Prostate cancer develops in the prostate gland of men. It is one of the most common types of cancer. It is usually seen in men older than 50 years of age. The prostate is a small walnut-shaped gland that produces seminal fluid required to nourish and transports sperm. Prostate cancer develops slowly. More often, it is confined to the prostate gland, requiring minimal or no treatment.
It can take from 8 to 15 years for prostate cancer to spread from its origin to other parts of the body (metastasis), typically the bones. In many cases, prostate cancer does not affect the man's natural lifespan. Certain types of prostate cancer can be aggressive and spread quickly to other parts of the body. If prostate cancer is detected early and is confined to the prostate gland, the prognosis is excellent.
A prostate-specific antigen (PSA) is often raised in cases of prostate cancers. This blood test is typically done as a screening test, routinely for older men to help detect the cancer in the early stages. It can also be done to monitor the progress of treatment in prostate cancers. However, it is not specific or accurate for cancer diagnosis. Infection of the prostate or the noncancerous enlargement of the prostate can also cause prostate cancer.
What are the other ways to diagnose prostate cancer?
Testing healthy men with no symptoms for prostate cancer is controversial. However, many doctors do recommend asymptomatic men aged older than 50 years of age, who have other risk factors, to get screened for prostate cancer routinely. This is because there are often no symptoms in the early stages. The advantage of screening routinely is the early detection of cancer and treatment, as well as the possibility of complete cure.
Screening tests for prostate cancer might include
- Digital rectal exam (DRE): This is the part of a physical examination performed by a doctor on an outpatient basis. The prostate is situated adjacent to the rectum. The doctor (with gloves on) inserts a finger into the rectum to examine the prostate, feel its texture and assess its shape and size. The doctor uses a numbing lubricant while examining to reduce discomfort during examination.
- Prostate-specific antigen (PSA) test: If the PSA level is higher than normal, it indicates prostate abnormalities. PSA levels are also increased during prostate infection or benign enlargement of the prostate. PSA test helps to monitor disease progression and response to treatment. Further investigations, such as ultrasound (USG) and magnetic resonance imaging (MRI) of the prostate, are required to confirm the diagnosis.
- Diagnostic tests for prostate cancer: If there are abnormal findings in the screening tests, the doctor may advise
- Ultrasound: Transrectal (through the rectum) ultrasound is done using a small probe inserted into the rectum to study the prostate gland.
- Magnetic resonance imaging (MRI) scan
- Prostate biopsy: A small sample of prostate tissue is collected using a thin needle inserted into the prostate.
- Detecting the presence of metastasis
- Detection of metastasis (spread of cancer): The doctor may recommend one or more of the following tests if metastasis is suspected:
What causes prostate cancer?
The exact cause of prostate cancer is not known. The tumor arises from cells with abnormal changes in the deoxyribonucleic acid (DNA) of the prostate.
Certain factors can increase the risk of prostate cancer. They include
- Age: The risk of prostate cancer increases with age. It is most commonly seen in people aged older than 50 years of age.
- Ethnic groups: African Americans have a higher risk of prostate cancer than other ethnic groups. Cancer in this population is also more likely to be aggressive.
- Family history: If a first-degree relative has prostate cancer, it increases the risk as well. Having the genes (BRCA1 or BRCA2) in the family that increase the risk of breast cancer or a strong family history of breast cancer also increases the risk of developing prostate cancer.
- Obesity: Obese people have a higher risk of developing prostate cancer, which could also be aggressive and recurrent despite treatment.
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What are the signs and symptoms of prostate cancer?
Prostate cancer can cause the following signs and symptoms in the later stages:
How is prostate cancer treated?
The treatment options for prostate cancer depend on the aggressiveness of the tumor, whether it is metastasized and the overall health of the patient. Treatment may involve one or a combination of multiple treatment modalities.
Treatment options include
- Observation and follow-up: Low-grade prostate cancer may not require treatment immediately. Hence, the doctor may recommend observation and regular follow-up.
- Surgery: Surgery to remove the prostate with or without surrounding structures.
- Radiation therapy: Uses high-powered beams to kill cancer cells.
- Cryotherapy: Involves freezing tissues of the prostate using cold gas to kill the cancer cells.
- High-intensity focused ultrasound (HIFU): Uses concentrated heat generated by ultrasound energy, killing the cancer cells.
- Hormone therapy: Involves taking medication to stop the production of the male hormone, testosterone or block the action of testosterone. Prostate cancer cells require testosterone to grow.
- Chemotherapy: Uses medications to kill cancer cells.
- Immunotherapy: Immunotherapy modulated the body’s immune system to help fight cancer.
- Targeted drug therapy: Targeted drug treatments target specific abnormalities present within cancer cells and block them, causing cancer cells to die.
- Pain management: Large prostate cancers and metastasis can cause significant pain for which the doctor would prescribe appropriate painkillers.
- Emotional support: Helps with the emotional stress and depression that may be associated with a chronic disease.
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Centers for Disease Control and Prevention. What Is Prostate Cancer? https://www.cdc.gov/cancer/prostate/basic_info/what-is-prostate-cancer.htm
Tracy CR. Prostate Cancer. Medscape. https://emedicine.medscape.com/article/1967731-overview
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