The prostate is a small gland in males resembling the shape of a walnut that forms the seminal fluid that nourishes and allows the carriage of sperm. Cancer of the prostate is one of the commonest types of cancer. Many prostate cancers grow very slowly and are mostly restricted to the prostate gland. They may need little or sometimes no treatment at all, whereas some other types are highly aggressive and can spread within a very short duration of time. Prostate cancer detected at its earliest but still confined to the prostate gland has the highest chance for successful treatment.

The cause of prostate cancer is unknown. Usually, prostate cancer starts when cells in the prostate gland develop differences in their DNA. Usually, DNA within a cell acts as a motherboard containing instructions that tell a cell what to do. The changes within the DNA of a tumor cell direct the cells to grow and multiply more rapidly than normal cells do at their pace. The abnormal cells continue to grow while the normal cells would die. The rapid accumulation and multiplication of abnormal cells form a tumor that can grow and invade the nearby tissue. Within less time, some abnormal cancer cells can isolate from the origin and spread (metastasize) to many other parts of the body.

Factors that can increase the risk of prostate cancer are as follows:

·         Older age. The risk of prostate cancer increases with progressing age. It's very common after the age of 50 years.

·         Race. It is undetermined why black people have a higher risk of prostate cancer than people of other races. Prostate cancer is also more likely to be aggressive in them and is usually diagnosed in advanced stages.

·         Family history. A history of prostate cancer in blood relations such as a parent, sibling, or child is more likely to increase the risk of having prostate cancer. Also, if a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) is present, then prostate cancer risk is high. Family history of breast cancer in first-degree relatives also supports the risk of prostate cancer.

·         Obesity. Individuals who are obese may have a higher possibility of getting prostate cancer than people who have a healthy weight and normal BMI, though studies showed mixed results as well. In obese people, prostate cancer is likely to be more aggressive and possibly do not cure easily after initial treatment than healthy individuals.

Prostate cancer is among the most common cancers in the USA. Around 1 in 6 white men and 1 in 5 black would be diagnosed with prostate cancer once in their life. The incidence of prostate cancer increases as the person ages. It affects 60% of men above 60 years of age. It is uncommon in men under 50 years of age. 

Prostate cancer at its early stages may not show any signs and symptoms at all. More advanced prostate cancer may show some signs and symptoms such as:

·         Reduction in the force of the stream of urine

·         Blood in the urine (hematuria)

·         Blood in the seminal fluid

·         Pain in bones

·         Losing weight suddenly

·         Erectile dysfunction

·         Difficulty in urination    

Some of the important prostate screening tests are following.

·         Digital rectal examination.

·         Prostate-specific antigen test

If screening tests are abnormal, then further investigation is required, which includes:

·         Ultrasound.

·         Magnetic resonance imaging.

·         Prostate biopsy

If the doctor expects the spread of cancer, the following imaging tests are recommended.

·         Magnetic resonance imaging.

·         Bone scan

·         Ultrasound.

·         Computerized tomographic scan. (CT scan)

·         Positron emission tomography scan. (PET scan)

Treatment depends on the rate of cancer that is growing, the spread, the patient’s health, and the benefits or side effects of the treatment. Some options include:

·         Prostatectomy.

·         Radiation therapy (Freezing prostate tissue or heating prostate tissue)

·         Hormone therapy includes Luteinizing hormone-releasing hormone or gonadotropin-releasing hormone agonist and antagonist to reduce testosterone production.

·         External beam radiation.

·         Brachytherapy

·         Removal of testicles (orchiectomy)

·         Chemotherapy

·         Immunotherapy

·         Targeted drug therapy For advanced prostate cancer cases or recurrent cases.

·         Complementary and alternative medicine can help manage the side effects of prostate cancer and related treatment.

The outcome depends on the stage of cancer at the time of diagnosis, prostatectomy, the PSA levels, the capsular penetration, and the spread in the body. Advanced cancers have a poor prognosis, while cancer in its initial stages has a good outcome. 

The risk of prostate cancer can be considerably reduced if the following measures are adopted:

• Eating a healthy diet. Try to include a variety of fruits, vegetables, and whole grains in your diet. Fruits and vegetables contain many essential vitamins and nutrients that can improve health.
• Exercising at least 3 days of the week. Exercise improves overall health as it helps maintain weight, improves mood, and regulates hormones. Those who are newbies to exercise must start slow and work the way up to more exercise every other day.
• Maintain a healthy weight.  By selecting a healthy diet and exercising at least 5 days of the week, a healthy weight according to BMI should be maintained. If weight reduction is required, add more exercise and decrease the number of calories consumed each day. Contact dietician for help to create a plan for healthy weight loss.
• Talk to your health professional about the increased risk of prostate cancer. If the risk of prostate cancer is high, the doctor may consider medications or some other treatments to reduce the risk. Taking 5-alpha reductase inhibitors, including finasteride and dutasteride, may decrease the overall risk of already ingrown prostate cancer. These drugs can also be used to control the increase in the size of the prostate gland and the loss of hair. It is always advisable to consult your healthcare provider.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 27, 2023.

References

Advanced Prostate Cancer: Treatment Advances and Future Directions - ScienceDirect

https://www.sciencedirect.com/science/article/abs/pii/S2405803320301400

What Is Prostate Cancer?| Prostate Cancer Types

https://www.cancer.org/cancer/types/prostate-cancer/about/what-is-prostate-cancer.html