Prostate cancer is the abnormal growth of cells in a man’s prostate gland.
Prostate gland (is a nut-shaped gland in men) that produces seminal fluid, the fluid that nourishes and transports sperm. It makes part of the fluid for semen.
In young men, the prostate is about the size of a walnut. This grows with age.
Cancer occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes.
Occurrences of prostate cancer vary widely across the world. The high rates may be affected by increasing rates of detection.
Prostate cancer develops most frequently in men over fifty. This cancer can only occur in men, as the prostate is exclusively of the male reproductive tract.
For many men a diagnosis of prostate cancer can be frightening, not only because of the threat to their lives, but because of the threat to their sexuality.
In fact, the possible consequences of treatment for prostate cancer which include bladder control problems and erectile dysfunction (ED) or impotence can be a great concern for some men.
It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer.
However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.
Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test. There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope.
Further tests, such as X-rays and bone scans, may be performed to determine whether prostate cancer has spread.
Prostate cancer is very common and is an older man’s disease. Most men who get it are older than 65. Since prostate cancer is a disease of older men, many will die of other causes before the prostate cancer can spread or cause symptoms. This makes treatment selection difficult.
If prostate cancer is detected early i.e. when it’s still confined to the prostate gland then a better chance of successful treatment with minimal or short-term side effects is possible. Successful treatment of cancer that has spread beyond the prostate gland is more difficult. But treatments exist that can help control prostate cancer.
Prostate cancer can be treated with surgery, radiation therapy, hormone therapy, occasionally chemotherapy, or some combination of these. The age and underlying health of the man as well as the extent of spread, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease.
The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life. Prostate cancer can be categorized as follows:
- Locally advanced prostate cancer is cancer that has grown through the outer rim of the prostate and into nearby tissue.
- Metastatic prostate cancer is cancer that has spread, or metastasized, to the lymph nodes or other areas of the body.
- Recurrent prostate cancer is cancer that has come back after previous treatment. The cancer can reappear in the prostate, near the prostate, or in another part of the body. If it reappears in another part of the body—often the bones—it is still called prostate cancer because it started in the prostate.
Prostate Cancer Cause
Research suggests that a combination of factors may play a role, including heredity, ethnicity, hormones, diet and the environment. The exact prostate cancer cause is unknown, but experts believe that the age and family history may have something to do with the chances of getting the disease.
As the cause of prostate cancer isn’t fully understood at present there are certain factors that make prostate cancer more likely, which are listed below.
- The risk of prostate cancer increases steadily with age and it is rare in men under 50 years.
- The risk is higher if one has close relatives (a father, uncle or brother) who have had prostate cancer.
- If several women in the family have had breast cancer (especially if they were diagnosed at less than 40 years of age) an inherited faulty gene may be present. The gene may also increase the risk of the men in that family getting prostate cancer.
- Some races such as African-Caribbean or African-American are at highest risk than the Asian which is at lower risk.
- A high fat diet may increase the risk.
Prostate Cancer Symptoms or Prostate Cancer Signs
Early stage of prostate cancer usually causes no symptoms. That’s why many cases of prostate cancer aren’t detected until it has spread beyond the prostate. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy.
The prostate cancer symptoms or prostate cancer signs include:
- Frequent urination
- Increased urination at night called nocturia.
- Difficulty starting urination called hesitancy
- Maintaining a steady stream of urine
- Blood in the urine called hematuria.
- Pain during urination called dysuria.
- Dull pain in the lower pelvic area
- Urgency of urination
- Being unable to urinate at all.
- Weak urine flow and dribbling
- Intermittent urine flow
- A sensation that the bladder doesn’t empty
- Painful ejaculation
- General pain in the lower back, hips or upper thighs
- Loss of appetite and weight
- Persistent bone pain
- Having blood in the semen called hematospermia or hemospermia (advanced prostate cancer)
Prostate cancer may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation.
Advanced prostate cancer may cause additional symptoms as the disease spreads to other parts of the body. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis or ribs, from cancer which has spread to these bones. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.
Prostate Cancer Stage
Prostate cancer has four basic stages. Staging takes into account the size of the tumor, whether the lymph glands (also called lymph nodes) are affected and whether the tumor has spread anywhere else.
The four basic stages of Prostate cancer are
- Stage 1: the cancer is very small and completely inside the prostate gland which feels normal when a rectal examination is done
- Stage 2: the cancer is still inside the prostate gland, but is larger and a lump or hard area can be felt when a rectal examination is done
- Stage 3: the cancer has broken through the covering of the prostate and may have grown into the neck of the bladder or the seminal vesicle
- Stage 4: the cancer has spread to another part of the body
Staging or determining the stage is an important part of evaluating prostate cancer in a way how far the cancer has spread. Knowing the stage helps define prognosis and is useful when selecting therapies.
The most common system is the four-stage TNM system (abbreviated from Tumor/Nodes/Metastases). Its components include the size of the tumor, the number of involved lymph nodes, and the presence of any other metastases.
The most important distinction made by any staging system is whether or not the cancer is still confined to the prostate. In the TNM system, clinical T1 and T2 cancers are found only in the prostate, while T3 and T4 cancers have spread elsewhere. Several tests can be used to look for evidence of spread.
These include computed tomography to evaluate spread within the pelvis, bone scans to look for spread to the bones, and endorectal coil magnetic resonance imaging to closely evaluate the prostatic capsule and the seminal vesicles.
After a prostate biopsy, a pathologist looks at the samples under a microscope. If cancer is present, the pathologist reports the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow.
The Gleason system is used to grade prostate tumors from 2 to 10, where a Gleason score of 10 indicates the most abnormalities. The pathologist assigns a number from 1 to 5 for the most common pattern observed under the microscope and does the same for the second most common pattern. The sum of these two numbers is the Gleason score.
The Whitmore-Jewett stage is another method sometimes used. Proper grading of the tumor is critical, since the grade of the tumor is one of the major factors used to determine the treatment recommendation.
Prostate Cancer Treatment
Prostate cancer treatment may involve watchful waiting, surgery, radiation therapy, High Intensity Focused Ultrasound (HIFU), chemotherapy, cryosurgery, hormonal therapy, or some combination.
The better option of treatment depends on the stage of the disease, the Gleason score, and the PSA level.
Other important factors are the man’s age, his general health, and his feelings about potential treatments and their possible side effects.
Because all treatments can have significant side effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.
If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors who treat prostate cancer use a variety of nomograms to predict the probability of spread.
Treatment by watchful waiting, HIFU, radiation therapy, cryosurgery, and surgery are generally offered to men whose cancer remains within the prostate.
Hormonal therapy and chemotherapy are often reserved for disease which has spread beyond the prostate. However, there are exceptions: radiation therapy may be used for some advanced tumors, and hormonal therapy is used for some early stage tumors. Cryotherapy, hormonal therapy, and chemotherapy may also be offered if initial treatment fails and the cancer progresses.
There are new treatments being developed such as cryotherapy. This is surgery to freeze the prostate with liquid gas and kill cancer cells.
High intensity focused ultrasound (HIFU) is a treatment given using a machine that gives off high frequency sound waves. Some cancer cells die when this is focused directly onto them.
Treatment for locally advanced or metastatic prostate cancer may include hormone therapy, surgery, radiation therapy, chemotherapy, and pain medicine. The patients may want to talk with their doctor about entering a clinical trial of new cancer treatment options.
A wide variety of emotions after being diagnosed may be experienced by almost all the patients. Most men feel some denial, anger, and grief. Others may have fewer emotions. There is no “normal” way to react. There are many things that which can help with these emotional reaction to prostate cancer. Talking with family and friends may help a bit with the emotions. Some men may find that spending time alone is what they need.
Treatment for locally advanced prostate cancer
Locally advanced Prostate Cancer i.e. Prostate cancer that has spread to tissues around the prostate may be treated with:
Prostatectomy: New surgical developments include keyhole surgery (laparoscopic prostatectomy) where the prostate is removed through smaller incisions. This operation takes out the prostate gland and the cancer in and around it. Surgery can be successful if the tumor has not spread beyond the outside of the prostate and is easily removed.
This treatment uses special drugs to destroy cancer cells. Prostate cancer often needs the body’s male hormones to survive. Hormone therapy decreases the amount of testosterone and other male hormones in the body. This often causes tumors to shrink. Shrinking the tumors also can ease severe bone pain caused by the spread of cancer to the bones.
The most common drugs are:
- LH-RH agonists and GnRH agonists: These drugs stop the body from making testosterone.
- Antiandrogens: These often are used along with LH-RH agonists. Antiandrogens help block the body’s supply of testosterone.
Hormone therapy usually is combined with radiation therapy.
This treatment uses high-energy rays, such as X-rays, to destroy the cancer. It usually is combined with hormone therapy.
Treatment for metastatic prostate cancer
Treatment for prostate cancer that has spread to the bones and/or other organs in the body (metastatic prostate cancer) is aimed at relieving symptoms and slowing the cancer’s growth. Treatment include surgery, radiation therapy, chemotherapy and hormone therapy.
Surgery is used in 2 different ways which includes:
- To remove blockages that are causing problems (TURP)
- To remove the testicles to reduce the supply of testosterone to the cancer (orchiectomy).
Hormone therapy is used to slow cancer growth and relieve pain by shrinking the tumors. This uses special drugs to destroy cancer cells. Hormone therapy can also improve urinary symptoms. It may be used alone or in combination with radiation therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
For Prostate Cancer radiation therapy is used to shrink tumors and ease pain. External-beam radiation, which uses a large machine to aim a beam of radiation at the tumor, usually is combined with hormone therapy.
Chemotherapy uses drugs to stop the growth of cancer cells. The doctor may recommend chemotherapy following surgery to kill any cancer cells that may have spread outside the prostate. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both.
Prostate Cancer Prognosis
Prostate Cancer Prognosis is different for different patients. In Western societies the Prostate cancer rates are higher and prognosis poorer than the rest of the world. Many of the risk factors for prostate cancer are more prevalent in the Western world, including longer life expectancy and diets high in animal fats.
Also, where there is more access to screening programs, there is a higher detection rate. Prostate cancer is the ninth most common cancer in the world, but is the number one non-skin cancer in United States men. Prostate cancer affected eighteen percent of American men and caused death in three percent in 2005. In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s.
In India in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years. African-American men have 50-60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China. In Nigeria, two percent of men develop prostate cancer and 64% of them are dead after two years.
In patients who undergo treatment, the most important clinical prognostic indicators of disease outcome are stage, pre-therapy PSA level and Gleason score.
In general, the higher the grade and the stage, the poorer the prognosis. Nomograms can be used to calculate the estimated risk of the individual patient. The predictions are based on the experience of large groups of patients suffering from cancers at various stages.
Prostate Cancer Survival Rate
The five-year relative prostate cancer survival rate is the percentage of patients who do not die from prostate cancer within five years after the cancer is found. (Men with prostate cancer who die of other causes are not counted.)
Of course, patients might live more than five years after diagnosis. These five-year survival rates are based on men with prostate cancer first treated more than five years ago. Men treated today may have a more favorable outlook.
Overall, 99% of men diagnosed with prostate cancer survive at least five years. Further, 92% survive at least 10 years, and 61% survive at least 15 years.
Ninety percent of all prostate cancers are found while they are still within the prostate or only in nearby areas. The five-year relative survival rate for these men is nearly 100%.
For the men whose cancer has already spread to distant parts of the body when it is found, 34% will survive at least five years.
These numbers provide an overall picture, but one should keep in mind that every man’s situation is unique and the statistics can’t predict exactly what will happen in one’s case. Talking to a cancer care team about personal chances of a cure, or how long one might survive the cancer is a good advice as they know the situation best.
Prostate Cancer Prevention
It is very clear that Prostate cancer prevention is not possible. However, there are steps to be taken to reduce the risk of developing this disease.
The risk of dying from prostate cancer is increased if the person is overweight. Maintaining a healthy weight may help to survive this disease.
A vaccine to keep prostate cancer from coming back once it has been treated is being tested. This treatment encourages the body’s immune system to destroy cancer cells that remain after prostate cancer surgery. Early results suggest that vaccines may be able to help slow the growth of prostate cancer.
As said Prostate cancer can’t be prevented, but some measures can be taken to reduce the risk or possibly slow the disease’s progression. The most important steps can be summed up as follows:
- Eating well
- Getting regular exercise
- Drug protection