Prostate Cancer: Understanding Causes, Symptoms, and Treatment

22 March,2024

Prostate Cancer is a form of cancer that begins in the prostate gland, which is a small walnut-shaped gland that produces seminal fluid. With over 1.4 million cases in 2020, prostate cancer has become the second most common cancer among men. Overall, it is the fourth most common cancer in the world.

Being diagnosed with cancer of the prostate can be a daunting experience. But here's some positive news. The death rate due to prostate cancer is declining year on year. With advancements in medical sciences, the prognosis of prostate cancer has significantly improved. 99 of 100 people diagnosed with prostate cancer that is localized and not spread to other body parts are alive five years later. It means early diagnosis and treatment are necessary for curing prostate cancer.

This blog aims at spreading awareness about prostate cancer and providing information regarding various aspects of the disease, including its causes, symptoms, diagnosis, prevention, and treatment options.

What is Prostate Cancer?

Prostate gland cancer begins when the cells in the prostate start to grow uncontrollably. Over time, cancerous cells can spread to other body parts, such as the bones and lymph nodes. It primarily affects older men, with the average age of diagnosis being around 65 years old. 

While prostate cancer can be slow-growing without causing any symptoms in its early stages, it is still important to detect and treat it as early as possible to increase the chances of successful outcomes. Types of prostate cancer include – 

• Adenocarcinoma: It is the most frequently diagnosed prostate cancer and develops in the gland cells that make the prostate fluid. Subtypes include acinar adenocarcinoma (cancer starts from the gland cells lining the prostate) and ductal adenocarcinoma (cancer first develops in the cells that line the tubes/ducts of the prostate).
• Transitional Cell Carcinoma: It is a less common type of prostate cancer responsible for 2-4% of total cases. The cancer starts from the cells lining the duct carrying the urine to the urethra. It first develops in the bladder and then spreads to the prostate.
• Squamous Cell Carcinoma: This type of prostate cancer develops from the flat cells (squamous cells) covering the gland. They are fast-growing and tend to spread more quickly than adenocarcinomas.

Other rare types of prostate cancer include neuroendocrine tumors, sarcoma, small cell carcinoma, and lymphoma. 

What are the Symptoms of Prostate Cancer?

At its early stages, prostate cancer often does not show noticeable symptoms. However, as the cancer progresses, certain signs may manifest. These signs can include – 

• Frequent urination
• Difficulty in starting or stopping urination
• Weak urine flow
• Blood in the urine or semen
• Pain or discomfort in the pelvic area
• Erectile dysfunction 

If you experience any of these symptoms, it is essential to consult an oncologist for further evaluation.

It's important to note that while these symptoms can be indicative of prostate cancer, they can also be caused by other conditions, such as benign prostatic hyperplasia (BPH) or urinary tract infections. Therefore, a thorough medical examination is crucial to determine the underlying cause of these symptoms.

How is Prostate Cancer Diagnosed? 

Diagnosing prostate cancer involves a combination of screening tests and further diagnostic procedures. Standard screening tests include –

• Prostate-Specific Antigen (PSA) Blood Test: A blood test measures PSA levels in the blood. Raised PSA levels may indicate the presence of prostate cancer, but further investigations are required to confirm the diagnosis. 
• Digital Rectal Exam: During a DRE (digital rectal exam), a healthcare worker inserts a gloved, lubricated finger in the rectum to inspect the prostate for abnormalities such as lumps or hard areas. While this exam may be uncomfortable, it is a crucial part of diagnosing prostate cancer as it can provide valuable information about the prostate's size, shape, and texture.
• Biopsy: A prostate biopsy is often recommended when there is an elevation in the PSA levels or abnormalities are detected during a DRE. During this procedure, small prostate tissue samples are taken using a thin needle and observed under a microscope for the presence of tumor cells. A biopsy is the most definitive way to diagnose prostate cancer, as it can provide detailed information about the aggressiveness and stage of the tumor.
• MRI Scan: An MRI creates precise, detailed images of the prostate gland and nearby areas. While planning a biopsy, MRI helps identify and locate the part of the prostate that is most likely to be cancerous. MRI also helps stage the cancer and determine if it has spread/metastasized to seminal vesicles or nearby structures. 
• PET Scan: A positron emission tomography (PET) scan detects prostate cancer using tracers like fluciclovine F18, choline C11, and sodium fluoride F18. These tracers are injected into the body and collected by the cancer cells. A special camera takes pictures of the prostate, and the cancer cells are identified.
• Transrectal Ultrasound (TRUS): The healthcare professional places a small, lubricated probe into the rectum during TRUS. This probe gives off soundwaves that enter the prostate gland and give echoes. A computer turns these echoes into black-and-white images of the prostate. These images help identify the size of the gland and guide through treatments such as brachytherapy and cryotherapy. 

What are the Causes and Risk Factors of Prostate Cancer?

The exact reason for developing prostate cancer remains unknown. However, prostate cancer develops when the cells in the prostate gland go haywire and start multiplying in an unorganized and unregulated manner. Mutations are responsible for causing damage to the division cycle of the cells in the body.

Researchers have identified multiple risk factors that increase the likelihood of developing this disease. Advancing age is the most notable risk factor, with the majority of prostate gland cancer cases occurring in men over the age of 65. Other risk factors include –

• A family history of prostate cancer
• African-American ethnicity
• Certain genetic mutations
• Obesity
• A diet high in red meat or low in fruits and vegetables

Research suggests that inflammation in the prostate gland may also play a role in the development of prostate cancer. Chronic inflammation, often caused by untreated infections or other conditions, can lead to DNA damage and an increased risk of cancerous growth. 

Exposure to certain chemicals and environmental toxins, such as Agent Orange, cadmium, and pesticides, is associated with an increased risk of prostate cancer.

Furthermore, hormonal imbalances, specifically high levels of testosterone or dihydrotestosterone (DHT), have been associated with an increased risk of prostate cancer. These hormones can stimulate the growth of cells in the prostate, potentially leading to the formation of cancerous tumors. 

Can Prostate Cancer Be Prevented?

While it is not always possible to prevent prostate cancer entirely, certain lifestyle choices and habits help lower the risk of having this condition. These include – 

• Regular physical exercise, a healthy weight, and a balanced diet that is rich in vegetables, raw fruits, and whole grains can contribute to overall well-being and potentially lower the risk of prostate cancer. 
• Additionally, attending regular check-ups and screenings is crucial as your healthcare provider recommends detecting potential issues early on.
• Furthermore, studies have shown that certain dietary supplements also play a role in reducing the risk of prostate cancer. For example, lycopene, an antioxidant found in tomatoes, has been linked to prostate cancer prevention.
• Green tea, rich in polyphenols, has shown promising results in some studies for its potential protective effects against prostate cancer.
• The body produces an enzyme called 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT). DHT is the primary hormone accountable for the growth of the prostate gland. Doctors can recommend 5-alpha reductase inhibitors such as finasteride to prevent the making of DHT, ultimately slowing the growth of the prostate.

It's important to note that while these lifestyle changes and dietary additions can help lower the risk of prostate cancer, they are not foolproof methods. Age and genetic factors also play a significant role in the development of this disease. 

Therefore, it's essential to consult with an oncologist to create a personalized plan that considers your risk factors and overall health status.

What is the Treatment for Prostate Cancer?

The treatment for prostate cancer may vary depending on factors such as the stage of the cancer, overall health, and personal preferences. Standard treatment options include active surveillance (monitoring the cancer without immediate treatment), surgery to remove the prostate gland (prostatectomy), radiation therapy, hormone therapy to block the effects of testosterone, chemotherapy, and immunotherapy. Treatment decisions should be made in consultation with a healthcare team, considering the individual's unique circumstances and preferences.

• Active surveillance: It is often recommended for low-risk prostate cancer cases, where the cancer is slow-growing and may not require immediate treatment. This approach involves regular monitoring through PSA tests, digital rectal exams, and periodic biopsies to track any changes in the cancer's behavior. It allows patients to avoid potential side effects of treatment while ensuring that intervention can be initiated if the tumor becomes more aggressive.
• Chemotherapy: When medical oncologists use medicines and drugs to keep the cancer cells from dividing and growing, it is known as chemotherapy. The regimen consists of specific cycles that will be given over a set period. Common drugs used for prostate cancer treatment include docetaxel and cabazitaxel.
• Radiation Therapy: Radiotherapy or radiation therapy is another common treatment modality for prostate cancer. It involves a radiation oncologist using high-intensity rays to destroy/kill cancer cells. Common types of radiotherapy used for prostate cancer are external beam radiation therapy, brachytherapy, intensity-modulated radiation therapy, and proton therapy.
• Surgery: Surgery, specifically radical prostatectomy, is a standard treatment option for localized prostate cancer. During this procedure, the entire prostate gland is removed to eliminate the cancerous cells. Depending on the extent of the tumor, surrounding tissues, including lymph nodes, might also be removed to prevent the spread of the disease. While surgery can be effective in eliminating cancer, it can also lead to side effects such as erectile dysfunction and urinary incontinence, which the patient should discuss with the healthcare team before making a decision.
• Focal Therapies: Less invasive treatments that help destroy small prostate tumors come under focal therapies. Cryosurgery or cryoablation involves inserting metal probes through small incisions and freezing the cancer cells. High-intensity focused ultrasound (HIFU) is another focal therapy that uses heat to destroy cancer cells.
• Hormone Therapy: Androgen deprivation therapy (ADT) or hormone treatment works by lowering the amount of androgens (male hormones) in the body. Androgens are responsible for the growth of the prostate and gland, and ADT helps reduce their concentration in the body. It significantly slows down the growth of cancerous cells.
• Targeted Therapy: In targeted therapy, specific proteins, genes, and tissue environments contributing to the growth of cancer cells are identified and targeted. It offers the advantage of not harming normal healthy cells. Drugs used in targeted therapy are olaparib, rucaparib, talazoparib, and niraparib plus abiraterone.
• Lu-177 PSMA Therapy: The lutetium-177 PSMA therapy (Pulvicto) targets a specific protein known as prostate-specific membrane antigen (PSMA). PSMA is present on the surface of prostate cancer cells. The Lu-177 PSAM attaches to it and delivers radiation to cancer cells, ultimately causing their death.

What Questions to Ask the Healthcare Team if Diagnosed With Prostate Cancer?

Regular and clear communication is crucial in making informed decisions about your health care. Bringing someone with you for your doctor's appointments would be helpful. Consider asking your healthcare team the following questions:

• What type of prostate cancer do I have?
• How aggressive is it? 
• Can you explain my lab results and pathology report to me?
• What is the stage and Gleason score of prostate cancer? What does this mean? 
• Would you explain my treatment options? 
• What treatment plan would you recommend and why?
• What is the goal of each treatment? Will it eliminate the cancer?
• Who will be part of my treatment team? 
• How will the cancer treatment affect my everyday life? 
• Will I be able to exercise, work, and do my usual day-to-day activities? 
• Will this treatment affect my sex life? If so, how and for how long? 
• Will this treatment affect my fertility and ability to have children?  
• What long-term side effects may be associated with my prostate cancer treatment? 
• If I have a problem or question, who should I contact?

Takeaway

Prostate cancer is the second most common cancer in men worldwide, with a higher incidence in older individuals. It is a prevalent form of cancer that primarily affects men, particularly those above the age of 65. Regular screenings, such as prostate-specific antigen (PSA) tests and digital rectal exams, can aid in the early diagnosis of prostate cancer when treatment is most effective. Men must be proactive about their health and discuss any symptoms or concerns with the doctors to ensure timely diagnosis and appropriate management.