Prostate Cancer: Causes, Symptoms, Treatment

Medically reviewed: 19, February 2024

Drug for treatment: Abiraterone

Symptoms: Bloated Stomach

Prostate cancer: What is it?

Prostate cancer is a type of malignancy that develops in the prostate gland, which is part of the male reproductive system. Its primary function is producing seminal fluid that nourishes and transports sperm. This form of cancer usually grows slowly and remains confined to the prostate gland, where it may not cause serious harm.

However, while some types are slow-growing, others can be aggressive and spread quickly to other parts of the body. Early detection and treatment significantly improve outcomes for most men.

Here is an overview of prostate cancer:

Prostate cancer is a type of malignant tumor that originates in the prostate gland, a small walnut-shaped organ located just beneath the bladder in men.

The primary role of the prostate gland is to produce seminal fluid, which nourishes and protects sperms during ejaculation. In most instances, prostate cancer advances gradually and stays within the gland without causing significant damage; however, certain strains grow and propagate swiftly, potentially spreading to adjacent organs or distant sites throughout the body.

Consequently, early identification and intervention remain crucial for successful management and favorable health outcomes. Below, we provide detailed insights on different facets of prostate cancer.

Statistics & Prevalence

1. According to the American Cancer Society, prostate cancer is the second leading cause of cancer deaths among men in the United States.
2. Prostate cancer is a prevalent health concern affecting a significant portion of the male population, with an estimated one out of every eight men being at risk of receiving a diagnosis at some point in their lives.
3. It is estimated that there will be around 193,000 new cases of prostate cancer and nearly 33,000 deaths due to the disease in the U.S. in 2020.
4. Prostate cancer is more common in older men; about six in ten cases are found in males aged 65 or older.
5. African American men have a higher risk of developing and dying from prostate cancer than any other racial or ethnic group.

Demographic Distribution

Age constitutes the greatest risk factor associated with prostate cancer development. Generally, older adults encounter higher odds of being affected compared to younger counterparts.

While rare before the age of 40 years, incidences tend to escalate dramatically post-50, peaking between 65-69 years.

Similarly, inheriting particular gene mutations, notably BRCA1/BRCA2, HOXB13, and DNA mismatch repair genes, has been implicated in increasing hereditary predisposition towards prostate cancer. Diets rich in processed foods, red meat, dairy products, saturated fats, and low calcium intake also seem to augment chances of contracting the condition.

Prostate cancer symptoms

Prostate cancer, especially in its early stages, often does not present clear or apparent symptoms. Many men with prostate cancer may never experience noticeable signs of the disease, which highlights the importance of regular screenings and check-ups.

Nevertheless, some individuals might report experiencing various symptoms depending on the growth and location of the tumor within the prostate gland or if the cancer has spread beyond the prostate. Let us discuss common symptoms linked to prostate cancer and understand how to identify them.

Localized Prostate Cancer Symptoms

When prostate cancer is confined to the prostate gland, it may induce urinary problems due to the proximity of the prostate to the urethra. Some typical urinary symptoms consist of:

• Urinating more frequently, especially at night
• Difficulty initiating or maintaining a steady urine stream (hesitancy or weakened flow)
• Interrupted urine flow accompanied by sudden stops and starts
• Straining or pushing to empty the bladder completely
• Sense of incomplete bladder evacuation even following voiding
• Burning sensation or discomfort during urination (dysuria)
• The occurrence of blood in the urine, medically referred to as hematuria, or the presence of blood in the semen, known as hematospermia, can be indicative of an underlying health condition or injury.

These symptoms may overlap with those of benign prostatic hyperplasia (BPH)—a noncancerous enlargement of the prostate unrelated to malignancy. Thus, distinguishing between BPH and prostate cancer requires professional consultation and accurate diagnostic workup.

Metastatic Prostate Cancer Symptoms

Once prostate cancer migrates outside the confines of the prostate gland, referred to as metastatic or advanced prostate cancer, it tends to affect additional bodily functions and regions, giving rise to diverse sets of symptoms.

These widespread consequences result from secondary tumor growths established either in nearby tissues or distant organs, mainly bones, lungs, liver, and brain. Typical manifestations encountered in metastatic scenarios embrace:

1. Persistent bone pain affecting vertebrae, ribs, pelvis, or thighs
2. Swelling in legs or feet caused by edema (fluid accumulation) due to lymph node enlargements or impaired venous drainage
3. Unexplainable weight loss coupled with poor appetite and malnutrition
4. Fatigue or exhaustion attributable to anemia (low red blood cell count) or deconditioning from extended inactivity
5. Renal insufficiency evidenced by dark urine, decreased output, and electrolyte disturbances
6. Neurological deficits rooted in nerve compressions brought about by solid tumor masses near vital neural structures (e.g., spine, skull base)

Such complex symptoms demand specialized attention from trained healthcare providers experienced in treating advanced stages of prostate cancer. Integrative and supportive care aims to preserve functionality, enhance quality of life, and prolong survival.

When do you need to seek medical attention?

Patients must seek immediate medical advice under specific circumstances indicating severe or acute deterioration requiring urgent evaluation and probable intervention. Red flags warranting prompt action include:

1. Sudden onset of difficulty walking, balancing, or coordinating movements
2. Unmanageable bowel or bladder incontinence pointing to potential cord compression
3. Acute kidney injury induced by obstructive uropathy arising from large tumor masses impeding urinary outflow
4. Rapidly progressive lower extremity swelling suspicious for deep vein thrombosis (DVT) or lymphatic blockages
5. Overwhelming infection indicated by persistent fevers, chills, or septic shock triggering rapid heartbeat, hypotension, and confusion
6. Life-threatening hemorrhage characterized by massive blood loss, lightheadedness, syncope, or hypovolemic shock

Prostate Cancer Stages

Understanding the stages of prostate cancer is essential because it determines the appropriate course of treatment and predicts the likelihood of recovery. Doctors rely on several tools to assign a stage to the cancer, mostly focusing on the tumor’s size, whether it has invaded neighboring tissue, and whether it has metastasized elsewhere in the body.

Four primary methods define the stages of prostate cancer:

1. TNM system,
2. Gleason score,
3. PSA level,
4. risk stratification.

We shall delve deeper into each method and describe how doctors combine findings to determine the stage accurately.

The TNM System

The TNM system focuses on three key metrics:

• T for tumor size and extension,
• N for lymph node invasion,
• M for metastasis.

Each metric receives a value describing its state, which combines to give an overall picture of the cancer’s spread.

Table 1 summarizes the values assigned to each parameter and describes what they represent.

Table 1: Summary of TNM parameters in prostate cancer

Parameter	Value	Description
T	T1	Clinically undetectable
	T2	Confined to the prostate
	T3	Beyond the prostate into surrounding tissues
	T4	Invades other nearby organs
N	N0	No regional lymph node metastasis detected
	N1	Metastasis to single or multiple regional LNs
M	M0	No evidence of remote metastasis
	M1	Distant metastasis confirmed
	M1a	Spread to lymph nodes outside the pelvis
	M1b	Growth in bones
	M1c	Other organ involvements (lung, liver, or brain)

Gleason Score

The Gleason score evaluates the appearance of cancer cells under a microscope to estimate how likely they are to spread rapidly. Histologists derive a number between 2 and 10 based on how much the cancerous cells deviate from normal ones and multiplying it by a percentage relating to their abundance in distinct locations of sampled tissue. Higher scores signify more aggressive tumors.

PSA Level

Doctors measure Prostate-Specific Antigen (PSA) concentration in the bloodstream to gauge prostate activity and monitor abnormality trends. Although not infallible, higher PSA levels may correlate with advanced or aggressive cancer. Nonetheless, factors like prostate size, inflammation, or medications can influence PSA readings too.

Risk Stratification

Combining information gathered from TNM classifications, Gleason scores, and PSA levels enables physicians to allocate patients to different risk categories for guiding treatment decisions. Three major risk group definitions cover Low, Intermediate, and High-risk categories, ensuring suitable therapy selections aligned with patients’ needs.

• Low risk:

Stage T1-T2a
Gleason score ≤ 6
PSA ≤ 10 ng/ml

• Intermediate risk:

Stage T2b-T2c OR
Gleason score = 7 OR
PSA > 10 but < 20 ng/ml

• High risk:

Stage T3 OR
Gleason score ≥ 8 OR
PSA ≥ 20 ng/ml

What are the common symptoms of prostate cancer at each stage?

Prostate cancer Stage I (T1)

Localized cancer inside the prostate gland without reaching the capsule. At this stage, the majority of patients don’t experience any symptoms, thus, it is frequently discovered during incidental exams.

Prostate cancer Stage II (T2)

The cancer is still contained within the prostate gland but extends to one or both lobes. Patients may begin observing subtle urinary tract symptoms like weak urine flow, inconsistency in the flow rate, or feeling the urge to urinate more frequently, particularly during the night. There might be discomfort while sitting, especially for long periods, as well as mild pain during ejaculation.

Prostate cancer Stage III (T3)

At this point, the tumor breaks free from the prostate gland capsule and begins infecting nearby tissues and seminal vesicles. Noticeable symptoms start appearing, with greater distress felt during urination and sexual activities. Signs to look out for include:

• Persistent pain in the lower back, hips, or thighs
• Obvious difficulties with urinary continence
• Appearance of blood traces in the urine (hematuria) or semen (hematospermia)

Prostate cancer Stage IV (T4)

Advanced metastasis is evident with prostate cancer having reached distant organs like the bones, lymph nodes, liver, or lungs. During this late phase, the symptoms intensify considerably, impacting daily functioning negatively.

Potential warning signals are:

• Markedly waning energy levels and stamina
• Intolerable bone pain localized to the spine, ribs, or hip bones
• Loss of muscle mass (cachexia) and unexpected weight reduction
• Anemia, breathlessness, or chest tightness due to lung involvement
• Visible jaundice triggered by liver metastasis
• Memory troubles and cognitive decline tied to cerebral or skull-based metastasis

Remember that many early-stage prostate cancers won’t bring forth obvious symptoms. Annual check-ups consisting of PSA (prostate-specific antigen) blood tests and DREs (digital rectal examinations) are recommended to catch prostate cancer early. If you find yourself suffering from any unusual symptoms mentioned above, please get in touch with your physician to figure out the exact root cause and arrange proper remedial actions accordingly.

Prostate cancer diagnostics and screening tests

Prostate cancer screening tests are designed to detect signs of prostate cancer in asymptomatic men, enabling early diagnosis, intervention, and improved health outcomes. Several screening methods exist; understanding their benefits, limitations, and implications is crucial for informed shared decision-making between healthcare providers and patients.

Discussed below are widely recognized prostate cancer screening tests, detailing their principles, utility, and caveats.

Prostate-Specific Antigen (PSA) Test

This blood test quantifies PSA concentrations, a substance secreted predominantly by prostate epithelial cells. Levels exceeding established cutoffs raise suspicions of prostate disorders, including cancer. Despite drawbacks, such as overlapping ranges seen in benign and malignant states, the PSA test serves as a cornerstone in prostate cancer screening.

Variants of PSA tests include:

• Total PSA (overall measurement),
• Free PSA (unbound fraction),
• Complexed PSA (bound to protease inhibitors),
• %Free PSA (% of total unbound),
• Prostate Health Index (combining total, free, and [-2]proPSA variants).

These refinements facilitate incremental improvements in specificity, helping discern indolent vs. aggressive cancers.

Digital Rectal Examination (DRE)

Physicians perform manual palpation of the posterior prostate region by inserting a gloved finger into the rectum, noting irregularities in shape, texture, symmetry, and consistency suggesting neoplastic growth. Though lacking sensitivity, DRE complements PSA testing, providing valuable tactile feedback unattainable solely via liquid assays.

Multiparametric Magnetic Resonance Imaging (mpMRI)

Non-invasive mpMRI uses magnetic fields, radio waves, and computer algorithms to generate cross-sectional images revealing internal structural anomalies.

Parameters evaluated encompass diffusion-weighted imaging, dynamic contrast enhancement, and T2-weighted sequences, allowing radiologists to visually inspect suspect loci suspected of harboring malignancy. Recent studies advocate utilizing mpMRI to guide systematic biopsy targeting specific zones rather than random sampling, thereby reducing false negative rates and minimizing unnecessary procedure-associated morbidity.

Biopsy

Targeted or TRUS-guided (transrectal ultrasound)-directed core needle biopsies obtain representative specimens for histopathologic analysis. Positive diagnoses require demonstration of unequivocal carcinoma, followed by architectural grading ascribed by modified Gleason scoring criteria that account for cell morphologies, arrangements, and cytomorphometric attributes. Biopsies offer definitive confirmation but entail risks, such as bleeding, pain, and infection.

Prostate Сancer Treatment

The approach to treating prostate cancer differs from case to case, taking into consideration factors like the extent to which the cancer has spread, the individual’s general well-being, and their individual choices and preferences.

Prostate cancer treatment encompasses a comprehensive range of five primary therapeutic approaches, including:

1. active surveillance,
2. surgical intervention,
3. radiation therapy,
4. hormone manipulation,
5. chemotherapy,
6. immunotherapy.

Active Surveillance

Instead of aggressive frontline treatment, some prostate cancers can be carefully monitored through active surveillance. Primarily suited for low-grade malignancies with minimal threat, active surveillance comprises:

• Periodic PSA (Prostate-Specific Antigen) Tests
• Digital Rectal Examinations (DREs)
• Serial Biopsies

By tracking disease progression diligently, doctors decide when and if further intervention becomes necessary. Advantages include averting unwarranted side effects and maintaining quality of life while containing costs associated with invasive procedures.

Prostate Cancer Surgery

Radical prostatectomy involves complete removal of the prostate gland, seminal vesicles, and surrounding lymph nodes, offering potential eradication provided cancer hasn’t spread beyond resectable limits.

Minimally invasive laparoscopic or robotic-assisted surgeries minimize trauma compared to traditional open operations. Post-surgery risks encompass incontinence and erectile dysfunction.

Radiation Therapy

Applying ionizing radiation damages DNA, halting cancer cell division and replication. Utilizing focused beams delivered externally via machines or internally via implanted seeds (brachytherapy), radiation therapy targets precise volumes aimed at eliminating diseased tissue while minimizing collateral harm to healthy organs. Adverse reactions incorporate skin irritation, rectal bleeding, and genito-urinary toxicities.

Hormone Therapy

Androgen deprivation therapy (ADT) reduces circulating testosterone and analogues responsible for driving proliferation in prostate cancer cells.

Chemical castration via Gonadotropin-Releasing Hormone Agonists (GNRHa), Antiandrogens blocking androgen synthesis or receptor binding, or combinations are common ADT tactics applied alone or conjunctively with other treatments to manage advanced or recurrent cancers. Side effects span hot flashes, breast enlargement, mood alterations, loss of muscle mass, and osteoporosis.

Chemotherapy

Utilizing cytotoxic drugs administered systemically to reach diffuse sites, chemotherapy attacks actively dividing cancer cells. Albeit less frequently prescribed for primary prostate cancer, chemotherapy plays a substantial adjuvant role in treating relapsed disease refractory to hormonal manipulations.

Taxanes (docetaxel, cabazitaxel), platinums (carboplatin), and vinca alkaloids exemplify typical classes engaged against metastatic caseloads, despite collateral damage impacting fast-dividing normal cells such as hair follicles and gastrointestinal linings.

Immunotherapy

Leveraging our immune system’s innate defense capabilities, immunotherapeutic interventions bolster anti-neoplastic responses against malignancies via direct stimulation or indirect activation.

Checkpoint inhibitors like pembrolizumab (Keytruda®) interrupt regulatory molecules hindering T-cell effector function whereas adoptive transfer recruits exogenously engineered chimeric antigen receptors (CAR) expressing T-cells capable of recognizing prostate cancer antigens provoking targeted destruction.

Unfortunately, limited success has materialized given prostate cancer’s ability to circumvent host immuno-surveillance tactics, although promising research continues to unfold.

What do I do if I got diagnosed with Prostate Cancer?

First, stay calm and remember that receiving a prostate cancer diagnosis is not an immediate death sentence. With current medical advancements and varied treatment options, many men live long and fulfilling lives post-diagnosis.

• Seek expert opinions: Schedule appointments with specialists who focus on prostate cancer, such as urologists and radiation oncologists. They will review your case, conduct tests, and suggest the best course of action based on factors such as the cancer stage, your overall health, and personal preferences.
• Learn about available treatment options: Study various treatments like active surveillance, surgery, radiation therapy, hormone therapy, cryotherapy, and chemotherapy. Keep notes and ask questions to gain clarity regarding each approach’s pros and cons.
• Choose a treatment route: Collaborate with your medical team to weigh the benefits and challenges presented by different treatment paths. Then settle on the most suitable strategy together.
• Create a support network: Share your diagnosis with trusted friends and loved ones. Embrace their assistance and establish a reliable support structure that encourages positivity, open dialogue, and psychological relief.
• Prioritize your health: Make conscious efforts to maintain a wholesome lifestyle, including eating nutritious meals, remaining physically active, and quitting smoking or consuming alcohol excessively. Optimal overall health improves the efficacy of cancer treatments.
• Stay updated: Remain educated about the latest developments in prostate cancer research, treatment breakthroughs, and innovative technologies. Consider participating in clinical trials or joining patient advocacy organizations dedicated to advancing treatment options and improving patients’ lives.

Lastly, communicate openly with your medical team about your feelings, fears, hopes, and expectations. Engaging candidly ensures you receive compassionate, personalized care catered specifically to your situation.

Questions and answers about Prostate Cancer

Is prostate cancer curable?

Yes, prostate cancer can be treated and sometimes cured entirely, depending on the cancer’s aggressiveness, stage, and overall health of the patient. Various treatments, such as surgery, radiation therapy, hormone therapy, and chemotherapy, are available to combat prostate cancer effectively.

Can prostate cancer be prevented?

Currently, there is no proven way to prevent prostate cancer conclusively. However, maintaining a healthy lifestyle by eating a balanced diet rich in fruits and vegetables, exercising regularly, and keeping a healthy weight might decrease the probability of getting the disease. Furthermore, regular prostate examinations allow early detection and quicker initiation of treatment.

How often should one get checked for prostate cancer?

Regular prostate cancer screening depends on factors like age, race, and family history. Experts advise beginning annual PSA (Prostate-Specific Antigen) tests and digital rectal examinations at age 50 for most men, or as young as 40-45 if you belong to a high-risk group. Always consult your healthcare provider for a personalized plan.

Can I live 20 years with prostate cancer? What is the life expectancy of a man with prostate cancer?

What happens during a prostate biopsy?

A prostate biopsy involves taking samples from the gland using hollow needles guided by ultrasound imaging. Performed via the rectum, the process extracts small pieces of tissue to analyze under a microscope. Usually done as an outpatient procedure, a biopsy carries risks like bleeding, infection, and temporary discomfort.

Are there side effects from prostate cancer treatments?

Possible side effects include urinary incontinence, sexual dysfunction, bowel problems, fatigue, depression, anxiety, lymphedema, and infertility. Different treatments carry varying risks and burdens, so discussing possible outcomes and selecting the least detrimental option with your healthcare team is advisable.

Key Takeaways about Prostate Cancer

• Risk Factors:

There are several factors that are known to increase the risk of developing prostate cancer:

• Age: Risk increases rapidly after age 50.
• Race: African American men face twice the risk compared to caucasian men.
• Family history: Having a first-degree relative (father, brother, or son) with prostate cancer significantly raises the risk.
• Genetic mutations: Specific inherited genetic changes can increase risk.
• Symptoms:

Early stages of prostate cancer often show no symptoms, making regular screening crucial for early detection. Late stage symptoms might include:

1. Trouble urinating, including a weak stream, frequent need to go, pain or burning during urination, and trouble starting or stopping urine flow
2. Blood in the urine or semen
3. Pain in the hips, back, chest, or other areas due to metastasis

• Screening & Diagnosis:

Two main tests are used to detect prostate cancer:

• The PSA blood test is a medical procedure that involves measuring the levels of a specific protein called prostate-specific antigen. This protein is produced by the prostate gland, which is a part of the male reproductive system.
• High levels could indicate cancer.
• Digital rectal exam (DRE): Physician checks the prostate for bumps, soft or hard spots, or other abnormalities.

If results suggest possible cancer, additional diagnostic procedures typically ensue, such as biopsies, MRIs, CT scans, or bone scans to confirm diagnosis and assess severity. Gleason score evaluation helps categorize aggressiveness based on microscopic examination of tumor patterns.

• Treatment:

Treatment options depend on individual patient characteristics, staging, and grading results and range from active surveillance, surgery, radiation therapy, hormone therapy, targeted therapies, chemotherapy, immunotherapies, or clinical trials. Regular check-ups, monitoring, and potential interventions aim at managing recurrence risks and controlling progression. Ultimately, personalized approaches tailored to individuals contribute to improved quality of life and increased survival rates. Consult healthcare professionals for comprehensive guidance regarding preventative measures, screening protocols, and appropriate therapeutic strategies concerning prostate cancer.