Prostate Cancer

1 What is Prostate Cancer?

Prostate cancer, one of the common cancers in men, develops in prostate, a small gland in male reproductive system that produces the seminal fluid. The seminal fluid nourishes and transports sperm.

Prostate cancer can grow either slowly or rapidly. Slow growing prostate cancer is usually limited to prostate gland and may not cause serious harm. Whereas, rapidly growing prostate cancer can spread to other parts of the body and cause harm.

The treatment of prostate cancer is likely to be successful if detected early when it's limited to prostate only.

2 Symptoms

Usually no signs and symptoms of prostate cancer are experienced at early stage. Signs and symptoms of advanced prostate cancer include:

  • Difficulty in urination,
  • Weak flow of urine,
  • Blood in semen,
  • Pain in the pelvic area,
  • Bone pain,
  • Problem with erection.
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When to see a doctor? 

If you experience any troublesome signs and symptoms, visit your doctor. Prostate cancer screening is a debatable test. Discuss with your doctor about the benefits and risks of the screening test.

3 Causes

The exact cause of prostate cancer is unknown.

It is believed to develop when changes occur in DNA of prostate cells (DNA mutations). The mutated DNA causes “out-of-control” cell growth and multiplication.

These abnormal cells live longer than normal cells and may spread to neighboring tissue or to other parts of body.

4 Making a Diagnosis

Making a diagnosis of prostate cancer is done by performing several tests.

If prostate cancer is suspected, you may be referred to an urologist (specialist of urinary tract and male reproductive system), an oncologist (specialist who treats cancer) or a radiation oncologist (an oncologist whose area of expertise is radiation therapy).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. Here is what you can do:

List out all the symptoms.

Write down your key medical information. 

Ask a friend or a family member to accompany you during the visit

Write down the names of all your medications, vitamins or supplements. 

Make a list of the questions to ask your doctor. Some typical questions can be: 

  • Do my symptoms indicate prostate cancer? 
  • What’s the size of my prostate cancer? 
  • Has my prostate cancer spread to other parts? 
  • What is my Gleason score? 
  • What is my prostate-specific antigen (PSA) level? 
  • Do I need more tests? 
  • What are my treatment options and side effects of each option? 
  • Do I need to start cancer treatment now or shall I wait to see if the cancer grows? 
  • How do you predict my prognosis? 

What your doctor wants to know?

Be well prepared to answer the questions your doctor is likely to ask:

  • When did you start noticing symptoms? 
  • Have your symptoms been continuous or occasional? 
  • How severe are your symptoms? 
  • Does anything improve or aggravate your symptoms? 

Screening for prostate cancer 

Prostate cancer screening for men in their 50s or those who carry risk factors is a topic of debate among medical organizations. Tests for screening of prostate cancer include:

  • Digital rectal exam (DRE): In this test, your doctor puts a gloved, lubricated finger into your rectum to look for any abnormalities in your prostate. 
  • Prostate-specific antigen (PSA) test: Blood level of PSA is raised in people with prostate cancer or infection or inflammation. 

Combination of DRE and PSA test can detect prostate cancers at early stage. 

Diagnosing prostate cancer 

If DRE or PSA test shows unusual results, your doctor proceeds with:

Ultrasound: It uses sound waves to produce images of your prostate. Transrectal ultrasound involves inserting a special probe into your rectum. Prostate biopsy: A sample of tissues from your prostate is removed from the affected area and sent to lab for further analysis.

Staging Prostate Cancer 

Once the diagnosis is confirmed, the next step is staging the disease. Most commonly, Gleason score is used to determine your disease stage. It ranges from 2 (nonaggressive cancer) to 10 (aggressive cancer). Cancer with higher Gleason score tends to spread more quickly. In some cases, your doctor may recommend imaging tests like bone scan, ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan to detect if the cancer has spread to other body parts. Stage of your cancer is a major factor that determines your treatment and its outcome. 

Stage I: Cancer is limited to small area of prostate and the cancer cells are nonaggressive

Stage II: Cancer is aggressive and may be small or large

Stage III:  The cancer has spread to nearby tissues

Stage IV: The cancer has spread to other body parts, such as bladder, lymph nodes, bones or other organs

5 Treatment

Treatment for prostate cancer depends on the speed of cancer progression, cancer stage, and overall health.

An active surveillance may be enough for early stage prostate cancer. It involves frequent blood tests, rectal exams and possible biopsy for monitoring the development of cancer. Treatment is necessary if cancer is progressing.

Active surveillance is an option for the cancers that produce no signs, have slow growth and are confined to prostate only. One of the major disadvantages of active surveillance is, “missed” disease progression as symptoms may not be noticed between the checkups. 

  • Radiation therapy: It uses ionizing radiation to destroy cancer cell. Radiation may be given from a source your body (external beam radiation) or the source may be placed in your prostate (brachytherapy). It may cause painful urination, urinary urgency, loose stool, erectile dysfunction.
  • Hormone therapy: Hormone therapy works by blocking the production of testosterone in your body. As prostate cancer cells depend on testosterone for their growth, blocking its production kills the cancer cells. It includes:
    • Medications that block testosterone production: Medications such as luteinizing hormone-releasing hormone (LH-RH) agonists inhibit testosterone production by preventing the stimulation of testicle to synthesize testosterone. Examples include leuprolide, goserelin, triptorelin and abiraterone. 
    • Medications that deprive cancer cells of testosterone: Anti-androgens like bicalutamide, flutamide, and nilutamide block the effect of testosterone on cancer cells. 
    • Orchiectomy: It is a surgery to remove the testicles which results in decreased testosterone production. 

Hormone therapy may cause side effects like erectile dysfunction, hot flashes, brittle bones, reduced sex drive or weight gain. 

  • Surgery to remove the prostate: Radical prostatectomy involves surgical removal of cancer cells along with neighboring tissue and lymph nodes. Radical prostatectomy can be conducted by: 
    • Robot assisted surgery: The surgery is conducted by your surgeon using a robot that’s inserted into your abdomen through incisions on your body. 
    • Retropubic surgery: The prostate gland is removed through a small cut in your lower abdomen.
    • Perineal surgery: The prostate is removed through incision between your anus and scrotum. 
    • Laparoscopic prostatectomy: The prostate is removed through small incisions in the abdomen with the help of laparoscope (a tiny camera). Problems with erection or urinary control are common after a radical prostatectomy. 
  • Cryosurgery or cryoablation: It uses liquid nitrogen to freeze cancer cells. The cancer cells are exposed to liquid nitrogen via a needle followed by heating. Cryosurgery is beneficial for men who don’t respond to radiation therapy.
  • Chemotherapy: It uses oral or injectable drugs to kill cancer cells. It is used for a cancer that has spread to other body parts or is resistant to hormone therapy.
  • Biological therapy: It involves injecting genetically modified immune cells into your body. Sipuleucel-T is a FDA approved therapy for advanced, recurrent prostate cancer. 

6 Prevention

You can prevent prostate cancer with following tips:

  • Eat healthy: Avoid high dietary fat. Choose foods rich in vitamins and minerals.
  • Exercise: Exercise regularly to reduce level of PSA.
  • Maintain a healthy weight: Maintain a healthy weight through physical activities and healthy diet.

Some studies suggest 5-alpha reductase inhibitors, such as finasteride may reduce the risk of prostate cancer while some suggest the opposite.

7 Alternative and Homeopathic Remedies

Alternative remedies don’t cure prostate cancer. They may be used to relieve stress and side effects of cancer treatment.

You may try alternative therapies like:

  • art therapy,
  • dance or movement therapy,
  • exercise,
  • meditation,
  • music therapy,
  • relaxation techniques.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with prostate cancer.

Living with a cancer is a challenge that accompanies physical and mental trauma. Following tips may help you cope up with your emotions:

  • Learn enough and stay updated about your condition. 
  • Stay close to your friends and family: Find someone to talk to and listen to. Your friends and family can provide you the required emotional support. 
  • Join support groups: Find a support group in your community or look for an online group to share what you feel
  • Stay healthy: Take a healthy diet full of fruits and vegetable. Exercise regularly and sleep well

9 Risks and Complications

There are several risks and complications associated with prostate cancer.

Risks

  • Age: You risk increases with increasing age 
  • Being black: You are likely to develop prostate cancer, that too aggressive or advanced, if you are black
  • Family history of prostate or breast cancer: You are at increased risk of developing prostate cancer if men in your family have had prostate cancer. Presence of gene (BRCA1 or BRCA2) that increases the risk of breast cancer, also increases such chances 
  • Obesity: If you are obese and diagnosed with prostate cancer, the cancer is more likely to be advanced which is difficult to treat

Complications 

  • Cancer that spreads: Prostate cancer can attack nearby tissues or spread to other body parts. Invasion of bone by prostate cancer can cause broken bone and pain. 
  • Incontinence: Cancer or its treatment can cause urinary incontinence, which can be treated by medication, catheters or surgery
  • Erectile dysfunction: Various factors like prostate cancer, surgery, radiation or hormone treatments can cause erectile dysfunction. Medications, vacuum devices and surgery can treat this complication
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