What is the Prostate cancer ?
The prostate, a tiny walnut-shaped gland that is part of a man's reproductive system, develops prostate cancer.
What is the function of the prostate gland?
A portion of the male reproductive system is the prostate gland. During ejaculation, the gland produces fluid that combines with semen. This fluid protects and maintains the health of sperm in preparation for conception and pregnancy.
What is the location of the prostate gland?
The prostate gland is located in front of the rectum, under a man's bladder. The urethra goes through the prostate gland's core. This tube transports urine and sperm from the penis to the outside of the body. Behind the prostate gland are the seminal vesicles that produce sperm.
What is the prevalence of Prostate cancer?
Approximately one in every nine men will be diagnosed with prostate cancer at some point in their lives. Prostate cancer is the second most frequent cancer in men, behind skin cancer. Every year, about 200,000 men in the United States are diagnosed with prostate cancer. There are several effective therapies available, and some men do not need therapy at all. Every year, some 33,000 men die as a result of the condition.
Who is at risk for Prostate cancer?
Men over the age of 55 are at a higher risk of developing the condition. As you become older, your chances of acquiring prostate cancer grow. Men over the age of 65 account for 60% of prostate cancer cases. Other aspects to consider are:
- Race and ethnicity (black men have the highest risk).
- Sexually transmitted infections.
- Prostate cancer runs in the family.
- Smoking.
- Gene changes
Several inherited gene changes (mutations) seem to raise prostate cancer risk, but they probably account for only a small percentage of cases overall. For example:
- Inherited mutations of the BRCA1or BRCA2 genes, which are linked to an increased risk of breast and ovarian cancers in some families, can also increase prostate cancer risk in men (especially mutations in BRCA2).
- Men with Lynch syndrome(also known as hereditary non-polyposis colorectal cancer, or HNPCC), a condition caused by inherited gene changes, have an increased risk for a number of cancers, including prostate cancer.
What forms of Prostate cancer are there?
- Small cell carcinomas.
- Transitional cell carcinomas.
- Tumors of the neuroendocrine system.
What are the symptoms of prostate cancer ?
Prostate cancer rarely causes symptoms in its early stages. As the disease progresses, a number of problems may arise:
- Urination needs are frequent and occasionally urgent, particularly at night.
- Weak urine flow or flow that begins and stops.
- Urination that hurts (dysuria).
- Incontinence of the bowels (feces).
- Erectile dysfunction and painful ejaculation (ED).
- Blood in the sperm or urine (hematospermia).
- Pain in the lower back, hips, and chest.
- Numbness in the legs or feet.
Are any prostate problems a symptom of prostate cancer?
Not all masses in the prostate gland are malignant, and not all prostate problems are indicative of cancer. Other conditions that cause symptoms similar to prostate cancer include:
BPH (benign prostatic hyperplasia): Almost every man suffers from benign prostatic hyperplasia (BPH) at some time in his life. This disease causes the prostate gland to enlarge, but does not increase the risk of cancer. The enlarged gland squeezes the urethra, which prevents sperm and urine from passing through. Treatment consists of taking antibiotics and other medicines, and in some cases surgery may help.
How do you know if you have prostate cancer?
Prostate cancer screenings are the most efficient technique to detect the disease early. If your cancer risk is average, your first prostate screening will most likely be around the age of 55. If you have a family history of the illness or are Black, your healthcare professional may begin testing sooner. Screening is usually discontinued beyond the age of 70, however it may be resumed in exceptional conditions.
Prostate cancer screening tests include:
- Your physician uses a gloved, lubricated finger to feel the prostate gland, which sits in front of the rectum, during a digital rectal exam. Bumps or hard spots might be signs of malignancy.
- PSA blood test: The prostate gland produces a protein known as a protein-specific antigen (PSA) (PSA). PSA levels that are too high might be a sign of malignancy. If you have BPH or prostatitis, your levels will also increase.
- Biopsy: The most definite approach to identify prostate cancer is to take a needle biopsy and look for cancer cells in the tissue. Magnetic resonance imaging (MRI) technology offers comprehensive pictures of the prostate during an MRI-guided prostate biopsy.
How is prostate cancer diagnosed?
There are many tests used for diagnosing prostate cancer. Not all tests described here are commonly used for every person. Your doctor may consider these factors when choosing a diagnostic test:
- The type of cancer suspected
- Your age and general health
- The results of earlier medical tests
Early tests -
If prostate cancer is suspected, a physical examination and the following tests may be used to decide if more diagnostic tests are needed:
- PSA test.
- Digital rectal examination (DRE) - A doctor uses a DRE to find abnormal parts of the prostate by feeling the area using a finger. It is not very precise and not every doctor has expertise in the technique; therefore, DRE does not usually detect early prostate cancer.
- Biomarker tests.
Making a diagnosis -
If the PSA or DRE test results are abnormal, then further tests will be used to confirm whether a person has prostate cancer.
- A biopsy is the removal of a small amount of tissue for examination under a microscope. To get a tissue sample, a surgeon most often uses transrectal ultrasound (TRUS, see below) and a biopsy tool to take very small slivers of prostate tissue.
- MRI fusion biopsy. An MRI fusion biopsy combines an MRI scan (see below) with TRUS.
- Transrectal ultrasound (TRUS). A doctor inserts a probe into the rectum that takes a picture of the prostate using sound waves that bounce off the prostate. A TRUS is usually done at the same time as a biopsy.
Finding out if the cancer has spread -
To find out if cancer has spread outside of the prostate, doctors may perform the imaging tests listed below.
- Whole-body bone scan.
- Computed tomography (CT or CAT) scan.
- Magnetic resonance imaging (MRI).
- Positron emission tomography (PET) or PET-CT scan.
After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.
What are the stages of prostate cancer ?
After a diagnosis of prostate cancer, doctors try to find out whether and how far the cancer has spread. This process is called staging. Prostate cancer staging describes how far the cancer has spread in the body. This helps to determine how serious the cancer is and how best to treat it. Doctors also use cancer staging when talking about survival statistics.
There are 2 types of staging for prostate cancer:
- Clinical staging.This is based on the results of DRE, PSA testing, and Gleason score (see “Gleason score for grading prostate cancer” below). These test results will help determine whether x-rays, bone scans, CT scans, or MRI are also needed. If scans are needed, they can add more information to help the doctor figure out the clinical stage.
- Pathologic staging.This is based on information found during surgery, plus the laboratory results of the prostate tissue removed during surgery, also called the pathology. The surgery often includes the removal of the entire prostate and some lymph nodes. Examination of the removed lymph nodes can provide more information for pathologic staging.
Clinical stages of Prostate :
- Stage I:Cancer in this early stage is usually slow growing. The tumor cannot be felt and involves one-half of 1 side of the prostate or even less than that. PSA levels are low. The cancer cells look like healthy cells.
- Stage II: The tumor is found only in the prostate. PSA levels are medium or low. Stage II prostate cancer is small but may have an increasing risk of growing and spreading.
- Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells are still well differentiated.
- Stage IIB:The tumor is found only inside the prostate, and it may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated.
- Stage IIC: The tumor is found only inside the prostate, and it may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated.
- Stage III: PSA levels are high, the tumor is growing, or the cancer is high grade. These all indicate a locally advanced cancer that is likely to grow and spread.
- Stage IIIA:The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high.
- Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum.
- Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells.
- Stage IV: The cancer has spread beyond the prostate.
- Stage IVA:The cancer has spread to the regional lymph nodes.
- Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.
- Recurrent: Recurrent prostate cancer is cancer that has come back after treatment. It may come back in the prostate area again or in other parts of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.
Gleason score for grading prostate cancer -
Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.
Doctors look at the Gleason score in addition to stage to help plan treatment. For example, active surveillance may be an option for someone with a small tumor, low PSA level, and a Gleason score of 6. People with a higher Gleason score may need treatment that is more intensive, even if the cancer is not large or has not spread.
- Gleason X: The Gleason score cannot be determined.
- Gleason 6 or lower: The cells look similar to healthy cells, which is called well differentiated.
- Gleason 7: The cells look somewhat similar to healthy cells, which is called moderately differentiated.
- Gleason 8, 9, or 10: The cells look very different from healthy cells, which is called poorly differentiated or undifferentiated.
What are some of the side effects of prostate cancer?
Some malignant tumors rapidly spread outside of the prostate (metastasize). The most prevalent sites of prostate cancer spread are the bones and lymph nodes. The liver, brain, lungs, and other organs may all be affected.
What is the best way to manage or treat prostate cancer?
Most common types of treatment for cancer :
- Surgery
- Chemotherapy
- Radiation Therapy
- Targeted Therapy
- Immunotherapy
- Stem Cell or Bone Marrow Transplant
- Hormone Therapy
Because cancer develops slowly and does not spread, some individuals never require therapy. The majority of prostate cancers are relatively treatable with therapy. There are many treatment options available, including:
- Active surveillance involves having screenings, scans, and biopsies every one to three years to track the progression of cancer. If the cancer is only in the prostate, is slow-growing, and is not producing symptoms, active monitoring is the best option.
- Watchful waiting sounds similar to active surveillance, but it's more often utilized in elderly or weak patients. This strategy, like active surveillance, does not include definite therapy at the time of diagnosis. The testing, on the other hand, is significantly less frequent and mostly focused on symptom treatment.
- Brachytherapy is a kind of internal radiation therapy in which radioactive seeds are implanted inside the prostate. This method preserves the surrounding healthy tissue.
- External beam radiation treatment involves the use of a machine to send powerful X-ray beams directly to the tumor. External radiation treatment that delivers high doses of radiation to the illness site is known as intensity-modulated radiation therapy.
If the cancer has migrated outside of the prostate gland, your doctor may consider systemic therapy. Chemotherapy, androgen deprivation hormone therapy, and immunotherapy are examples of these treatments.
- Focal therapy is a newer kind of treatment that focuses on treating just the cancer-affected portion of the prostate. If your cancer hasn't spread, you may be able to attempt this therapy. High-intensity focused ultrasound (HIFU), cryotherapy, laser ablation, and photodynamic treatment are all examples of focal therapies.
Surgery
Surgery involves the removal of the prostate and some surrounding lymph nodes during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For prostate cancer, a urologist or urologic oncologist is the surgical oncologist involved in treatment. The type of surgery depends on the stage of the disease, the patient’s overall health, and other factors.
Radical (open) prostatectomy. A radical prostatectomy is the surgical removal of the entire prostate and the seminal vesicles. Lymph nodes in the pelvic area may also be removed. This operation has the risk of affecting sexual function. Nerve-sparing surgery, when possible, increases the chance that the patient can maintain sexual function after surgery by avoiding surgical damage to the nerves that allow erections and orgasm to occur. Orgasm can occur even if some nerves are cut because these are separate processes. Urinary incontinence is also a possible side effect of radical prostatectomy. To help resume normal sexual function, drugs, penile implants, or injections may be recommended. Sometimes, another surgery can fix urinary incontinence.
Robotic or laparoscopic prostatectomy. This type of surgery is less invasive than a radical prostatectomy and may shorten recovery time. A camera and instruments are inserted through small keyhole incisions in the patient’s abdomen. The surgeon then directs the robotic instruments to remove the prostate gland. In general, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects are similar to those of a radical (open) prostatectomy. Talk with your doctor about whether your treatment center offers this procedure and how it compares with the results of the radical (open) prostatectomy.
Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles. It is described in detail in “Systemic treatments” below.
Transurethral resection of the prostate (TURP). TURP is most often used to relieve symptoms of a urinary blockage, not to treat prostate cancer. In this procedure, with the patient under full anesthesia, which is medication to block the awareness of pain, a surgeon inserts a narrow tube with a cutting device called a cystoscope into the urethra and then into the prostate to remove prostate tissue.
What are the treatment-related side effects of prostate cancer ?
Loss of sexual desire.
Treatments that reduce testosterone can lower your sexual desire. This will make you less interested in physical intimacy and having sex. It can also cause erectile dysfunction. There are no medical treatments to increase sexual desire, but treatments that lower testosterone may be temporarily stopped to let testosterone levels rise again. Fortunately, sexual desire is also influenced by other factors, such as relationship satisfaction, self-esteem, and psychological health. Because desire can be significantly dampened by loss of testosterone, it is important to learn how to optimize these other elements. Read a Cancer.Net Blog post about coping with the loss of sexual desire.
Erectile dysfunction.
Erectile dysfunction or ED is when you cannot have or keep a penile erection. There are medications to help treat this condition, as well as medical devices like suppositories and a penile pump or implant. Read a Cancer.Net Blog post about asking for help with erectile problems.
Less semen and dry orgasm.
Treatment may cause your orgasms to have less semen. Some treatments may result in orgasm with no semen at all. When this happens, it is called a dry orgasm. Having less or no semen does not affect a person’s feelings of pleasure during orgasm. However, it does affect your chances of fathering a child.
A smaller penis.
Some patients may find that their penis shrinks by up to an inch after treatment, particularly after prostatectomy. Some research has found that this side effect is temporary, and the penis regains its size after a year. If this happens to you, speak with your health care team about penile rehabilitation, which can help with the recovery of the health of your penis.
Can Prostate Cancer be prevented?
There is no sure way to prevent prostate cancer. Many risk factors such as age, race, and family history can’t be controlled. But there are some things you can do that might lower your risk of prostate cancer.
Vitamin, mineral, and other supplements -
- Vitamin E and selenium: Some early studies suggested that taking vitamin E or selenium supplements might lower prostate cancer risk.
But in a large study known as the Selenium and Vitamin E Cancer Prevention Trial (SELECT), neither vitamin E nor selenium supplements were found to lower prostate cancer risk. In fact, men in the study taking the vitamin E supplements were later found to have a slightly higher risk of prostate cancer.
- Soy and isoflavones: Some early research has suggested possible benefits from soy proteins (called isoflavones) in lowering prostate cancer risk. Several studies are now looking more closely at the possible effects of these proteins.
Medicines -
Some drugs might help reduce the risk of prostate cancer.
5-alpha reductase inhibitors -
5-alpha reductase is an enzyme in the body that changes testosterone into dihydrotestosterone (DHT), the main hormone that causes the prostate to grow. Drugs called 5-alpha reductase inhibitors, such as finasteride (Proscar) and dutasteride (Avodart), block this enzyme from making DHT. These drugs are used to treat benign prostatic hyperplasia (BPH), a non-cancerous growth of the prostate.
Large studies of both of these drugs have been done to see if they might also be useful in lowering prostate cancer risk. In these studies, men taking either drug were less likely to develop prostate cancer after several years than men getting an inactive placebo.
When the results were looked at more closely, the men who took these drugs had fewer low-grade prostate cancers, but they had about the same (or a slightly higher) risk of higher-grade prostate cancers, which are more likely to grow and spread. Long term, it’s not clear if these drugs affect death rates, as men in these studies had similar survival whether or not they took one of these drugs.
These drugs can cause sexual side effects such as lowered sexual desire and erectile dysfunction (impotence), as well as the growth of breast tissue in some men. But they can help with urinary problems from BPH such as trouble urinating and leaking urine (incontinence).
Aspirin -
Some research suggests that men who take a daily aspirin might have a lower risk of getting and dying from prostate cancer. But more research is needed to show if the possible benefits outweigh the risks. Long-term aspirin use can have side effects, including an increased risk of bleeding in the digestive tract. While aspirin can also have other health benefits, at this time most doctors don’t recommend taking it just to try to lower prostate cancer risk.
Other drugs
Other drugs and dietary supplements that might help lower prostate cancer risk are now being studied. But so far, no drug or supplement has been found to be helpful in studies large enough for experts to recommend them.
What can I do to avoid prostate cancer?
Prostate cancer strikes the majority of men as they grow older for no apparent reason. There is no way to avoid it. If you have specific prostate cancer risk factors, however, doing the following activities may help you reduce your risk and diagnose the illness early:
- Prostate screenings should be done on a frequent basis.
- Maintain a healthy body mass index (BMI).
- Exercise on a regular basis.
- Consume a well-balanced diet.
- Stop smoking.
What is the prognosis (prognosis) for prostate cancer patients?
Because prostate cancer is a slow-growing malignancy, most men die of causes other than the illness. The importance of early diagnosis in achieving better results cannot be overstated. Almost all men diagnosed with localized cancer that hasn't spread outside of the prostate survive for at least five years following diagnosis (about 97 percent to 98 percent). One-third of men who have metastatic cancer that has spread outside of the gland live for five years.