Prostate cancer is a cancer that occurs in a man’s prostate-a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm. It is one of the most common types of cancer for men. It usually grows slowly and initially remains confined to the prostate gland where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment and other types are aggressive and can spread quickly.
Prostate cancer that is detected early when it is still confined to the prostate gland that has a better chance of successful treatment.
Prostate cancer may not cause signs or symptoms in its early stages. This type of cancer is more advanced may cause signs and symptoms such as:
- Trouble urinating
- Decreased force in the stream of urine
- Blood in the urine
- Blood in the semen
- Swelling in the legs
- Discomfort in the pelvic area
- Bone pain
It is not clear what causes prostate cancer. It begins when some cells in the prostate become abnormal. Mutations in the abnormal cells’ DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can break off and spread (metastasize) to other parts of the body.
Factors that can increase the risk of prostate cancer include:
Older age: The risk of prostate cancer increases with age. Prostate cancer is most common in men older than 65.
Family history of prostate cancer: If men in any family have had prostate cancer, the risk may be increased.
Obesity: Obese men diagnosed with prostate cancer may be more likely to have advanced disease that is more difficult to treat.
Complications of prostate cancer and its treatments include:
Cancer that spreads: Prostate cancer can spread to nearby organs or travel through the bloodstream or lymphatic system to the bones or other organs. Advanced prostate cancer can cause fatigue, weakness and weight loss. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it can no longer be cured.
Incontinence: Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type one has, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery.
Erectile dysfunction: Erectile dysfunction can be a result of prostate cancer or it’s treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction.
Screening for prostate cancer
Prostate screening tests might include:
Digital rectal exam (DRE): During a DRE, doctor inserts a gloved, lubricated finger into the rectum to examine the prostate, which is adjacent to the rectum. If doctor finds any abnormalities in the texture, shape or size of the gland, the patient may need more tests.
Prostate Specific Antigen (PSA) test: A blood sample is drawn from a vein in the arm and analyses it for
PSA and a substance are naturally produced by the prostate gland. It is normal for a small amount of
PSA and would be in the blood stream. However, if a higher than normal level is found, it may be an indication
of prostate infection, inflammation, enlargement or cancer.
PSA testing combined with DRE helps identify prostate cancers at their earliest stages, but studies haven’t proved that these tests save lives. For that reason, there is much debate surrounding prostate cancer screening.
Diagnosing prostate cancer
If an abnormality is detected on a DRE or PSA test, doctor may recommend tests to determine whether the patient has prostate cancer, such as:
Ultrasound: If other tests raise concerns, doctor may use transrectal ultrasound to further evaluate the prostate. A small probe, about the size and shape of a cigar, is inserted into the rectum. The probe uses sound waves to make a picture of the prostate gland.
Collecting a sample of prostate tissue: If initial test results suggest that it is prostate cancer then the doctor may recommend a procedure to collect a sample of suspicious cells from the prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that is inserted into the prostate to collect tissue. The tissue sample is analyzed in a laboratory to determine whether cancer cells are present.
Determining whether prostate cancer is aggressive when a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and the cancer cells are compared with normal cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly. More aggressive cancer cells have a higher grade.
Determining how far the cancer has spread
Once a cancer diagnosis has been made, doctor works to determine the extent (stage) of the cancer. Many men won’t require these additional tests. But if doctor suspects the cancer may have spread beyond the prostate, imaging tests such as these may be recommended:
– Bone scan
– Computerized tomography (CT scan)
– Magnetic Resonance Imaging (MRI)
Once testing is complete, doctor assigns the cancer a stage. This helps determine the treatment options. The prostate cancer stages are:
– Stage 1. This stage signifies very early cancer that is confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren’t considered aggressive.
– Stage 2. Cancer at this stage may still be small, but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage 2 may be larger and may have grown to involve both sides of the prostate gland.
– Stage 3. The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
– Stage 4. The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.
Treatments and drugs
Prostate cancer treatment options depend on several factors, such as how fast the cancer is growing, how much it has spread, the overall health, as well as the benefits and the potential side effects of the treatment.
Immediate treatment may not be necessary for men diagnosed with a very early stage of prostate cancer; treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend watchful waiting, which is sometimes called active surveillance. In watchful waiting, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of the cancer.
If tests show the cancer is progressing, one may opt for a prostate cancer treatment such as surgery or radiation. Watchful waiting may be an option for cancer that isn’t causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Watchful waiting may also be considered for a man who has another serious health condition or an advanced age that makes cancer treatment more difficult. Watchful waiting carries a risk that the cancer may grow and spread between checkups, making it less likely to be cured.
Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:
– Radiation that comes from outside of the body (external beam radiation). During external beam radiation therapy, the patient lies on a table while a machine moves around the body, directing high-powered energy beams to the prostate cancer. The patient typically undergoes external beam radiation treatments five days a week for several weeks. Most external beam radiation uses x-rays to deliver the radiation.
– Radiation placed inside the body (brachytherapy). Brachytherapy involves placing many rice-sized radioactive seeds in the prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. Doctor implants the radioactive seeds in the prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don’t need to be removed.
Side effects of radiation therapy can include painful urination, frequent urination and urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur. There is a small risk of radiation causing another form of cancer, such as bladder cancer or rectal cancer, in the prostate.
Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting of the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:
– Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone.
– Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching the cancer cells. These drugs typically are given along with an LH-RH agonist or given before taking an LH-RH agonist.
– Surgery. Surgery to remove the testicles (Orchiectomy). Removing the testicles reduces testosterone levels in the body. The effectiveness of Orchiectomy in lowering testosterone levels is similar to that of hormone therapy medications, but Orchiectomy may lower testosterone levels more quickly.
Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy. This can make it more likely that radiation therapy will be successful. Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind.
Side effects of hormone therapy may include erectile dysfunction, hot flushes, loss of bone mass, reduced sex drive and weight gain. Hormone therapy also increases the risk of heart disease and heart attack.
Surgery to remove prostate
Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction.
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in the arm, in pill form or both. Chemotherapy may also be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy.
Coping and support
When a patient receives a diagnosis of prostate cancer, the patient may experience a range of feelings – including disbelief, fear, anger, anxiety and depression. With time, each man finds his own way of coping with a prostate cancer diagnosis.
The patient can learn as much as about the cancer and its treatment. Having a better idea of what to expect from treatment and life after treatment can make the patient feel more in control of the cancer. The patient can ask the doctor, nurse or other health care professional to recommend some reliable sources of information to get started.
The friends and family of the patient can provide support during and after the treatment. Friends and family can help with the small tasks the patient won’t have energy for during treatment. And having a close friend or family member to talk to can be helpful when the patient is feeling stressed or overwhelmed.
Friends and family can’t always understand what it’s like to face cancer. Other cancer survivors provide a unique network of support. The doctor or other member of the health care team can suggest about support groups or organizations in the community that can connect the patient with other cancer survivors.
Take care of the patient during cancer treatment by eating a diet full of fruits and vegetables. Patient should try to exercise most days of the week. Get enough sleep each night so that patient wakes feeling rested.
If the patient experience erectile dysfunction, the patient’s natural reaction may be to avoid all sexual contact. But the patient can consider touching, holding, hugging and caressing as ways to continue sharing sexuality with the patient’s partner.
Patient can reduce the risk of prostate cancer if he:
– Choose a healthy diet full of fruits and vegetables. Avoid high fat foods and instead focus on choosing a variety of fruits, vegetables and whole grains. Fruits and vegetables contain many vitamins and nutrients that can contribute to the health of the patient. One nutrient that is consistently linked to prostate cancer prevention is lycopene, which can be found in raw or cooked tomatoes. Whether patient can prevent prostate cancer through diet has yet to be conclusively proved. But eating a healthy diet with a variety of fruits and vegetables can improve the overall health.
– Choose healthy foods over supplements. No studies have shown that supplements play a role in reducing the risk of prostate cancer. While there has been some interest in vitamins and minerals, such as vitamin E and Selenium to lower prostate cancer risk, studies haven’t found a benefit to taking supplements to create high levels of these nutrients in the body. Instead, choose foods that are rich in vitamins and minerals so that patient can maintain healthy levels of vitamins in the body.
– Exercise most days of the week. Exercise improves the overall health of the patient, helps to maintain the weight and improves the mood. There is some evidence that the men who get the most exercise have a lower incidence of prostate cancer when compared with men who let little or no exercise. Try to exercise most days of the week. If the patient is new to exercise, start slow and work the way up to more exercise time each day.
– Maintain a healthy weight. If the current weight of the patient is healthy, work to maintain it by exercising most days of the week. If the patient needs to lose weight, add more exercise and reduce the number the calories the patient eats each day. Ask the doctor for help creating a plan for healthy weight loss.
– Talk to the doctor about increased risk of prostate cancer. Men with a high risk of prostate cancer may consider medications or other treatments to reduce their risk. Some studies suggest that taking 5- alpha reeducates inhibitors, including finasteride, may reduce the overall risk of developing prostate cancer in men age 55 and older. This drug is used to control prostate gland enlargement and hair loss in men. However, some evidence indicates that men taking these medications may have an increased risk of getting a more serious form of prostate cancer (high- grade prostate cancer). If you are concerned about the risk of developing prostate cancer, talk with the doctor.
Dr. A.K.M. Aminul Hoque
Associate Prof. (Medicine)
Dhaka Medical College & Hospital,