What is Prostate Cancer?: Symptoms, Causes and Treatment

Prostate Cancer is a type of cancer that occurs in the prostate gland. It is the most common in males. The prostate is the gland situated between the bladder and the penis, in front of the rectum. It produces seminal fluid, nourishing and transporting sperm. Prostate cancers that grow slowly and are confined to the prostate gland may not cause serious problems. However, aggressive prostate cancers that spread quickly may have some complications

The type of prostate cancer tells a doctor about the cell where cancer has started. Following are the different types of prostate cancer:

1. Adenocarcinoma (the most common type): These cancers develop in the prostate gland cells. It is of two types: acinar adenocarcinoma (which starts in the gland cells that line the prostate gland) and ductal adenocarcinoma (which develops in the cells that line the ducts of the prostate gland).
2. Small-cell carcinoma (about 1% of prostate cancers): These cancers develop in the prostate’s small round cells and spread very quickly. 
3. Squamous cell carcinoma (about half a per cent of prostate cancers): These develop in flat cells covering the prostate. 
4. Transitional cell or urothelial carcinoma (between 2 to 4% of prostate cancers): It starts in the urethra and spreads to the prostate.
5. Neuroendocrine tumours: About half of these start in the neuroendocrine cells in the digestive system. 
6. Soft tissue sarcoma (less than 0.1% of prostate cancers): It develops in supportive tissues, including nerves, muscles, fat, and blood vessels.

An individual may experience no symptoms of prostate cancer in its early stages. However, more advanced prostate cancer may cause symptoms including:

1. Difficulty in urination
2. A weak urine stream
3. Frequent urge to urinate
4. Blood in urine
5. Blood in semen
6. Painful or burning sensation while urination
7. Pain in the pelvis, hips, or back
8. Bone pain
9. Tiredness 
10. Unexplained weight loss
11. Erectile dysfunction

It is unclear what causes prostate cancer. Researchers claim that genetic material (DNA) and dietary habits are associated with prostate cancer.

1. Genetic Material (DNA): Researchers have found that prostate cancer begins when the cells in the prostate bring changes in their DNA. A cell’s DNA contains the instructions for the cell. These changes in the DNA instruct the cells to grow more rapidly than normal cells. At first, the cells’ changes are slow and are not cancerous. However, with time, the accumulation of abnormal cells can become cancerous. Furthermore, some abnormal cells may break away and spread to other body parts. 
2. Dietary Habits: Studies have found that men who eat a diet with a large amount of fat (meat and dairy products) are more likely to develop prostate cancer. According to experts, the factor that links diet to prostate cancer is probably hormones. Intake of large amounts of fats increases the production of testosterone and other hormones, speeding up prostate cancer growth.

The following are the probable risk factors for prostate cancer that might put an individual at a higher chance of developing the disease: 

1. Age: The prostate cancer risk increases with age. A person is at a higher risk of having prostate cancer after 50 years. 
2. Race: Black people are at a higher risk of developing prostate cancer than other races. Moreover, it is also more likely to be advanced in black people. 
3. Family history: The risk of prostate cancer may be increased if a blood relative has a history of prostate cancer. 
4. Genetic factors: The risk of prostate cancer may increase if a person has inherited genes that increase the breast cancer risk (BRCA1 or BRCA2) or a strong family history of breast cancer. 
5. Obesity: People with obesity and an unhealthy lifestyle have a higher risk of prostate cancer than those with a healthy diet. Furthermore, the cancer is likely to be more aggressive and return after initial treatment.

There is no definitive way to prevent the condition from developing. Still, there are measures to reduce the risk of developing prostate cancer. Below mentioned are some of the measures for the prevention of prostate cancer: 

1. Eating a healthy diet full of fruits, vegetables, and whole grains
2. Exercising regularly
3. Maintaining a healthy weight
4. Talking to your doctor about your increased risk of prostate cancer
5. Avoid alcohol intake 
6. Avoid smoking or chewing tobacco

Even if there are no symptoms, men in their 50s should consider prostate cancer screening, especially if they have a family history of prostate cancer or other risk factors. The prostate screening tests include:

1. Digital rectal exam (DRE): The doctor examines the prostate by inserting a gloved, lubricated finger into the rectum. If the doctor finds any abnormalities in the shape or size of the gland, the patient may need further diagnostic tests. 
2. Prostate-specific antigen (PSA) test: The doctor collects a blood sample to determine the level of PSA, a naturally produced substance by the prostate gland. While a small amount of PSA is normal, a higher than usual level may indicate inflammation, infection, enlargement, or cancer of the prostate. 
3. Prostate cancer antigen 3 (PCA3) test: The test measures the levels of the PCA3 gene, which are found in high levels in prostate cancer cells. Unlike PSA, PCA3 is unaffected by an enlarged prostate or other prostate gland conditions. However, it is not a substitute for PSA testing and is used along with the PSA test and others. 

The doctor may conduct further tests to diagnose prostate cancer if any abnormalities are detected in the prostate cancer screening. The tests include:

1. Transrectal ultrasound: The doctor inserts a small probe with a camera into the rectum. By using sound waves, the probe creates a picture of the prostate gland.
2. Prostate biopsy: The doctor may collect a sample of cells from the prostate to determine if cancer cells are present in the prostate. A thin needle is inserted into the prostate during the procedure to collect the tissue. The sample is analysed in a lab to determine if cancer cells are present.
3. Magnetic resonance imaging (MRI): The doctor may recommend an MRI scan to create a more detailed prostate image.

Once the presence of cancer in the prostate is confirmed, the doctor will conduct tests to determine the grade of the cancer cells:

1. Gleason score: It is the most common scale doctors use to grade prostate cancer and know whether cancer will grow slowly or rapidly. It combines the two numbers assigned to the cancer cells after examining them under the microscope. Most Gleason tests range from a score of 6 to 10.
   1. A score of 6 indicates low-grade, slow-growing prostate cancer.
   2. A score of 7 indicates medium-grade prostate cancer.
   3. A score between 8 to 10 indicates high-grade, faster-growing prostate cancer. 
2. Genomic testing: The doctor conducts this test to analyse the prostate cells and determine their gene mutations. It helps determine how cancer will grow and which treatment may work against it. These tests are not necessary for everyone with prostate cancer.

If the doctor suspects that cancer may have spread beyond the prostate, he/she may recommend the following imaging tests:

1. Ultrasound
2. Bone scan
3. CT scan
4. MRI
5. Positron emission tomography (PET) test

Every person does not need to undergo every test. After reviewing the condition, the doctor will determine which test best suits the patient's condition.

The treatment for prostate cancer may depend on the cancer stage and the overall health of the patient.

Treatment for Early-Stage Prostate Cancer

If the cancer is small and localised, the doctor may recommend the following treatment options:

1. Monitoring: A patient may not need treatment right away for low-grade prostate cancer. The doctor may conduct regular blood tests, prostate biopsies, and rectal exams to monitor the progression of prostate cancer. If cancer progresses, the doctor may recommend treatments such as surgery or radiation.
2. Surgery: Radical prostatectomy is the surgery performed to treat prostate cancer. The surgeon removes the prostate gland, some surrounding tissue, and lymph nodes during the surgery. Surgery is often used when the cancer is confined to the prostate gland. It can be performed in two ways:
   1. Robot-assisted laparoscopic prostatectomy: involves several small incisions in the abdomen. 
   2. Retropubic surgery: involves one long incision in the abdomen.
3. Radiation therapy: The doctor uses high-powered radiation to kill cancer cells or prevent them from growing. Radiation therapy may include:
   1. External radiation therapy: sends radiation from outside the body toward the cancer cells.
   2. Internal radiation therapy or brachytherapy: places radioactive sources in the prostate tissue.
4. Ablation therapy: this therapy destroys the prostate tissue by using extremely hot or cold temperatures. The options include:
   1. Freezing the prostate tissue (cryotherapy or cryoablation): uses a very cold gas to freeze the prostate tissue. Freezing kills the cancer cells and some surrounding healthy tissue.
   2. Heating the prostate tissue (high-intensity focused ultrasound): uses concentrated ultrasound energy to heat the prostate tissue, causing it to die.

Treatment for Advanced Prostate Cancer

As cancer advances, it can spread throughout the body. The treatment options for advanced prostate cancer include:

1. Hormone therapy: The cells of prostate cancer depend on the male hormone testosterone to help them grow. The therapy stops the body from producing testosterone, causing the cancer cells to die. The therapy options include:
   1. Medications known as gonadotropin-releasing hormone (GnRH) or luteinising hormone-releasing hormone (LHRH) can stop the body from producing testosterone. 
   2. Medications known as anti-androgens can block testosterone from reaching cancer cells. 
   3. Orchiectomy is a surgery performed to remove the testicles, reducing testosterone levels in the body.
2. Chemotherapy: The treatment uses drugs to kill cancer cells. The drugs are administered through a vein in the arms, as a pill, or both. Chemotherapy may be an option if cancer does not respond to hormone therapy.
3. Immunotherapy: The treatment uses the immune system to fight cancer. The options include:
   1. Restoring the cells to fight cancer: In this treatment, some of the immune cells are engineered in a laboratory to fight cancer. Then the doctor injects them back into the body through a vein. 
   2. Helping the immune cells identify the cancer cells: In this treatment, immunotherapy drugs help the immune system identify and fight cancer. 
4. Targeted therapy: This treatment focuses on certain abnormalities within the cancer cells. Targeted therapy drugs block these abnormalities, causing cancer cells to die. Some targeted therapies work only when the cancer cells have genetic mutations. The doctor may send the cancer cells to be tested in a laboratory to see if this is the right treatment for the patient.

If prostate cancer is not treated in time, it can lead to worsening symptoms and also can put an individual's life in danger. The risks and complications of prostate cancer include:

1. Metastasis (cancer that spreads to other body parts): If left untreated, prostate cancer can spread to other body parts like the bladder. It may also travel through the bloodstream to reach the bones and other organs. Prostate cancer spread to the bones can result in pain and broken bones. Cancer may be controlled once it spreads to other body parts; however, it is unlikely to be cured. 
2. Erectile dysfunction: Prostate cancer can lead to erectile dysfunction. It is also a complication of the treatment for prostate cancer. The doctor may recommend medications, vacuum erection devices, or surgery to treat erectile dysfunction.  
3. Incontinence: Urinary incontinence may be a complication of both prostate cancer and its treatment. The treatments for incontinence include medications, catheters, and surgery. 

When to see a doctor?

The patient can consult the doctor if he experiences:

1. Difficulty in urination
2. A weak urine stream
3. Blood in urine
4. Blood in semen
5. Painful or burning sensation while urination
6. Pain in the pelvis, hips, or back

Differences in lifestyle and dietary habits may account for the development of prostate cancer. Good nutrition will help an individual reduce the incidence of prostate cancer. Below are some dietary habits an individual needs to keep in mind.

1. Primarily plant-based should be consumed
2. Include plenty of fruits and vegetables
3. Consume fibre-rich food
4. Eat diet which is low in fat
5. Limit the number of simple sugars
6. Drink adequate fluids