Prostate cancer is a medical condition affecting the prostate gland. This disease causes cells in the prostatic gland to reproduce and develop at an abnormal rate to form a malignant mass. If left untreated, the cells of the malignancy may spread to other organs of the body and may cause other cancers (metastasis), making the treatment less effective, thus reducing the survival chance considerably.
The risk for prostate cancer increases with age. In fact, Age is the main factor for developing certain prostate diseases including BPH and prostate cancer. Symptoms and treatment vary depending on the stage of the tumor. The treatment itself may cause certain side effects, such as impotency and Erectile Dysfunction. However, when the disease is detected in early stages, controlling or completely curing it is well possible.
Prostate Cancer Symptoms can be taken for ordinary UTI symptoms at the beginning. In general, if you have the medical condition you will mostly experience at least one of these symptoms of urinary problems such ashaving a hard time starting or stopping the urine flow, and the need to urinate often, especially at night.
Prostate cancer treatment recommended by your oncologist depends greatly on the localization of the cancer, the stage of development it has reached, and the degree of organ encroachment of the disease. Usually treatment is chosen after these factors are taken into consideration. External factors such as, age, health status and life expectancy (in accordance to the stage of the cancer) are also considered. In addition, certain types of cancer require more aggressive treatment. For instance, a relapsed prostate cancer can be treated with special measures.
Regardless, Radiation Therapy, Chemotherapy, Surgery, and Hormone Therapy are the main therapies for most cancers including prostate cancer. In certain cases, the health care provider can decide to practice Waiting and Watching to monitor the growth of the gland and the reaction of the tumor.
Therefore, if you experience symptoms similar to those of prostate cancer it is wise to consult your doctor as earliest possible. As you know, the earlier you catch the tumor the more chance you have to heal.
Prostate Cancer Statistics
Prostate cancer is the most common cancer in men over 50 years old. It is regarded as the second leading cause of cancer death in men after lung cancer. Each year, about 620,000 new cases of prostate cancer are registered in the world. In North America, prostate cancer is the most common cancer in men. In the United States alone, approximately 186.000 men were diagnosed with prostate cancer in 2008; 28.600 men died of the disease.
According to the National Cancer Institute, it is estimated that 192,280 men were diagnosed with and 27,360 men died of prostate cancer in 2009. Certain age groups, however, seem to be more affected by the disease. From 2002-2006, the median age at diagnosis for cancer of the prostate was 68 years of age. Percentages and ages of people diagnosed with prostate cancer were approximately:
- 0% under age 20;
- 0% between 20 and 34;
- 6% between 35 and 44;
- 7% between 45 and 54;
- 0% between 55 and 64;
- 6% between 65 and 74;
- 4% between 75 and 84;
- 7% 85+ years of age.
Race may also play a role in the development of the disease. According to American Cancer Society, Black men have the highest rate of prostate cancer incidence:
- Black – 239.8 per – 100,000 men
- White – 153.0 per – 100,000 men
- Hispanic – 133.4 per – 100,000 men
- Asian/Pacific Islander – 91.1 per 100,000 men
- American Indian/Alaska Native – 76.1 per 100,000 men.
Prostate Cancer Causes
The cells of your prostate gland reproduce throughout your lifetime. Every day, new cells are born to replace cells that are damaged (necrosis) or too old (“Apoptosis” or “Programmed Cell Death”). Prostate cancer occurs when this process is impaired and a group of cells begin to divide rapidly and uncontrollably without dying.
Cancer is caused by a modification of a gene within a cell – an abnormal change in the DNA of a gene, either spontaneously during cell division, or under the influence of external agents called mutagens. All mutagens do not induce cancer; they are, however, the first necessary step to the development of cancerous cells.
Usually, prostate cancer starts in the cells inside the prostate gland. Prostate cancer is a multifactorial disease, there is no unique cause leading to it, but many factors may increase the risk of its development. Although there many causative factors, it is important to note that the risk of developing prostate cancer increases with age.
Prostate Cancer Risk Factors
Many factors can increase your chance of having prostate cancer. If you find yourself in one of these categories below, it does not mean you will have prostate cancer, but your chances of developing it is higher compared to others:
- Age– prostate cancer mainly affects men over 50 years; the average age at diagnosis is 70 years.
- Race– men of African descent are more at risk of becoming a victim of prostate cancer than Caucasians.
- Family history– if your father has suffered from prostate cancer, your risk is higher; therefore, if you have a history of prostate cancer in your family, adopt a healthy lifestyle and diet to reduce the risk.
- High testosterone levels– it is believed that high testosterone levels may play a role in development of prostate cancer; however, this theory is not proven. The reason that some scientists come up with the theory is because it is shown that men who use testosterone therapy are more likely to develop prostate cancer.
- Diet– a large majority of prostate cancer cases may be related to dietary factors. Many researchers have shown that a diet rich in unhealthy fats may be associated with an increased risk of prostate cancer. Animal fat content in red meat have been stigmatized in many epidemiological studies. In addition, dairy products also seem to slightly increase the risk of prostate cancer.
- Other factors– other suspected but not fully proven factors may include:
- a) obesity
- b) smoking
- c) vasectomy
- d) lack of exercise
- e) benign prostatichyperplasia(BPH)
- f) Sexually Transmitted Diseases.
Prostate Cancer Symptoms
Prostate cancer tends to grow without causing any signs or symptoms. It is discovered during blood tests – including prostate–specific antigen (PSA) test or digital rectal examination – performed for other medical conditions having symptoms related to prostate cancer(benign prostatic hyperplasia for instance). When symptoms finally emerge; it often indicates an advanced prostate cancer.
As the tumor grows within the prostate gland, you may experience the following symptoms:
- frequent need to urinate, especially at night;
- urgent need to urinate (urgency)
- burning or pain during urination
- urinary hesitancy/urinary intermittency(u rinary stream starts and stops)
- sensation of incomplete emptying of the bladder
- difficulty starting or stopping urinating, or inability to urinate
- painful ejaculation
- Presence of blood in urine or semen.
If the cancer has already spread into the lymph nodes in your pelvis or bones, you may also experience:
- bone fractures
- chronic bone pain
- swelling in your legs
- compression of the spinal cord
- Pain or discomfort in your pelvic area.
Prostate Cancer Complications
In addition of the complications of the disease itself, surgery for prostate cancer can also lead to serious problems. The major complications that can be resulted from a radical prostatectomy are impotence, urinary incontinence and urethral stricture (narrowing of the urethra). Radical prostatectomy also increases the risk of other complications such as pneumonia, blood clots, infection and (rarely) death.
Metastasis – cancer cells from the prostate gland can spread locally into the bones, lymph nodes, rectum, and bladder. The tumor can also invade distant sites in the body through the bloodstream to form new cancers. Although rare, an advanced prostate cancer can invade the following organs:
- lumbar vertebrae
- thoracic vertebrae
- Adrenal glands.
Impotence – the nerves responsible for erection of the penis are located very near the prostate gland. Therefore, a radical prostatectomy can damage these nerves and cause erection problems. Besides the surgery, radiation or hormonal treatments can also lead to erectile dysfunction. However, nowadays, there are surgical therapies used to treat prostate cancer that preserve those nerves and prevent impotence. If you would like to continue your sexual life after the surgical therapy, talk to your doctor before the surgery.
Urinary incontinence – both cancer and its treatment can be associated with urinary problems. After surgery, it is likely not to have bladder control immediately. This problem does not occur in all men, and even when it happens, urinary continence usually returns within a few months after the surgery. In case the incontinence continues for a long period of time, an artificial urinary sphincter transplant can be the only therapeutic option.
Bone pain – although at first it can be completely asymptomatic, sometimes the cancer spreads beyond the prostate gland to affect nearby or distant bones, causing bone pain and other symptoms related to bone disease. Bone metastases of prostate cancer may even cause destruction of the affected bone. This destruction, in addition to pain, can be responsible for serious metabolic disorders due to high levels of calcium in the blood.
Other complications – In addition, both prostate cancer and its treatment can lead to:
- pelvic compression
- Malaise or general sick-
Prostate Cancer Diagnosis
Usually, to detect a prostate cancer, very specific tests are performed: digital rectal exam (DRE), prostate-specific antigen (PSA) test, transrectal ultrasound (TRUS) and biopsy.
Digital rectal exam (DRE) – a rectal examination is a painless palpation of the posterior abdomen and the organs in it. During the procedure, your doctor will introduce a glove finger in your anus to search for abnormalities such as inflammation. Gently, your physician will inspect the lining of your rectum, trying to:
- detect abnormal tissue growth on the surface of the rectum;
- specify exactly where the tumor is located
- assess the size, volume and appearance of the tumor
- Determine if the tumor can move or if it is fixed to the wall of the rectum.
Prostate-specific antigen (PSA) test – prostate specific antigen is a protein produced exclusively by the prostate. It plays two major roles: 1) liquefying the semen to facilitate the movement of sperm; 2) helping to dissolve the cervical mucus to facilitate the entry of sperm. The PSA is present in the blood of all men; however, high rates, between 4 and 10 ng/ml are often associated with benign prostatic hyperplasia (BPH) or prostate cancer. Though not fully accurate, the PSA test is an important tool in detecting early prostate cancer.
Transrectal ultrasound – this imaging technique is often used in the prostate cancer diagnosis. It consists of using inaudible sound waves produced by a probe inserted into the rectum to create an image of organs in the pelvis. Ultrasound images are captured in real time; therefore, your doctor is able to visualize movements of organs and tissues of the pelvis. An ultrasound of the prostate is used to detect possible problems in the prostate gland, and indicate whether the prostate gland is enlarged or if it is occupied by a cancerous tumor.
Biopsy – although other diagnostic techniques can be used to reveal a prostate cancer, a biopsy is usually required to accurately confirm the disease. In fact, a prostate biopsy is the only test that can affirm the presence or absence of cancerous cells inside the prostate gland. Usually, a prostate biopsy consists of removing cells or tissues from the prostate gland to examine under a microscope. Indeed, analysis of samples under a microscope can distinguish benign tumor from malignant tumor (cancer).
There are many types of biopsies that can be performed in prostate cancer diagnosis. The type of biopsy practiced depends on the size or the location of the tumor. However, whatever the method used, it must be done carefully so it does not promote the spread of cancer cells into healthy.
Bone scan – this imaging technique allows your doctor to visualize your bone and detect very early abnormalities, sometimes not even visible on routine X-rays. During the procedure, the specialist will inject a small amount of radioactive material (radiotracer) into a vein which will bind to the diseased bone. The radiation emitted is detected by a gamma camera that creates picture of the skeleton. The purpose of this test in prostate cancer diagnosis is to determine if the cancer has spread to any bone in your body.
Ultrasound – this painless imaging technique uses high-frequency sound waves to visualize various organs in your body including the prostate gland. In the diagnosis of prostate cancer, it involves applying an ultrasound sensor (transducer) on your upper abdomen in order to obtain images of the prostate. The transducer emits sound waves through the tissues of the prostate gland, which then return as an echo. The echo is then collected and analyzed by a computer system that transmits a live image on a video screen.
T scan – a scanner is the use x-rays to form images of the internal organs. It can detect abnormalities not visible on standard x-rays or ultrasound. A CT scan allows not only the diagnosis but also highlighting of lymph nodes or liver metastasis.
Magnetic resonance imaging (MRI) – an MRI with contrast injection allows your health care provider to visualize organs of the inside of your body. In the case of prostate cancer, it can analyze the structure of your prostate gland to search for abnormalities: inflammation, abnormal tissue growth, etc. In addition, MRI allows your doctor to determine the exact size and extent of the tumor in your prostate gland.
Lymph node biopsy – a lymph node biopsy is a recent surgical intervention used in the diagnosis of prostate cancer. During the procedure, samples of lymph nodes are collected for laboratory analysis to determine if the cancer has spread to nearby lymph nodes. In general, one or more lymph nodes closed to your prostate are removed. This test is recommended if the MRI or CT scan has revealed enlarged lymph nodes.
Prostate Cancer Stages
Once the cancer is detected in your prostate gland, your doctor will determine if it exceeds the prostatic capsule or not. Usually, the microscopic examination of samples taken during the biopsy associated with other medical procedures allows your physician to determine the stage of the cancer. In general, prostate cancer develops in four stages:
- Stage I– the tumor cannot be detected during rectal exam; it is, most of the times, discovered accidentally during exams for other prostate issues such as benign prostate enlargement (BPH).
- Stage II– a stage 2 prostate cancer is palpable on rectal examination, but remains localized to the prostate gland;
- Stage III– stage 3 prostate cancer has spread outside the prostate gland, seminal vesicles or other nearby tissues;
- Stage IV– at this final stage, the cancer has invaded adjacent organs in the prostate: lymph nodes, bones, lungs or other organs.
Prostate Cancer Treatment
Knowing your age, medical history, and the stage of the cancer, your oncologist along with a group of physicians will determine the most effective treatment to combat the disease. Most of the times, a combination of therapies are used to increase chances of recovery. The main treatments for prostate cancer are surgery, cryosurgery, chemotherapy, radiotherapy, and hormonal therapy. In some cases, you may be recommended a watchful waiting (also known as expectant therapy, observation or deferred therapy).
In case the cancer cells are confined to the prostate gland, your doctor may suggest a program of close monitoring, including analysis of your PSA and periodic clinical examinations; no medication or surgery will be recommended. This technique is safe in an early phase of prostate cancer, as the development of prostate cancer is often slow.
Your oncologist may also recommend you a watchful waiting if you are elderly; because in most cases, the tumor will not have time to grow before other health problems do occur. It is, therefore, better to observe the cancer without performing any surgery, which can lead to major complications. In fact, in elderly patients, the cancer treatment may cause more problems than the cancer itself.
Surgery can be performed in some cases of prostate cancer. In general, your surgeon will perform surgery if the cancerous cells have not spread into other distant sites of your body; in this case, your surgeon will remove the tumor from your body by removing the prostate, totally or partially. If the tumor is very large, your surgeon may decide not to proceed with surgery to avoid very serious damages to your nervous system.
Radical prostatectomy – also called radical retropubic prostatectomy, radical prostatectomy is a surgical procedure involving removal of the entire prostate gland and, sometimes, the seminal vesicles. In general, radical prostatectomy is performed under general spinal or epidural anesthesia. This surgical intervention cannot be performed if the cancer exceeds the limits of the prostate gland. A radical retropubic prostatectomy often requires blood transfusion.
Some patients can have good results from radical retropubic prostatectomy; however, about 10% of patients with a localized prostate cancer will develop local recurrence within 5 years following the surgery. In addition, radical retropubic prostatectomy tends to cause complications such as urinary incontinence and impotence.
Transurethral resection of the prostate (TURP) – this procedure is usually performed in cases of benignprostatic hyperplasia. In the treatment of prostate cancer, it is used as a palliative treatment for urinary problems due to obstruction of the urinary tract caused by the disease. The operation can bring an improvement; however, it should be associated with an appropriate treatment to prevent recurrence of the obstruction.
Laparoscopic Robotic Assisted Prostatectomy – also known as robotic prostatectomy, this is a new form of surgery performed with the assistance of a surgical robot. During the procedure, there is no direct contact with you and your surgeon. The surgeon sits in another place (room), but able to view and control the procedure using a camera with the binocular Insite vision system. According to U-M Health System group, the goal of the roboticprostatectomy is to:
- excise the cancer completely;
- provide good urinary continence post-operatively;
- Maintain ability to have erections after the surgery (if present before the surgery).
Radiation Therapy (Radiotherapy)
Radiation therapy is a local regional treatment practiced to destroy cancer cells using high-powered X-rays. Unlike chemotherapy, it does not damage surrounding healthy tissue. In general, radiotherapy is used to treat cancers that are localized to the prostate gland, or prostate cancers that has spread into the surrounding tissues only. It can be used to reduce the volume of the tumor and/or to prevent local complications. Your oncologist may recommend external beam radiation or internal radiation therapy (brachytherapy).
- External radiation– in this form of radiotherapy, high-energy rays come from outside the body and focus on the prostate and some surrounding tissues. The radiotherapy specialist will use very specific dosage so that the radiation is concentrated on the diseased tissue and sparing neighboring organs. In some cases, the volume to be irradiated may be limited to the prostate or spread to regional lymph nodes. In general, the treatment is painless and somewhat similar to an ordinary x-ray. The therapy involves one session per day5, 5 days a week for 7 to 8 weeks.
Side effect may include: Urinary problems (temporary), rectal urgency, loose stools, rectal bleeding, discomfort during bowel movements, and erectile dysfunction.
- Internal radiotherapy– also called brachytherapy, internal radiotherapy involves implanting dozens of rice-sized radioactive seeds into the prostate in order to destroy the cancer cells. Their installation is performed under general or epidural anesthesia and lasts 1 h 30 to 2 hours. The radioactive seeds can remain in your prostate gland for months; however, their radioactivity decreases with time and virtually useless after six months. Although brachytherapy requires a short hospitalization, most patients go home the day of the procedure.
Brachytherapy is practiced to treat small or moderate-sized tumor. In addition, it is recommended that you stay at least six feet away from children and pregnant women after the treatment. After treatment, you may experience erectile dysfunction and burning while urinating.
Prostate Cancer Chemotherapy
Chemotherapy is the most common form of cancer treatment. Unlike surgery and radiotherapy, it can be used to treat noninvasive prostate cancer and advanced prostate cancer for which surgery can’t be performed. Chemotherapy involves using powerful chemicals to kill cancer cells or prevent them reproducing. Unlike surgery, chemotherapy is a systemic treatment that affects your whole body. That is, the drugs are designed to destroy cancer cells throughout your body. Chemotherapy drugs can be given in many ways:
- injection (the most common)
- intra-arterial (IA)
- intraperitoneal (IP)
- intravenous (IV)
- Orally (taken by mouth).
Chemotherapy Side effects – by attacking cancer cells, the chemotherapy drugs affect healthy cells that divide rapidly, which often causes side effects. Side effects vary from one patient to another and from drug to another. The most common chemotherapy side effects include:
- hair loss
- loss of appetite
- abdominal pain
- Sore mouth
- feeling sick
- Flu-like symptoms: chills, fever, muscle aches, etc.
Hormone therapy consists of using medications capable of depriving cancer cells of male hormones they need to multiply. Hormone treatment is performed if the cancer has spread beyond the prostate gland or has recurred after other treatments. Your oncologist may use hormone therapy to treat cancer localized to the prostate in order to reduce the volume of the prostate gland to make possible a surgical intervention or a radiotherapy. In addition, if you are very old, your doctor may recommend hormone therapy as a palliative treatment to improve your life.
Hormone therapy drugs commonly used to treat prostate cancer include:
- leuprolide (Lupron, Viadur)
- goserelin (Zoladex)
- bicalutamide (Casodex)
- nilutamide (Nilandron)
Hormone therapy medications can cause a variety of side effects:
- liver damage
- hot flashes
- weight gain
- breast enlargement
- Reduction in muscle and bone mass.
Prostate Cancer Survival Rates
Your prostate cancer prognosis depends on your age, size and stage of the tumor at diagnosis. However, compared to other cancers, the prognosis of prostate cancer is not alarming. In most cases, the cancer remains localized in the prostate and has little or no effect on general health or longevity.
Another benefit is that the prostate cancer progresses slowly. In most cases, after diagnosis, the cancer grows slowly and remains confined to the prostate gland for 10 years or more. Thus, many prostate cancer victims die with prostate cancer but not of prostate cancer
The survival rates of prostate cancer vary from one race to another. The overall 5-year relative survival rate for 1999-2005 from 17 SEER (Surveillance Epidemiology and Ends Results) geographic areas was 99.7%. Five-year relative survival rates by race were:
- 9% for white men;
- 5% for black men.
Prostate Cancer Prevention
In addition to diet, your lifestyle as well as your environment (including your workplace) can be open door to the development of cancer in your body. Prevention of prostate cancer is not always possible, but there are steps you can take to prevent it. If you want to prevent formation of cancerous cells in your prostate, you should:
- have regular medical examination including a rectal examination; if your family has a history of prostate cancer, it is recommended to start screening at the age of 45;
- reduce your exposure to ultraviolet (UV) radiation from the sun or artificial tanning devices, such as tanning beds;
- do not smoke, including second hand smoke
- exercise regularly
- maintain a healthy weight
- limit your intake of alcohol
- practice safe sex
- Adopt a healthy diet: a diet containing 5 to 10 servings of fruits and vegetables a day may help prevent prostate. In addition, you can increase your intake of supplements vitamin E, selenium, omega3, etc.