Depending on the tissue or organ where the cancer begins, there are around 200 types of cancers and these are called primary cancers. Some cancers have a high likelihood of spreading from one tissue to another and this is called metastasis. Secondary or metastatic cancers are those that have spread from primary locations, the location where they have first appeared. Prostate cancer occurs in the prostate, a gland in the male reproductive system.
The prostate:
The prostate gland is a small muscular gland about the size of a walnut located at the bottom of the bladder and in front of the rectum. Weighing around 30 grams, the prostate surrounds the urethra, the tube that carries urine from the bladder.
Function:
Prostate is not essential for life but is important for reproduction. The prostate is an exocrine gland that is responsible for the urine control and the secretion of fluids which are useful for sperm viability. It produces a fluid that transports and nourishes the sperm to fuse with the female ovum or egg. It causes the contraction of the fluids and forces these out during orgasms.
Prostate-specific antigen (PSA), a protein ejected by the prostate helps the semen to remain in its liquid state. The main function of the prostate is to release seminal fluid, a fluid that nourishes and transports the sperm.
Prostate Cancer Risk factors:
- Prostate cancer is often observed in men who are above 50 years and the risk of developing this cancer type increases with age.
- When compared to white men, black men are at a higher risk of developing prostate cancer at an early age.
- 20% of prostate cancers are familial prostate cancers which are a result of abnormal combinations of shared genes and environmental or lifestyle factors.
- Exposure to levels of BPA toxins also contribute in developing prostate cancer.
- Men having HBOC, which is associated with DNA-repair mutations to the BRCA1 and/or BRCA2 genes, at a higher risk of developing an aggressive form of prostate cancer.
- Men with elevated levels of estrogen and testosterone have an increased risk of developing prostate cancer.
- Inflammation near the prostate area can damage the DNA of the cells which stimulates the normal prostate to become cancerous triggering the growth of prostate cancer.
- High levels of calcium in the body leads to prostate cancer in a few men.
- Men whose daily activity lacks physical activity tend to become obese, which encourages the growth of prostate cancer.
Read more about the risk factors of prostate cancer here.
Precancerous conditions of prostate cancer:
Conditions that have the potential to develop into cancers are termed precancerous conditions. Cancer that starts in the prostate gland is called prostate cancer and the most common of the precancerous conditions of prostate cancer are as follows:
- Prostatic intraepithelial neoplasia (PIN)
- Proliferative inflammatory atrophy (PIA)
- Atypical small acinar proliferation (ASAP)
Read more about the precancerous conditions of prostate cancer here.
Symptoms of prostate cancer:
Most of these symptoms vary for each individual. The extent of impact of these symptoms on the body depends on the stage of the cancer along with the resistance and tolerance levels of the patient. The common signs of prostate cancer are as follows:
- Reduced control over the bladder
- Blood in urine
- Frequent urination, especially at night
- Pain and burning during urination
- Erectile dysfunction
- Swelling
- Bone pain
- Numbness of hips, legs or feet
- Blood in semen
Read more about the symptoms of prostate cancer here.
Diagnosis of prostate cancer:
Prostate cancer has three basic stages of diagnosis which are discussed below along with the tests used in each stage.
Preliminary tests:
Tests are run if the doctor suspects the patient to have prostate cancer to determine if further testing is needed or if the presented symptoms can be explained by other conditions. The following are some of the tests done:
- PSA test: This test are done to check the levels of prostate specific antigen (PSA) which are released by the prostate tissues. Abnormal levels of the PSA indicates prostate cancer, BPH or inflammation of the prostate.
- Free PSA: This is a type of PSA test that is performed to measure the free PSA in the bloodstream. This test gives the ratio of free PSA to total PSA.
- DRE: Digital rectal examination is carried out by the doctor feeling the prostate area using a finger. This test does not give accurate results though and early stages of prostate cancer cannot be detected through DRE.
- Biomarker tests: Biomarkers are substances that the tumours make in the blood, urine or tissues. A score of 4K of the biomarker tests indicate higher risks of the patient developing prostate cancer.
Confirmation tests:
The following diagnostic tests are performed to confirm the presence of prostate cancer:
- PCA3
- Transrectal ultrasound
- Biopsy
Metastasis:
If the patient shows signs of secondary cancer or if the doctor suspects the cancer has spread to secondary locations, tests can be performed to know if the prostate cancer has metastasized. Mostly imaging tests are used for this, they are:
- Whole body bone scan
- CT scan
- PSMA-PET scan
- MRI
Read more about the diagnosis of prostate cancer here.
Staging of prostate cancer:
Staging of prostate cancer helps the doctors figure out how much the cancer has spread in the thyroid gland and determine its best treatment. Staging also helps calculate survival statistics. The lower the number of the stage, the less is the cancer has spread, with early stages being 1 and the most advanced stage being 4.
How is prostate cancer staged?
Cancer types that form tumours are usually staged using TNM system and the same method is used for prostate cancer too. Additionally, PSA levels and grade of tumour is also taken into consideration for prostate cancer. The stage of the cancer determines the extent to which the cancer has metastasized.
Tumour (T):
The stages are divided based on the size and extent of the cancer tumour in the primary location and the stages are Tis (T0) to T4. In addition to the tumour staging, a prefix can be attached before the stage to show if the tumour has been staged clinically or pathologically (c for clinical and p for pathological).
Node (N):
The node describes whether the cancer has spread to the lymph nodes or not.
Metastasis (M):
This gives information about the cancer spreading to other parts of the body.
PSA level:
Prostate specific antigen or PSA is a protein produced by the prostate gland. It is present in small quantities in men with healthy prostates but is elevated in the presence of prostate related disorders or prostate cancer. The PSA tests can be used to measure the levels of this protein in the patient and can be used to stage the cancer.
Grade:
Grade is a parameter used to describe how closely the cancerous cells represent normal cells of organ, in this case, the prostate gland. In prostate cancer, Gleason score is the grading system used to determine the grade of cancer and hence its aggressiveness. The overall Gleason score of the tumour is determined based on the two major regions of cancer growth and the Gleason sum of those regions. If there is a single tumour or uniform growth of cancer, the Gleason score is doubled to get the overall score. Five Grade groups are assigned based on the overall Gleason grade of the cancer.
Stages of prostate cancer:
Stage I:
Stage I of prostate cancer cannot be felt in physical examinations because it is microscopic. Microscopic prostate cancers are contained in less than half of the lobe of the prostates. In this stage, the cancer is confined to the prostate only and has PSA levels less than 10 and the Gleason score is less than 6. Read more about the stage I of prostate cancer here.
Stage II:
In this stage, the cancer has spread within the prostate involving one or both the lobes of the prostate. These cancers do not spread beyond the prostate to nearby lymph nodes or other organs. Read more about the stage II of prostate cancer here.
Stage III:
Stage III of prostate cancer has spread beyond the prostate to the nearby tissues, but not to any lymph nodes or distant tissues. These cancers are mostly felt through DRE tests and are identified in screening examinations also. Read more about the stage III of prostate cancer here.
Stage IV:
Stage IV of prostate cancer is a very advanced stage, with the cancer spreading to the lymph nodes and distant organs like the liver, bones or lungs. It has two substages. Read more about the stage IV of prostate cancer here.
Treatment methods for prostate cancer:
The following are the treatment options available for treating prostate cancer.
Active surveillance:
Because this cancer type grows very slowly, men may often not require any treatment immediately if not throughout their lifetime. Active surveillance is a method of monitoring the cancer closely regularly. PSA blood test, DRE (digital rectal examination), prostate biopsies may be done once in six months or so. If the results show signs of the cancer spreading, other treatment options are reviewed to eliminate the cancer.
Radiation therapy for Prostate Cancer:
This treatment uses high beams of x-rays to kill the malignant cells. The radiation is aimed at the cancer cells to kill them, restrict their growth and to shrink tumours. There are two main types of radiation therapy used in the treatment of prostate cancer:
- External beam radiation: In external beam radiation therapy, also called EBRT, beams of radiation are focused on the prostate gland from a machine outside the body and it is used to treat the early stages of cancer.
- Brachytherapy: Also called seed implantation or interstitial radiation therapy, small radioactive pellets of the size of a grain of rice are placed directly inside the prostate gland. This treatment is used alone in patients in the early stages of cancer showing relatively slow growth.
Read more about radiation therapy of prostate cancer here.
Radical prostatectomy:
Surgery is the preferred choice of treatment for prostate cancers that show symptoms but is confined to the the prostate gland. The main type of surgery used is called radical prostatectomy, in which in addition to the prostate gland, the tissue around it including the seminal vesicles may be removed. Radical retropubic prostatectomy and radical perineal prostatectomy are the two types of surgeries depending on how the prostate is approached.
Read more about surgery for prostate cancer here.
Hormone therapy:
Hormone therapy is used when the cancer has spread too much to allow radiation or surgery or the cancer has risk of recurrence, or to shrink the cancer before radiation therapy. Also called androgen deprivation therapy or androgen suppression therapy, this treatment aims to reduce the level of androgens, the male hormones in human which stimulate growth of prostate. Hormone therapy can shrink the cancer or slow down its growth but this treatment alone cannot cure prostate cancer. Read more about hormone therapy for prostate cancer here.
Chemotherapy:
Chemotherapy uses drugs to kill cancer cells throughout the body and is used if the prostate cancer has spread beyond the prostate gland. It is not the standard treatment for this cancer type and is usually opted if hormone therapy is not working. The treatment is given in cycles of medication and rest to allow the body to recover and reduce the intensity of side effects. Read more about chemotherapy for prostate cancer here.
Prostate Cancer Survival rate:
The survival rate usually refers to the five year survival rate that shows how many patients out of 100 live beyond five years after first being diagnosed by a specific cancer. It is an indicator to understand the outlook of the patient based on the type and stage of cancer.
Localised prostate cancer has 98% to 100% 5-year survival rate, while metastasized prostate cancer has a 5-year survival rate of 30%. The survival rates also show that this form of cancer is easily curable and rarely terminal.
Prevention of prostate cancer:
There are certain preventive measures that can be taken in order to avoid the development prostate cancer:
- Consume lots of fruits and vegetables rich in nutrients, especially those which are rich in antioxidants, especially lycopene.
- Include soybeans and tea in your diet. These food are rich in isoflavone which reduces the risk of developing prostate cancer
- Drinking lots of coffee contributes in preventing prostate cancer
- Avoid animal-based and plant-based fats
- Replace butter with olive oil
- Avoid prepackaged foods
- Consume lots of nuts and seeds
- Quit smoking
- Intake of fish or fish supplements and Omega-3 fatty acids also helps in reducing the risk of prostate cancer
- Have a check on the folate levels in the blood. Lowered folate levels increase the risk of developing prostate cancer.
- Avoid man-made supplements of folate
- Reduce the consumption of dairy products
- Regular exercising
- Regular health check ups
- Maintain healthy weight
Follow up plan:
The patients have to monitor his/her health regularly, even after active treatment for prostate cancer. They have to be monitored for any signs or symptoms of recurrent cancer, manage with the side effects of the treatments alone with the general health of the patient. The following is the follow up care for prostate cancer:
- Developing a follow-up care plan
- Regular monitoring of blood cell count
- Regular monitoring of hormonal levels
- Healthy diet as advised by a nutritionist
- Watching for recurrence of cancer
- Keeping personal health records
- Managing side effects
Care to be taken:
The follow up plan also includes a proper after care for the patient to follow:
- Regular check-ups with the doctor
- Have meals healthy in vitamin D
- Stay hydrated
- Not work too hard
- Keep skin moisturized
- Take nourishment supplements
- Take anti sickness medication to prevent reduce weakness
- Consult a doctor on any reactions
- Avoid spicy food
- Quit smoking
- Avoid alcohol
- Self hygiene is very important
