Prostrate Cancer

Uncontrolled or malignant growth of cells in the prostate gland is known as Prostate cancer. Men have this walnut-sized prostate gland located just below the bladder, in front of the rectum and surrounding the urethra (the tube that carries urine out of the bladder). This gland produces and stores fluid that aids the production of semen.

Prostate Cancer in men could be slow-growing, and before it causes significant problems, several men die of other diseases. However, several Prostate cancers can be deadly if they are more aggressive and spread out of the prostate gland's limits. With early detection and personalized treatment, the prostate cancer survival rate has improved to a great extent.

Prostate Cancer: Causes and Risk factors

What causes prostate cancer?
The causes of prostate cancer are unknown, but the researchers are studying certain risk factors to determine if these factors contribute to cancer development in prostate cells.

Who is at risk for prostate cancer?
Some men are at higher risk for prostate cancer as compared to others, which is why they need to be screened sooner. The risk of this cancer increases with age, mainly after 50. Some of the risk factors are:

  • 1Men with a family history of prostate cancer- If someone in your family has been diagnosed with Prostate cancer, especially at an early age, there will be more risk.
  • 2Men who have a family history of ovarian or breast cancer may have an inherited risk of developing prostate cancer.
  • 3Men with obesity
  • 4If they follow a high-fat diet
  • 5If they smoke
  • 6If they follow a sedentary lifestyle

These are some signs and symptoms of prostate cancer:

  • 1Urine has blood
  • 2Urination is frequent
  • 3Seminal fluid has blood
  • 4Increased urge to urinate at night
  • 5Interrupted or weak flow of urine or need to strain while urinating
  • 6A less common symptom is pain or burning during urination
  • 7If you face new emergence of erectile dysfunction
  • 8Many times enlarged prostate leads to pain or discomfort

Similar symptoms can also be caused by noncancerous prostate conditions like BPH or enlarged prostate. The causes of these symptoms may be due to different medical conditions that may not be related to cancer. Infection of the bladder or other conditions may also cause urinary symptoms. Symptoms that a man may experience if cancer has spread out of the prostate gland:

  • 1Fatigue
  • 2Unexplained weight loss
  • 3Legs or feet have swelling or fluid buildup
  • 4Changes in bowel movements
  • 5Experiencing pain in shoulders, thighs, hips, back, or other bones

When to see a Specialist

Kindly talk to your doctor if you see any of these changes stated above in yourself. Your doctor will diagnose your condition by asking how long and often you have experienced these symptoms. They will also ask other questions to figure out the cause of the problem.

In case the cancer is diagnosed, it is important to get cancer care and treatment by relieving symptoms. After the diagnosis, a patient is given palliative care or supportive care, and it continues throughout the treatment. Make sure to talk about the symptoms you experience with the healthcare team, including change in symptoms or new symptoms.

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Diagnosis of Prostrate Cancer

To diagnose prostate cancer, the following tests may be performed along with physical examination:

  • PSA Test

    Prostate tissue has PSA or Prostate-Specific Antigen, a protein found at a higher level in a man’s blood. If there is an abnormal activity in the prostate like BPH, prostate cancer, or inflammation of the prostate, levels of PSA can get raised. Doctors monitor PSA value’s features like PSA velocity or change over time, absolute level, and levels of prostate size to decide in case biopsy is required.

  • Free PSA test

    In this version of the PSA test, doctors measure a particular component known as the ‘free’ PSA. This is present in the bloodstream and is not bound to proteins. While the standard PSA test measures total PSA, including free PSA and normal PSA, the Free PSA test measures ratio between total PSA and free PSA. Through this ratio, doctors can diagnose whether an elevated PSA level is due to malignant conditions like prostate cancer.

  • DRE

    Doctors use digital rectal examination or DRE to check abnormal parts of the prostate gland by feeling the area with a finger. DRE is not used to detect early prostate cancer as it is not very precise, and not all doctors are experts with the technique.

  • Biomarker tests

    A person with cancer has a substance known as a biomarker that is found in urine, blood, or body tissues. This substance is produced by the body or by the tumour due to cancer, which is why biomarkers are also called tumour markers. This test includes the 4Kscore, which predicts whether a person will develop high-risk prostate cancer or not. PHI or Prostate Health Index predicts if someone has a chance to develop prostate cancer.

  • Prostate Biopsy

    If other tests like PSA blood test or DRE suggest that you might have prostate cancer, you might need a prostate biopsy. This is a procedure in which small pieces of the prostate are extracted and looked at under a microscope. The main method used to diagnose prostate cancer is core needle biopsy, which a urologist usually does.

  • PSMA PET SCAN

    To find out the staging of the disease, this investigation is done.

Treatment

Prostate Cancer treatment is done based on different factors like how fast the cancer is growing or whether it has spread out to other body parts. Treatment also depends on your overall health, along with side effects or potential benefits of the treatment.

  • Treating immediately may not be needed:

    The patient may not require treatment right away in case he has low-grade prostate cancer. In some cases, treatment may not be needed at all, but doctors may recommend active surveillance.

  • Surgery to remove prostate gland:

    Surgery for the prostate gland is performed to remove the prostate gland, some lymph nodes, and surrounding tissues. This surgery is known as radical prostatectomy, and the location of incisions for open prostatectomy is different than robotic prostatectomy incision. Surgery confined to the prostate is an option for treating cancer, and many times, it is used to treat advanced prostate cancer using in combination with other treatments.

    Surgeons may use these techniques to treat prostate cancer:

    Making many small incisions in the abdomen area: In this type of robot-assisted prostatectomy, surgical instruments are attached to a mechanical robot and inserted inside the body through many incisions in your abdomen. The robot’s hands are controlled by the surgeon sitting at a console to guide it to move the instruments. Most of these cancer operations are done through this technique.

    Making one long incision in the abdomen: this is known as retropubic surgery in which one long incision is made in your lower abdomen to reach and remove the prostate gland. Although this method is less common, it may be necessary in particular cases.

  • Radiation Therapy

    In Radiation therapy, cancer cells are killed using high-powered energy. Prostate cancer radiation therapy treatments are done where:

    • 1External beam radiation in which radiation comes from outside of your body.
    • 2Brachytherapy is when radiation is placed inside your body by adjusting radioactive sources in prostate tissue. Mostly, radiation comes from rice-sized radioactive seeds that are inserted into the prostate tissues. A low dose of radiation is delivered to the patient with these seeds over a long period. However, this method of treatment is used when cancer has not spread beyond the prostate.
  • Freezing or heating prostate tissue:

    Heat or cold is used in treatment to destroy prostate tissues with Ablative therapies and the options are:

    • 1Freezing prostate tissues: This therapy is known as Cryoablation or cryotherapy and in this prostate, tissues are frozen using a very cold gas. Later the tissues are left to thaw, and then the procedure is repeated. Cancer cells and some surrounding healthy tissues get killed with the cycles of freezing and thawing.
    • 2Heating prostate tissue: HIFU or High-intensity focused ultrasound treatment is given by use of concentrated ultrasound energy. Prostate tissues are killed by heating the prostate tissue.
  • Hormone Therapy

    This therapy or treatment is given to stop the production of the male hormone testosterone from the patient’s body. Testosterone enhances the growth of prostate cancer cells. When the supply of testosterone is cut off, cancer cells may die or grow slowly. This can be done using two ways, which are:

    • 1Medical castration: Antagonist or LHRH agonist
    • 2Surgical castration: In this, both testicles are removed
  • Chemotherapy

    Chemotherapy kills rapidly growing cells and cancer cells through the use of drugs. This therapy is administered in pill form or through a vein in your arm or using both. When cancer spreads to other areas of the body, then the Chemotherapy treatment option is used to treat prostate cancer. This option is also used for those cancers that do not respond to hormone therapy.

  • Immunotherapy

    In Immunotherapy, a patient's immune system is used to fight cancer. The cancer cells produce such proteins that hide cancer cells from the immune system cells; this is why the body's disease-fighting immune system does not attack cancer. However, Immunotherapy interferes with this process and kills cancer cells.

  • Targeted Drug Therapy

    This type of treatment mainly lays focus on some particular abnormalities that are present in the cancer cells. Targeted drug therapy blocks these abnormalities and causes cancer cells to die.

FAQs about Prostrate Cancer

  • What are the five main Prostate Cancer warning signs?
    • Frequent urination, mainly at night
    • There is a burning or painful sensation during ejaculation or urination
    • Presence of blood in semen or urine
    • Sudden erectile dysfunction
    • The patient faces difficulty in starting or stopping urination
  • Can Prostate Cancer kill a person?

    Prostate cancer shows up in about 240,000 men every year and is quite common. It kills about 30,000 men in a year. However, prostate cancer is not likely to kill most men before some other disease does. However, it is vital to find out which men are at more risk of dying early with prostate cancer as it kills so many men every year.

  • What is the chief cause of prostate cancer?

    The main underlying factor that links diet and prostate cancer is most probably hormonal. Dormant prostate cancer cells get stimulated into activity by high testosterone levels. There is increased production of hormones and testosterone with fats and testosterone speeds up the growth of this cancer.

  • Will drinking lots of water be good for your prostate?

    Water is quite important for your prostate, so stay hydrated. Drinking less water to reduce urination is not a great idea.

  • Does Prostate Cancer get cured on its own?

    Yes, prostate cancer is curable if detected and treated at an early stage. Most prostate cancer cases, which are more than 90%, can be discovered at an early stage, and these tumors are likely to respond to the treatment. Any type of treatment can be given to the patient; it does not always mean chemotherapy or surgery.

  • Which foods are not good for prostate cancer?

    Some foods like processed meats, red meat, and foods with high fat are bad for those who have prostate cancer. Plant-based foods are great for such patients, so you can consume soy, vegetables, and fruits. These foods can slow down the growth of prostate cancer.

  • Which exercises are good for the prostate?

    It is important to strengthen your pelvic floor muscles before and after the prostate cancer treatment and Kegel exercises are quite easy for this. Your urine flow is controlled with these muscles. Kegel exercises can control incontinence without the use of surgery or medication.

  • Prostate cancer needs to be checked how often?

    It is crucial to contact your doctor about how often you need to get screened. Every two or three years is enough for most of the men. Your doctor may recommend that you get screened more or less frequently, depending on your PSA tests results.

  • Which test is the most accurate one for prostate cancer?

    The primary method used to diagnose prostate cancer is the core needle biopsy, and a urologist mainly does it. The doctor usually look at the prostate during the biopsy, with an imaging test like TRUS or transrectal ultrasound or MRI or the fusion of both.

  • If PSA is 6.5, is it cancer?

    If the PSA levels are under 4ng/ml, then they are considered normal, but if these levels are over 4ng/ml are considered abnormal. If the PSA levels are between 4 to 10 ng/ml, then there is a risk of prostate cancer higher than normal. In case PSA levels are more than 10ng/nl, then the risk of prostate cancer is much higher.

  • Which form of prostate cancer is the most aggressive?

    The most aggressive form is Ductal prostate cancer, which is more aggressive than common prostate cancer. Treatment options that are possible include hormone therapy, surgery, chemotherapy, or radiotherapy, depending on your cancer condition.

  • What are the odds of beating prostate cancer?

    Most of the men who have local or regional prostate cancer have 100% 5-year survival rate. For those men who have prostate cancer spread to other parts of the body, the 5-year survival rate is 31%. There is a 98% 10-year survival rate for local, regional and distant prostate cancer combined.

Urologist, Uro Recostructive and Uro Oncosurgeon with 12+ years of experience.

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