Prostate cancer is the disease that begin when normal cells in the prostate change and start to grow out of control. Out of control growth will result into development of tumor that can be either benign or malignant. Benign tumor is the one that is still enclosed and cannot spread to other parts of the body. Malignant tumor is unclosed and can spread to other parts of the body. Malignant tumor is also called cancer.
Most prostate cancers grow more slowly than other types of cancer, although this is not always the case. Some prostate cancer cases may not cause any symptoms or problems for years.
Prostate is a small gland that is found in male reproductive system. It is located below the urinary bladder in front of the rectum. The size of prostate gland tend to changes with age as in young men it is normally about the size of a walnut but in older men, the size can be much larger. Prostate gland is responsible of producing seminal fluid that protect, support and help transportation of sperm during ejaculation.
The prostate gland is surrounded by muscles, which enables it to contract and facilitate ejaculation. It is located near nerves, blood vessels and muscles that are needed to control bladder function.
It is normal for prostate gland to grow with age. This growth of prostate can sometimes bring problems especially with urination. Men over the age of 50 normally experience urinary problems. These are normally due to enlargement of prostate gland a condition known as benign prostate hyperplasia (BPH). This is not cancer.
Types of prostate cancer
Prostate cancer is divided depending on cells from which cancer develop and appearance of cancer cells under microscope. These include the following;
• Adenocarcinoma. These develop from glandular cells of the prostate gland.
• Neuroendocrine. These develop from nerve cells.
• Small cell cancers. Cancer cells appear very small under microscope.
• Sarcomas. Develop from supportive and connective tissues such as muscle cells and blood vessels.
Risk factors of prostate cancer
When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but it does not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. Risk factors of prostate cancer include the following;
• Age. Prostate cancer is a disease more common to older people, so as age increases the risk also increase.
• Family history. Studies indicate that, some prostate cancers run in families. These kind of prostate cancers are also named as familial prostate cancer. These kind of prostate cancers takes only small percent of all prostate cancer in the country as most of cases do not relate to family history of the disease.
• Strong family history of breast and ovarian cancer. Men in the families with strong family history of breast and ovarian cancer are said to be at increased risk of developing prostate cancer. Inherited mutations of the BRCA1 or BRCA2 genes raise the risk of breast and ovarian cancers in some families. Mutations in these genes (especially in BRCA2) may also increase prostate cancer risk in some men.
• Diet. The link between diet and the risk of prostate cancer is not yet proven but some studies associate prostate cancer to high intake of red meat or high fat dietary products. More studies are still needed to prove this.
• Chemical exposure. Although more studies are required to prove this, some studies link prostate cancer to exposure to some chemicals. For example exposure to Agent Orange (Chemical that was used during Vietnam war).
Prevention of prostate cancer
To prevent something you need first to know what causes it. Since the specific cause of prostate cancer is still unknown, currently there is no proven way of completely preventing development of this cancer. Although there are no preventive measures, the risk of developing this cancer can be minimized by avoiding risk factors associated with prostate cancer.
• By the use of drugs. The use of 5-alpha-reductase inhibitors (5-ARIs), which includes finasteride and dutasteride, may lower a man’s risk of developing prostate cancer although it is still not clear as to whether benefits outweighs the risk, so it is advised to talk with your doctor before using.
• Diet and physical activity. Controlling the use of red meat and high fat dietary products is believed to lower the risk of developing prostate cancer. Physical activity will help reduce excess fat in the body which is also believed to increase the risk of prostate cancer.
Early detection and screening of prostate cancer
When it comes to cancer, early detection normally provide better treatment outcome. If prostate cancer is found early, chances for better treatment outcome are very high. For most cancers, early detection has been greatly contributed by the presence of screening processes.
Screening is the process of running some tests to someone with no symptoms of a certain disease with the intention of determining presence or absence of that disease. For prostate cancer, screening is normally done by using PSA and DRE tests.
• Prostate specific antigen (PSA). Prostate specific antigen (PSA) is a protein that is produced by prostate gland cells. This test is done by using blood. Men with prostate cancer normally have higher level of PSA than normal. Although prostate cancer can cause the raise of PSA level in the blood, sometimes PSA level will be high as a result of other health conditions such as benign prostate hyperplasia (BPH) and inflammation of prostate (prostatitis).
• Digital rectal examination (DRE). Digital rectal examination involve inserting gloved, lubricated finger into the rectum through anus to feel the surface of prostate gland and examine if there is any abnormality including bumps and hardened tissues of the prostate gland.
If any of the tests will reveal anything abnormal, more tests will be recommended to find the reason behind the abnormality.
Signs and symptoms of prostate cancer
People with prostate cancer tend to experience some of the following symptoms. Sometimes those signs and symptoms may be resulted from other medical conditions which are not cancers. Therefore, going to see a doctor upon experiencing any of the symptoms is advised. The signs and symptoms of prostate cancer include the following;
• Weak and slow urinary stream.
• Blood in the urine and semen
• Erection problems (erectile dysfunction)
• Feeling frequent or sudden need to urinate
• Pain in the lower back or pelvic pain.
• Frequent urge to urinate at night
• Pain in the back or pelvis.
Diagnosis of prostate cancer
Medical diagnosis simply means identification of nature of an illness by elimination of the symptoms. Normally people don`t go to hospital knowing they have cancer but during diagnostic procedures is when doctors detect the disease.
Following suspicion of the disease, doctors normally run combination of tests to determine whether there are cancerous cells in the body or not and if there are cancer cells, how far have they spread. Along with thorough medical history and physical examination, doctors normally use combination of the following tests to diagnose cancer.
Laboratory tests are important in ruling out other conditions and confirming diagnosis. For cancer diagnosis laboratory tests normally include blood tests, urine tests, tumor markers and other body fluids tests.
• Blood tests. Blood tests help to reveal level of different substances in the blood which will help doctors to know if there is anything wrong in the body. From blood tests doctors can see complete blood count which indicates number, size and maturity of blood cells. Also from the blood tests doctors can analyze if kidney and liver are working properly.
• Urine tests. Urine tests (urinalysis) involve laboratory examination of urine to check presence of blood, proteins, and other substances such as drugs. For instance blood in the urine may be an indication of benign condition, infection or other health problem.
• Tumor markers. These are biomarkers (proteins) that can be produced by both cancer cells and normal body cells in response to cancer. Tumor markers are released into the blood or urine. Although studies are still conducted to determine role of these markers in diagnosing cancer because sometimes people with benign condition will have elevated level of these proteins. Also not all tumors have their markers and some markers are not specific to one type of tumor.
• Other body fluids. Despite being rarely used, sometimes body fluids can be tested in the lab during diagnosis of cancer. For instance the use of cerebral spinal fluid (CSF) and pleural fluid. CSF is used in diagnosis of brain tumors while pleural fluid for lung cancer.
Diagnostic imagings involve tests that create pictures of inside the body that help the doctor to see if there is tumor or not. There are several imaging tests used in cancer diagnosis depending on the type and location of cancer suspected. These imaging tests include;
• Computed tomography (CT) scan. CT scan machine is a donut-shaped scanner that uses x-rays to create series of pictures of body organs from different angles. This machine is linked to a computer where those series of pictures taken will be combined to create a 3D- image of inside the body. During the scanning process patient will lie still on the table which will slide into the scanner. In order to get a clear image, sometimes the doctor will inject the patient with a contrast material before scanning. From the images the doctor will be able to differentiate between healthy and unhealthy tissues.
• Magnetic resonance imaging (MRI). MRI is an imaging technique that uses powerful magnet and radio waves to take series of pictures of body organs and create a 3D image in a computer linked to a machine. Just like in CT, during MRI procedure the patient will lie on a table that will slide into a long round chamber. Also during this procedure the doctor may inject the patient with a contrast material for clear image view.
• X-ray. This is an imaging technique that is uses low dose of radiation to create pictures of inside your body. Technician will position the patient and direct the x-ray beam to the intended part of the body.
• Ultrasound. Ultrasound is a diagnostic imaging procedure that uses high energy sound waves to produce images of organs inside the body. During the examination, a patient will lie on the table while the technician will slowly move a device called transducer on the skin over the part of the body that is being examined.
• PET scan. Positron emission tomography (PET) scan is an imaging test that uses radioactive glucose to create 3-D images of areas inside the body. Radioactive glucose is used for this test because cancer cells tend to absorb more glucose than normal body cells, so the scan will show which areas of the body has more glucose than others. Before the scan, doctor will inject the patient with tracer called radioactive glucose then during imaging the patient will be asked to lie on the table that will be moving back and forth through the scanner.
• Bone scan. Bone scan is used to examine bones. When it comes to cancer, bone scan is used for diagnosis of bone cancer or cancer that has metastasized into the bones. Before the test, patient will be injected with small amount of radioactive material that tends to collect more on abnormal parts of the bones. Then pictures that will be taken by a scan will indicate the distribution of those radioactive materials in the bones throughout the body.
Biopsy is a diagnostic procedure that involves removing a tissue sample from the body and examines it under microscope in the laboratory. Examination in the laboratory is normally done by a pathologist who will check if the cells in the tissue are cancerous or not. In most cancer cases, biopsy is considered to be the confirmatory test. Depending on the location and type of cancer, biopsy can be obtained in different ways. Some of them include;
• Using needle. By using a thin needle, doctors can draw same tissue or fluid for examination under microscope. This method can be used to draw some fluid (spinal tap), bone marrow (bone marrow aspiration), blood or small amount of tumor from the suspected organ such as liver and breast (fine needle aspiration).
• Surgery. Abnormal tissue samples are obtained while the doctor is performing the surgery. Tissues are then sent to the lab for examination during the surgery. If the surgeon removes just a portion of abnormal area it is called incisional biopsy while when the entire tumor (abnormal site) is removed it is called excisional biopsy.
• Using endoscope. Endoscope is a thin, lighted tube with a camera (focusing telescope) at the end. It is used for viewing inside the body through natural openings like mouth and anus. During an examination if the doctor sees any abnormal tissue, then endoscope can also be used to take sample for that tissue. There are different kinds of endoscopy exams depending on the site of the body being examined. Some of the exams include colonoscopy (for rectum and colon), bronchoscopy (for trachea, bronchi and lungs) and esophagogastroduodenoscopy EGD (for esophagus, stomach and duodenum)
In addition to medical history and physical examination, diagnosis of prostate cancer involves the use of biopsy, CT Scan, MRI Scan, bone scan, PET Scan and PSA test
Treatment of prostate cancer
Following cancer diagnosis, the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps.
After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option.
Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored.
In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These type of treatments are called clinical trials.
If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time
Treatment of prostate cancer requires a team of doctors and other health care professionals. This team work together and it is called multidisciplinary team. Team may vary depending on the treatment option for a particular case. But normally multidisciplinary team for treatment of prostate cancer includes, surgical oncologist, medical oncologist, endocrinologist, urologist, radiation oncologist, radiation therapist, pathologist and other health care professionals like oncology nurses, physiotherapist and palliative care team. Treatment options include the following;
Active surveillance is also called watchful waiting. It involves monitoring prostate cancer that isn’t causing any symptoms or problems and is considered to be low risk prostate cancer. Treatment of prostate cancer can seriously damage quality of life as it can sometimes lead to inability to achieve and maintain erection (erectile dysfunction) and ability to control urine flow (urinary incontinence).
For this reason, when dealing with very early prostate cancer or when the patient is very old or has other serious health problems, doctors recommend active surveillance rather than other invasive treatment options that could damage quality of life. Active surveillance will include having some tests such as PSA tests regularly.
Surgery is the treatment option that involve the removal of tumor and surrounding healthy tissues by an operation. This treatment option is performed by a specialized doctor known as surgical oncologist. For prostate cancer, surgery options will depend on the stage of the disease, overall health and other factors. The surgery options include the following;
• Open radical prostatectomy. Open radical prostatectomy involve removing the whole prostate and some surrounding tissues through a small cut at the lower abdomen. This type of surgery may affect sexual functions of a man. To ensure sexual functions (erection and orgasm) of a man remain after surgery, nerve sparing surgery is preferred when possible. Nerve sparing surgery is the surgery done while sparing nerves that enable erection and orgasm.
• Laparoscopic prostatectomy. Laparoscopic prostatectomy involve removing prostate through several small cuts in the abdomen. This type of surgery is less invasive with short recovery time compared to radical prostatectomy. During the procedure, a camera and instruments are inserted through small keyhole incisions in the patient’s abdomen. The surgeon then directs the robotic instruments to remove the prostate gland and some surrounding healthy tissue. This procedure is the resemble to that of open surgery, but this is performed using smaller incisions.
Side effects of surgery
Side effects of surgery depend on type and extent of surgery. Some of the possible side effects of surgery include the following;
• Risk of infection.
• Risk of erectile dysfunction
• Urinary incontinence
• Pain around the area of surgery
• Excess bleeding.
• Blood clots.
• Reaction from anesthesia
Radiation therapy is a treatment of cancer by using high energy x-rays or other radiation particles to destroy cancer cells. Radiation therapy is given by a specialized doctor known as radiation oncologist. There are two main types of radiation therapy, internal radiation therapy (brachytherapy) and external beam radiation therapy.
• External beam radiation therapy. Involve directing beam of radiation to the tumor from the source (machine) which is positioned outside the body. External beam radiation therapy can be delivered in different ways, including intensity-modulated radiation therapy (IMRT) and 3D conformal radiation therapy (3D-CRT). These techniques deliver high radiation dose to the tumor site while causing minimum damage to the surrounding tissues. These improvements have reduced the side effects from radiotherapy
• Internal radiation therapy (brachytherapy). This delivers radiations to the tumor from inside the body. It is a type of targeted internal radiation therapy where the radiation source is placed directly within the prostate gland. This allows higher doses of radiation to be given, while the effects on nearby tissues such as the rectum and bladder are highly minimized. Brachytherapy can be given at either a low-dose rate by inserting permanent seeds that are radioactive for months, or at a high-dose rate through temporary needle implants.
Side effects of radiation
Side effects of radiation therapy depend on the dose of radiation therapy given. Some side effects normally go away soon after completion of treatment but some may also be permanent. There are medications that may help to relieve if some of the effects become too severe. Some of the possible side effects include the following;
• Sexual dysfunction
• Mild skin reactions at the site of irradiation
• Loose bowel movement
• Upset stomach
• Loss of appetite
• Pain when urinating and poor urine flow due to seed implants
• Bladder irritation.
Chemotherapy is the use of drugs to destroy cancer cells or stop its growth and division. This treatment is given by a specialized doctor known as medical oncologist. Chemotherapy is the treatment option that is normally used for those advanced cases of prostate cancer. Most of these cases have already spread to other parts of the body. Type of chemotherapy used for treatment of such cases is known as systemic chemotherapy.
Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. It is normally given intravenously (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally).
Side effects of chemotherapy
Possible side effects of chemotherapy depends on the dose given, type of drug used and periodic time by which it has been used. These side effects include the following;
• Hair loss
• Nausea and/or vomiting
• Loss of appetite
• Feeling tired due to low red blood cells count
• Risk of infection due to decreased white blood cells
• Easily bruising and bleeding due to low blood platelets.
• Changed bowel habits such as constipation or diarrhea
Androgen deprivation therapy (ADT)
Androgen deprivation therapy (ADT) is the use of drugs to slow production of male reproductive hormones (androgen). Prostate cancer needs androgens to grow, so slowing the production of those hormones may slow the growth of the cancer or shrink it temporarily. The most common androgen is testosterone. This treatment used to be known as hormone therapy.
ADT is often used before, during and after radiation therapy but sometimes it is given with chemotherapy.
This kind of therapy is used to treat prostate cancer in different situations, including locally advanced, recurrent prostate cancer, and metastatic prostate cancer. In most cases, the treatment will not cure the cancer but can keep it under control for months and even years.
Side effects of androgen deprivation therapy
The side effects normally depend on type of drug used, dose given and periodic time by which the drug has been used. Some of the possible side effects of ADT include the following;
• Reduced sex drive
• Erection problems
• Loss of muscle strength
• Weight gain
• Hot flushes with sweating
• Cognitive dysfunction and memory loss
• Enlargement of breast (gynecomastia)