Prostate Cancer

PROSTATE CANCER

Prostate cancer is the most common cancer in men after skin cancer. Risk factors include age, family history, ethnicity, and diet. It is diagnosed by digital rectal exam, prostate specific antigen (PSA) test, and prostate biopsy.

Prostate cancer is cancer that occurs in the prostate — a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.

It’s not clear what causes prostate cancer. It is caused by the abnormal functioning of cells in the prostate.  DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die.

Prostate cancer begins when cells in the prostate gland start to grow out of control. The prostate is a gland found only in males. It makes some of the fluid that is part of semen.

The prostate is below the bladder (the hollow organ where urine is stored) and in front of the rectum (the last part of the intestines). Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the center of the prostate. 

Prostate cancer that’s detected early — when it’s still confined to the prostate gland — has a better chance of successful treatment

Symptoms

Prostate cancer may cause no signs or symptoms in its early stages.

It has more advanced may cause signs and symptoms such as:

  • decreased force of urine stream
  • difficulty starting (hesitancy);
  • the need to strain to urinate;
  • stopping/starting of the urine stream (intermittency);
  • frequent urination;
  • dribbling;
  • pain or burning during urination,
  • erectile dysfunction;
  • painful ejaculation;
  • blood in urine or semen and/or deep back, hip, pelvic or abdominal pain;
  • other symptoms may include weight loss, bone pain and lower extremity swelling.
  • Prostate cancer screening consists of periodic laboratory testing, usually every 1-2 years, which includes a prostate specific antigen (PSA) test and digital rectal examination. Prostate cancer screening is not for everyone and the pros/cons should be discussed with a primary care provider and/or urologist (specialist who treats problems with the urinary system).
  • Diagnosis of Prostate cancer done by removal of small cores of prostate tissue (prostate biopsies), which are then examined under the microscope by a pathologist.
  • Treatments for prostate cancer may include observation, active surveillance, surgery (radical prostatectomy), radiation therapy (external beam or placement of radioactive pellets into the prostate), hormone therapy, chemotherapy, immune/vaccine therapy, and other medical therapies that can affect prostate cancer cell growth.

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms that worry you.

Debate continues regarding the risks and benefits of prostate cancer screening, and medical organizations differ on their recommendations. Discuss prostate cancer screening with your doctor. Together, you can decide what’s best for you.

Types of prostate cancer

Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen).

Other types of cancer that can start in the prostate include:

  • Small cell carcinomas
  • Neuroendocrine tumors (other than small cell carcinomas)
  • Transitional cell carcinomas
  • These other types of prostate cancer are rare. It is almost certain to be an adenocarcinoma, if you are told you have prostate cancer,
  • Some prostate cancers grow and spread quickly, but most grow slowly. In fact, autopsy studies show 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 many cases, neither they nor their doctors even knew they had it.

DIAGNOSIS

The diagnosis of prostate cancer ultimately is based on the pathologist’s review of tissue removed at the time of the prostate biopsy. An abnormal PSA and/or abnormal digital rectal examination often are present and are the indications for the prostate biopsy.

DIFFERENT PROSTATE BIOPSY

Digital rectal examination (DRE): As part of a physical examination, your doctor inserts a gloved and lubricated finger into your rectum and feels toward the front of your body. The prostate gland is a walnut or larger sized gland immediately in front of the rectum, and beneath your bladder. The back portion of prostate gland can be felt in this manner. Findings on this exam are compared to notes about the patient’s prior digital rectal examinations.

Prostate specific antigen (PSA) blood test: The PSA blood test measures the level of a protein found in the blood that is produced by the prostate gland and helps keep semen in liquid form. The PSA test can indicate an increased likelihood of prostate cancer if the PSA is at an increased or elevated level or has changed significantly over time, but it does not provide a definitive diagnosis. Prostate cancer can be found in patients with a low PSA level, but this occurs less than 20% of the time.

Prostate biopsy: A biopsy refers to a procedure that involves taking of a sample of tissue from an area in the body. it is diagnosed of finding cancer cells on a biopsy sample from the prostate gland.

WHAT ARE THE TREATMENTS OF PROSTATE CANCER

Treatment options for prostate cancer are many, and while this is an advantage in that prostate cancer is such a common disease in men, it can also be a cause of great confusion.

Conventional medical treatment options for prostate cancer include the following (see our in-depth articles for each of the treatments below for more detail):

  • Active surveillance
  • Observation
  • Surgery (radical prostatectomy [RRPX]: open, laparoscopic, robotic, perineal)
  • Radiation therapy (external beam therapy [EBRT] and brachytherapy)
  • Focal therapy, including cryotherapy
  • Hormonal therapy
  • Chemotherapy
  • Immunotherapy/vaccine and other targeted therapies
  • Bone-directed therapy (bisphosphonates and denosumab)
  • Radiopharmaceuticals (radioactive substances used as drugs)
  • Research techniques including high-intensity focused ultrasound (HIFU) and others

What is the prognosis for prostate cancer?

The prognosis for prostate cancer varies widely and depends on many factors, including the age and health of the patient, the stage of the tumor.

  • The 5-year survival rate for most men with local or regional prostate cancer is 100%.
  • Ninety-eight percent are alive at 10 years.
  • For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%.

Is it possible to prevent prostate cancer?

For a disease as common as prostate cancer, a condition which one man in six will be diagnosed with in their lifetime, the ideal approach is to prevent men from getting prostate cancer.

Two clinical trials referred to as the Prostate Cancer Prevention Trial (PCPT) and the subsequent Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial were conducted over the past two decades. These studies demonstrated that both finasteride and dutasteride (Propecia and Avodart), when used in men between 50 and 75 years of age, reduced the incidence of prostate cancer by 28% and 23% respectively as compared to similar men taking a placebo.

The reduction in the overall incidence of prostate cancer was significant. The use of these drugs and their FDA-approval for prevention has been slow to come in part because of the lingering concern over the high-grade prostate cancer risk. Men in these trials got less prostate cancer if treated with these drugs, but the prostate cancers that they did get were more often high-grade (had higher Gleason scores) and thus appeared to be at risk for behaving more aggressively. Men with a family history of prostate cancer or other high risk factors, and in fact any man, should discuss the use of these drugs for this purpose.

Trials have been conducted on several vitamins and nutritional supplements and naturally-occurring compounds in an attempt to prevent prostate cancer.

Vitamin E and selenium were not effective in the prevention of prostate cancer in the SELECT trial. Vitamin E supplementation may have increased the incidence of prostate cancer.

  • Lycopene was also ineffective as a preventive agent.
  • Pomegranate juice had no meaningful impact on prostate cancer prevention.
  • Green tea had some early results suggestive of a possible protective effect, and a larger trial is under way.

Vitamin D and its derivatives have been studied in prostate cancer. There is no evidence that vitamin D protects against prostate cancer. The vitamin D derivative, calcitriol, has some therapeutic utility against this disease, and is still under study.

Prostate cancer is the most common cancer in men (after skin cancer), and the third leading cause of death from cancer in men. The biology of prostate cancer is better understood today than it was in the past.

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