The prostate is a small walnut-shaped gland below the bladder and in front of the rectum. It is part of a man's reproductive system. Prostate cancer arises from the prostate gland. It is widespread, affecting one out of every nine men.
The prostate gland is an integral part of the male reproductive system. This gland makes fluid that mixes with semen during ejaculation. This fluid helps protect sperm and provides a medium for sperm to travel. The urine tube carries urine and semen through the penis and out of the body.
About one in nine men will get a prostate cancer diagnosis during their lifetime.
Men over the age of fifty are prone to the disease. The chances of developing prostate cancer increase as we age. Sixty per cent of prostate tumours occur in men over the age of sixty-five. Other additional risk factors include ethnicity (black men have the highest risk), family history of prostate cancer, obesity and smoking.
Almost all prostate cancers are adenocarcinomas (malignant tumours). These cancers start in the cells of glands that make fluid. Rarely, some other types of cancer develop in the prostate. These include:
• Small cell carcinomas.
• Transitional cell carcinomas.
• Neuroendocrine tumours.
Symptoms and causes
Early-stage prostate cancer rarely causes symptoms. However, these problems may arise as the disease size increases and involve adjacent structures.
• Frequent need to urinate, sometimes urgency.
• Decreased urine flow.
• Painful urination.
• Bowel incontinence.
• Painful ejaculation.
• Erectile dysfunction (ED).
• Blood in semen or urine.
• Lower back pain.
• Leg or foot numbness.
• Digital rectal examination (DRE): Your doctor inserts a gloved, lubricated finger into the rectum and feels the prostate gland; hard, uneven areas indicate cancer.
• Prostate-specific antigen (PSA) test: The prostate gland makes a protein called a protein-specific antigen (PSA). Elevated PSA levels may indicate cancer.
• Biopsy: A TRUS guided biopsy to sample prostate tissue for cancer cells is the only way to diagnose prostate cancer.
Complications associated with prostate cancer
Some aggressive cancers spread fast outside of the prostate. Prostate cancer mostly spreads to the lymph nodes and bones. It can also develop in the liver, brain, lungs and other organs.
How is prostate cancer managed or treated?
Some people never need treatment because cancer grows slowly and does not spread. However, with treatment, most prostate cancers are highly curable. Treatment options include:
• Active surveillance: Active surveillance is done when the disease is slow-growing and not causing any symptoms.
• Watchful waiting: It is done for older and frailer patients. It is similar to active surveillance, and this does not involve active treatment at diagnosis.
• Brachytherapy: This is used for small volume disease in which needles are placed directly in the prostate and loaded with a radioactive source.
• External beam radiation therapy: A machine delivers intense X-ray beams directly to the tumour. Intensity-modulated radiation therapy is external radiation therapy that delivers potent doses of radiation to the disease site.
• Systemic therapies: The doctor may use systemic therapy when the disease has spread outside of the prostate cancer, and the disease is symptomatic. These therapies include chemotherapy and sometimes hormone therapy if the seen disease is localized. You may be able to try this treatment if cancer has not spread.
• Focal therapy options include (HIFU), cryotherapy, photodynamic therapy and laser ablation.
• Prostatectomy: This surgical procedure removes prostate cancer. Surgeons can perform laparoscopic surgery and radical robotic surgery through the abdominal route. These methods are less invasive than an open radical prostatectomy.
Side effects of Prostate cancer treatment
Some prostate cancer treatments may involve adjacent structures, can affect the bladder, erectile nerves and sphincter muscle, which controls urine flow. Potential problems that arise after treatment include:
• Some men experience urinary incontinence. People may leak urine when they cough, laugh or exercise, or may feel an urgent need to use the washroom even when their bladder is not full. This problem improves over the first six to 12 months without any treatment.
• Erectile dysfunction (ED): Surgery, radiation and hormones can damage the erectile nerves and affect the ability to get or maintain an erection. It may take a year or two to get out of this issue. In the meantime, medications like sildenafil (Viagra) can help by increasing the flow of blood to the penis.
• Infertility: Prostate cancer treatments can affect your ability to produce or ejaculate sperm, resulting in loss of fertility.
How to prevent prostate cancer?
Most men may develop prostate cancer as they get older for no reason. Prevention is not possible. However, if you have certain prostate cancer risk factors, taking these steps may help minimize your risk and catch the disease early:
• Get regular prostate screenings.
• Maintain a healthy weight.
• Exercise regularly.
• Eat a nutritious diet.
• Quit smoking.
About the Author
Dr Vikas Roshan