Prostate cancer is cancer developing in the prostate gland in men. It is one of the most common types of cancer seen in men older than 50 years of age. The prostate is a small walnut-shaped gland in men that produces seminal fluid required to nourish and transport the sperm. Prostate cancer is slow-growing cancer. If prostate cancer is detected early and is confined to the prostate gland, the prognosis is excellent. Certain types of prostate cancer can be aggressive and spread quickly to other parts of the body.
The exact cause of prostate cancer is not known. The tumor arises from the cells with abnormal changes in the DNA of the glandular cells. These abnormal cells rapidly grow and divide, invading the surrounding structures and can metastasize (spread to other parts of the body). Certain factors can increase the risk of prostate cancer.
Risk factors for prostate cancer:
- Age: The risk of prostate cancer increases with age, and this cancer is most commonly seen in men older than 50 years of age.
- Race: African Americans have a higher risk of prostate cancer than other races. Cancer in African Americans is also more likely to be aggressive.
- Family history: If a patient’s blood relative has prostate cancer, it increases their risk as well. Having a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer also increases the risk of prostate cancer.
- Obesity: People with obesity have a high risk of prostate cancer, which is also more likely to be aggressive and recurrent despite treatment.
What Are the Signs and Symptoms of Prostate Cancer?
Prostate cancer may not cause any signs and symptoms in the early stages. Hence, men older than 50 years of age with or without other risk factors should consult a doctor to get screened for prostate cancer.
Prostate cancer can cause the following signs and symptoms in the later stages:
How Is Prostate Cancer Diagnosed
Many doctors recommend asymptomatic men older than 50 years of age, especially those with other risk factors, to get screened for prostate cancer routinely because there are often no symptoms in the early stages. The advantage of screening routinely is early detection of cancer and treatment with the possibility of complete cure.
Prostate screening tests might include:
- Digital rectal exam (DRE): This is part of a physical examination performed by a doctor on outpatient basis. The doctor, with gloves on, inserts a finger into the rectum to examine the prostate, feel the texture and assess the shape and size because the prostate is situated adjacent to the rectum. The doctor uses a numbing lubricant to reduce discomfort during examination.
- Prostate-specific antigen (PSA) test: This is a blood test performed to detect the levels of PSA, a substance that's naturally produced by the prostate gland. If the PSA level is higher than normal, it indicates prostate abnormalities. PSA levels are also increased in prostate infection or benign enlargement of the prostate. The PSA test is also done to monitor disease progression and response to treatment.
Diagnostic tests for prostate cancer:
If there are abnormal findings in screening tests, the doctor may advise the following diagnostic tests:
- Ultrasound: The doctor performs a trans-rectal (through the rectum) ultrasound by inserting a small probe into your rectum to study the prostate gland.
- Magnetic resonance imaging (MRI) scan
- Prostate biopsy: The doctor collects a small sample of the prostate tissue by inserting a thin needle into the prostate.
- Detecting the presence of metastasis with a bone scan, an ultrasound, a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan, and a positron emission tomography (PET) scan for the whole body.
How to Treat Prostate Cancer
Treatment options for prostate cancer depend on the aggressiveness of the tumor, whether it is metastasized, and overall health of the patient. Treatment may involve one or a combination multiple treatment modalities.
Treatment options include
- Observation and follow-up: Low-grade prostate cancer may not require immediate treatment. Hence, the doctor may recommend observation and regular follow-up. This may be an option for those who have a very small, slow-growing tumor confined to a small area in the prostate that is not causing any symptoms or for those with other serious medical conditions or very advanced age, making them medically unfit for other treatment options.
- Surgery: Surgery to remove the prostate is called prostatectomy, where the entire prostate gland is removed. Radical prostatectomy may be performed that involves removal of the prostate along with the surrounding tissues and lymph nodes. Surgery may be curative in most cases (if there is no metastasis) and may be combined with other treatments.
- Radiation therapy: Radiation therapy involves using high-powered energy to kill the cancer cells. It is a good option for treating cancer confined to the prostate.
- Cryotherapy: This involves freezing the prostate tissue using cold gas that can kill the cancer cells.
- Heating the prostate tissue: A high-intensity focused ultrasound (HIFU) uses concentrated heat generated by ultrasound energy causing cell death.
- Hormone therapy: This involves taking medications to stop the production of the male hormone, testosterone, or block the action of testosterone. Prostate cancer cells require testosterone to grow; hence, cutting off the supply of testosterone can cause the cancer cells to die and/or decrease the growth rate.
- Chemotherapy: Chemotherapy involves using medications to kill the cancer cells. It can also help kill the cancer cells that have metastasized.
- Immunotherapy: Immunotherapy modulates the body’s immune system to help fight cancer.
- Targeted drug therapy: It targets and blocks specific abnormalities present within the cancer cells, causing them to die.
- Pain management: Large prostate cancer and metastasis can cause significant pain for which the doctor would prescribe appropriate painkillers.
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