What is Prostate Cancer?
Prostate cancer begins in the prostate, a small gland that looks like a walnut, located beneath the bladder and in front of the rectum in males and individuals assigned male at birth (AMAB). This minute gland produces a fluid that combines with semen, ensuring the vigour of sperm for fertilisation and pregnancy.
Many cases of prostate cancer progress at a slow pace and remain localised within the prostate gland, posing a minimal threat. However, specific aggressive variants of prostate cancer can rapidly metastasise and require immediate treatment.
Types of Prostate Cancer
Over 95% of prostate cancers are categorised as adenocarcinomas, making it the most common type of prostate cancer. If you are diagnosed with prostate cancer, it is most probable that it falls under this category. However, there are a few other rare forms of prostate cancer that exist.
Each type of prostate cancer originates from different cells within the prostate gland. To find the specific cell types affected by cancer, doctors conduct a thorough analysis of your prostate tissue in a laboratory setting.
This information, combined with the stage and grade of the cancer, helps the doctor formulate a suitable treatment plan tailored to your needs.
Adenocarcinoma
There are two main types of adenocarcinoma:
1. Acinar adenocarcinoma: This type is typically found in most individuals. It grows in the gland cells that line the prostate gland.
2. Ductal adenocarcinoma: This variant starts in the cells that line the ducts of the prostate gland. It is commonly more aggressive compared to the other type, exhibiting faster growth and spreading.
Other Uncommon Variants of Prostate Cancer
Approximately 5% of prostate cancers do not fall under the category of adenocarcinomas. These rare forms include:
1. Small-cell carcinoma: Despite being commonly found in the lungs, small-cell carcinomas make up around 1% of prostate cancers. They originate from small round cells within the prostate and tend to spread rapidly. Typically, by the time it is diagnosed, this type of cancer has already metastasised to other areas of the body, like the bones.
2. Squamous cell carcinoma: Known as a type of skin cancer, squamous cell carcinoma contributes to less than 1% of prostate cancer cases, possibly even less than half a per cent. It begins from flat cells that cover the prostate. Similar to small-cell carcinoma, it is an aggressive and fast-growing variant.
3. Transitional cell (or urothelial) cancer: This type of cancer develops in the urethra. The tube is responsible for carrying urine out of the body. It is unclear how often it originates in the prostate and spreads to the urethra. More commonly, it originates in the bladder before spreading.
4. Neuroendocrine tumours: These tumours can arise in neuroendocrine cells all over the body. Neuroendocrine cells produce hormones that aid in functioning the organs they reside in, like the lungs, stomach, and pancreas. Roughly half of all neuroendocrine tumours originate in the digestive system. In a few cases, these tumours can develop within the neuroendocrine cells of the prostate.
5. Soft tissue sarcoma: This type of cancer originates in the supportive tissues of the body, including muscles, fat, nerves, and blood vessels. Within the prostate, soft tissue sarcomas are very uncommon, accounting for less than 0.1% of cases. This means that fewer than 1 in 1,000 men with prostate cancer are affected by this variant.
Symptoms of Prostate Cancer
As prostate cancer advances, symptoms may manifest, while early-stage prostate cancer remains typically asymptomatic. The following symptoms may arise as the disease progresses:
- Increased frequency of urination, sometimes accompanied by urgency, particularly during nighttime.
- Weak urine flow or intermittent flow.
- Loss of control over bowel movements (faecal incontinence).
- Pain or a burning sensation during urination (dysuria).
- Inability to control urination (urinary incontinence).
- Painful ejaculation and erectile dysfunction (ED).
- Pain experienced in the lower back, hip, or chest.
- Presence of blood in semen (hematospermia) or urine.
Risk factors
While the exact cause of prostate cancer remains surprising to doctors, certain factors may increase the likelihood of developing it:
1. Age: Prostate cancer risk tends to rise after the age of 50, even though it is uncommon before the age of 45.
2. Race or ethnicity: Black individuals are more vulnerable to prostate cancer compared to white individuals. Asian and Hispanic individuals have a lesser risk compared to both Black and white individuals.
3. Family history: Having a close relative with a history of prostate cancer increases the chances of developing the disease.
4. Genetic factors: Inherited traits, like BRCA1 and BRCA2 gene alterations, may upsurge the risk. These gene mutations are also related to an increased risk of breast cancer. Men born with Lynch syndrome are also at a higher risk of developing prostate and other types of cancer.
5. Diet: Some evidence suggests that diets high in fat may result in an increased risk of prostate cancer.
Diagnosis of Prostate Cancer
A biopsy is a medical procedure used for the diagnosis of prostate cancer. It involves taking out a small tissue sample from the prostate, which is then examined under a microscope to find the presence of cancer cells.
When the biopsy tissue is inspected under a microscope, it assists in determining the Gleason grade group. This grade group highlights the likelihood of cancer spreading. The score assigned to the grade group ranges from 1 to 5, with lower scores showing a lower probability of cancer spreading.
While a biopsy is the primary method for diagnosing prostate cancer, doctors may employ additional tools to ensure accurate placement of the biopsy. Transrectal ultrasound and magnetic resonance imaging (MRI) are generally used.
Transrectal ultrasound involves inserting a finger-sized probe into the rectum, which emits high-energy sound waves to generate a sonogram or image of the prostate. Alternatively, MRI employs magnets and radio waves to create detailed pictures on a computer. It is crucial to note that MRI does not involve any radiation.
Treatments, Tests, and Therapies for Prostate Cancer
Radical Prostatectomy
A prostatectomy is a surgical procedure which deals with the removal of either a portion or the entire prostate gland. This procedure is generally performed to address prostate cancer or benign prostatic hyperplasia.
One of the typical surgical approaches to prostatectomy is to make an incision and extract the prostate gland or a part of it. This can be done via either a retropubic or suprapubic incision in the lower abdomen or a perineum incision between the scrotum and the rectum.
Before undergoing a prostatectomy, it is often required to undergo a prostate biopsy.
Robotic prostatectomy
Robotic prostatectomy is a cutting-edge surgical technique carried out by a skilled team of laparoscopic surgeons, utilising advanced surgical technology to ensure minimal invasiveness.
Cryotherapy
The prostate gland, responsible for expelling urine from the body, is exclusively found in males and is located below the bladder and surrounding the urethra. Its chief function is to aid in the production of semen.
Cryotherapy is a procedure which involves freezing cancer cells and interrupting their blood supply. To achieve this, tiny needles are inserted directly into the tumour. These needles facilitate the exchange of argon gases with helium gases, resulting in a cycle of freezing and warming. Consequently, the frozen tissue eventually thaws and is naturally absorbed by the body.
Cryotherapy can be utilised to address different issues. In the case of prostate cancer treatment, a catheter is inserted into the urethra to prevent freezing. Ultrasound imagery is employed to guide the needles into the prostate tumours accurately.
Radiation therapy
Radiation therapy is a highly efficient treatment method that eradicates prostate cancer cells through the usage of powerful energy rays or particles.
Radiation can be delivered through different approaches, such as brachytherapy, which involves the implantation of seeds directly into the patient's body, or external beam radiation, where the energy is projected through the skin.
Surgery
Surgery is often utilised as a treatment for early-stage prostate cancer that has not expanded to distant areas like bones and lymph nodes. The primary objective of surgery in such cases is to remove the cancer altogether.
Radical prostatectomy, a procedure that involves the removal of the entire prostate gland, is the most commonly performed surgery for prostate cancer. Additionally, surgery may be employed as part of an inclusive approach to treating aggressive or metastatic prostate cancer.
The success of surgeries highly depends on the doctor's expertise and the medical centres where they are conducted. Optimal outcomes are typically observed when surgeries are performed in high-volume medical centres by skilled surgeons with vast experience performing these procedures.
It is worth noting that specific patients may be suitable candidates for multiple surgical techniques. In such cases, the doctor will assist you in selecting the most appropriate form of prostate cancer surgery based on your specific condition.
Immunotherapy for prostate cancer
Immunotherapy for prostate cancer functions by improving the patient's immune system to combat cancer cells. An FDA-approved immune therapy known as sipuleucel-T (Provenge) acts as a vaccine, stimulating the patient's immune system to target and remove prostate cancer cells.
Watchful waiting
Suppose you are confirmed with localised prostate cancer (cancer that has not spread to other parts of the body). In that case, you can closely monitor your condition instead of pursuing immediate treatment. Watchful waiting is a type of expectant management for prostate cancer that can be advantageous for men with a limited life expectancy and a slow-growing, low-risk form of the disease.
Chemotherapy
Chemotherapy is a type of therapy that utilises chemicals to eliminate or impede the growth of cancer cells. Even though it is not typically curative for prostate cancer, it can provide certain advantages to patients. One such benefit is alleviating highly advanced or metastatic disease symptoms, enhancing the patient's quality of life.
Moreover, when administered for a brief period after prostate cancer surgery, chemotherapy can enhance the outcome of the procedure. Also, it can be used in conjunction with hormone therapy to improve patient outcomes.
Besides, chemotherapy can extend the lifespan of prostate cancer patients who are not anymore responding to hormone therapy. Finally, it is employed to treat individuals with advanced prostate cancer who carry the AR-V7 gene variant.
Systemic therapy
Systemic therapy is an integral part of the treatment plan for individuals diagnosed with metastatic prostate cancer, a condition where the disease has spread to other areas of the body. This specialised approach targets cancer cells throughout the body by circulating and attacking them.
To manage significantly high-volume metastatic disease, doctors often employ a combination of hormone therapy, chemotherapy, and innovative agents. The medical field is continuously evolving, with new therapies and treatment regimens being developed to combat metastatic prostate cancer.
Prevention of Prostate Cancer
Research has shown that integrating the following lifestyle habits into your daily routine can potentially minimise the risk factors of prostate cancer and other types of cancers.
Engage in regular exercise: Regular physical activity has been linked with a lesser risk of prostate cancer. Aim for at least 75 minutes of vigorous or 150 minutes of moderate-intensity exercise per week.
Limit intake of unhealthy fats: Avoid consuming immoderate amounts of fat from red meats, dairy products, and processed meats. Alternatively, opt for healthier fats found in fatty fish and olive oil.
Maintain a healthy diet: Consuming a nutritious and balanced diet is essential for maintaining optimal weight and reducing cancer risk. Focus on eating a variety of fruits, whole grains, vegetables, and lean proteins.
Minimise sugar-sweetened drinks and processed foods: High consumption of sugar-sweetened beverages and highly processed foods has been linked with a heightened risk of cancer. Choose healthier alternatives and whole foods whenever possible.
Control calcium intake: Restrict your daily calcium intake to 1,200 milligrams. Excessive calcium consumption has been related to an increased risk of prostate cancer.
Keep stress levels in check: Chronic stress may negatively impact overall health, like increasing cancer risk. Find smart & healthy ways to manage stress, such as practising relaxation techniques, engaging in hobbies, or seeking support from loved ones.
Avoid smoking and immoderate alcohol consumption: Smoking and heavy alcohol use have been strongly associated with a higher risk of different cancers, including prostate cancer. Quit smoking and reduce alcohol intake to lessen your risk.
Incorporate nutrient-rich foods: Include tomatoes, broccoli, soy-based foods, cauliflower, and green tea in your diet. These foods are rich in beneficial nutrients that may help lower the risk of cancer.
Be cautious with multivitamins: Avoid overdosing on multivitamins, as immoderate intake of specific vitamins and minerals may adversely affect health.
Be mindful of supplements: Avoid taking vitamin E supplements and folic acid supplements, as they are connected to the risk of increasing prostate cancer.
Manage blood sugar, blood pressure, and cholesterol levels: Increased blood sugar levels, high blood pressure, and high cholesterol levels are related to an improved cancer risk.
By incorporating these healthy habits in your life, you can minimise your risk of prostate cancer and promote overall well-being.
