Prostate cancer is cancer that develops in the prostate glands 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 in men that produces seminal fluid. This fluid nourishes and transports sperm.
Prostate cancer is slow growing. Often, it is confined to the prostate gland, requiring minimal or no treatment. It can take up to 15 years for cancer to spread from the prostate to other parts of the body (metastasis), typically the bones. In many cases, prostate cancer does not affect the man's natural lifespan. 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.
Stages of prostate cancer
- Stage I: This is the slow growing and early stage of prostate cancer. The cancer cells appear healthy. The tumor cannot be felt and usually involves half of one side of the prostate or less. To help diagnose prostate cancer, a blood test may be done to detect certain proteins/hormones in the blood. These are called tumor markers, which are produce by tumors. Prostate cancer often produces a tumor marker called prostate-specific antigen (PSA). The test may be done as a screening test, routinely for older men to help detect the cancer in the early stages. However, the test will not detect all prostate cancers. The test can also be done to assess the stage of prostate cancer and monitor the progress of treatment.
- Stage II: The tumor is within the prostate. It is small but has a risk of growing and spreading. PSA levels are medium or low at this stage. Stage II is further divided into IIA, IIB and IIC depending on the extent of cell abnormalities.
- Stage III: The cancer is high-grade and more locally advanced. There is a high risk of spread. PSA levels are high. Stage III is subdivided into stages IIIA, IIIB and IIIC depending on the extent of local invasion.
- Stage IV: The cancer has spread beyond the prostate (metastasis). It spreads to the surrounding lymph nodes or other parts of the body, such as the bones.
How is prostate cancer diagnosed?
Testing healthy men with no symptoms for prostate cancer is controversial. However, many doctors do recommend asymptomatic men 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 usually also increased if there is a prostate infection or benign enlargement of the prostate as well. PSA test is also done to monitor disease progress and response to treatment.
Diagnostic tests for prostate cancer
If there are abnormal findings in the screening tests, the doctor may advise the following diagnostic tests:
- 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:
- Bone scan
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Positron emission tomography (PET) scan for the whole body
What are the signs and symptoms of prostate cancer?
Prostate cancer may not cause any signs and symptoms in its 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.
Signs and symptoms of prostate cancer in the later stages
How is prostate cancer treated?
The treatment options of prostate cancer depend on the aggressiveness of the tumor, metastasis of the cancer and 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 to kill 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 modulates the body’s immune system to 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.
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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- Risk factors include age, family history, ethnicity, and diet.
- Prostate cancer is diagnosed by a digital rectal exam, prostate-specific antigen (PSA) test, and prostate biopsy.
- Symptoms may include
- frequent need to urinate,
- incontinence, pain,
- blood in the urine,
- fatigue, and more.
- Prognosis and treatment depend on cancer staging.
- Watchful waiting,
- cryotherapy, and
- other management strategies are available.
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