What is Prostate Cancer?

Prostate cancer is cancer that occurs in the prostate, a gland that is a part of the male reproductive system. Located beneath the bladder, the prostate’s primary function is producing a fluid that mixes with sperm to become semen. Prostate cancer occurs when cells in the prostate gland begin to grow uncontrollably. These cells can then spread to other parts of the body. Prostate cancer is one of the most common types of cancer and is often highly treatable when detected early, making awareness of this type of cancer important. Read on to learn more about prostate cancer symptoms, screening, prevention, and treatment.

What are symptoms of prostate cancer?

Prostate cancer may cause little to no symptoms in its early stages. As the cancer progresses, the following symptoms may occur:

• Difficulty urinating
• Urinary incontinence
• Slow urine stream
• Frequent urination
• Erectile dysfunction
• Blood in the urine or semen
• Unexplained weight loss

Source: Mayo Clinic

How is prostate cancer diagnosed?

If you have symptoms that could be caused by prostate cancer, your GP may consider one or more preliminary tests. These could include a blood test to check the levels of prostate-specific antigen (PSA) or a physical prostate examination (digital rectal examination). After considering the results of these tests and other risk factors like age, family history, and ethnic background, you may be referred to the hospital for additional tests. It is also possible to test your PSA from home with a PSA Blood Test from Homed-IQ.

MRI Scan

If your PSA is elevated or there are other potential indications of prostate cancer, your doctor will refer you to the hospital for an MRI scan of your prostate. If the scan does not show any abnormalities, a prostate biopsy can usually be avoided. In many countries, using MRI scanning replaces old diagnostic guidelines, which recommended individuals with a high PSA level to directly get a prostate biopsy. The use of MRI scanning can allow patients without cancer to avoid the pain and potential side effects of a prostate biopsy. In patients with cancer, the use of MRI can indicate where the abnormalities are in the prostate, meaning fewer samples need to be taken in the biopsy (Radboudumc, 2020).

Prostate Biopsy

A biopsy is a procedure in which small samples of the prostate are taken and examined under a microscope. If cancer cells are found, the samples can be used to determine how fast the cancer will spread. This is known as “staging and grading” and determines next steps in treatment.

A core needle biopsy performed by a urologist is the most common method used to diagnose prostate cancer. This procedure involves inserting a hollow needle into the prostate, either through the wall of the rectum (a transrectal biopsy) or through the perineum (a transperineal biopsy). As the needle is removed, it takes a small cylinder of prostate tissue (American Cancer Society, 2019). This procedure is usually performed twelve times at different parts of the prostate, but can be reduced to three in patients that received an MRI beforehand (Radboudumc, 2020). The biopsy procedure can be performed under local or general anesthetic and usually takes around 20 minutes.

What are the risks of prostate biopsies?

Although biopsies can provide definitive diagnosis of prostate cancer, there are still some risks associated with them. These risks include:

• Missing the cancer.
• Needing additional biopsies if symptoms persist.
• Finding small, slow-growing cancers that do not need treatment. The discovery of these cancers can cause anxiety or the choice to undergo surgery or treatments with little to no benefit to your health. These treatments can cause side effects like incontinence and erectile dysfunction. In this situation, the diagnosis of cancer was more harmful (leading to side effects) than beneficial (did not save or prolong an individual’s life). This is known as overtreatment and is an important consideration when choosing to undergo a prostate biopsy.

Source: NHS, 2021

What are the types of prostate cancer?

Nearly all types of prostate cancer are adenocarcinomas, a cancer that occurs in the glands that line certain organs. The most common type of adenocarcinoma of the prostate is acinar adenocarcinoma, which occurs in the gland cells that line the prostate. A less common form is ductal adenocarcinoma which occurs in the tubes (ducts) of the prostate. Ductal adenocarcinoma tends to spread more quickly than acinar adenocarcinoma (Cancer Research UK, 2022).

Other types of cancer that can occur in the prostate are small cell carcinomas, neuroendocrine tumors, transitional cell carcinomas, and sarcomas. However, these types of cancers are rare. If you are diagnosed with prostate cancer it is almost certain to be an adenocarcinoma (American Cancer Society, 2019).

What is the treatment for prostate cancer?

Treatment for prostate cancer greatly depends on your individual diagnosis, including how big it is and whether it has spread to other parts of the body. Many cases of prostate cancer do not need treatment at all. This is because they will likely not cause a reduction in your life expectancy, and treatment would cause more side effects than benefits. While there are many types of treatment for prostate cancer, the most common treatments will be summarized. If you require treatment for prostate cancer, your care team will explain all treatment options to you.

Monitoring

For those that require treatment, your doctor may suggest watchful waiting or active surveillance of the cancer. Watchful waiting is a less intensive way to monitor cancer, without frequent tests or biopsies. This is sometimes used in older patients who are unlikely to have their lifespan shortened by prostate cancer, or those who do not want or cannot have treatment for the cancer. Active surveillance involves monitoring the cancer closely and discussing treatment if the cancer begins to grow (Cancer Research UK, 2022). This is sometimes used in cancer that is contained in the prostate gland and is of low to medium risk.

Surgery

A radical prostatectomy is the surgical removal of your prostate gland. This treatment can cure cancers that are contained in the prostate gland or have not spread too far. Risks of prostate removal surgery include incontinence and erectile dysfunction. Furthermore, you will be unable to ejaculate or have children following this procedure (NHS, 2021). 

Radiotherapy

Radiotherapy uses radiation to kill cancer cells. It can be used to cure prostate cancer that has not spread very far and slow the progression of cancer that has spread. Radiotherapy for prostate cancer may involve radiation that comes from outside the body (external beam radiation) or radiation placed inside your body (brachytherapy). External beam radiation is usually used for cancer within the prostate or that has spread to other parts of the body, as well as to kill remaining cancer cells after surgery. Brachytherapy is used to treat cancer that has not spread beyond the prostate (Mayo Clinic, 2022).

Hormone Therapy

Hormone therapy is a treatment that stops your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone can kill cancer cells or cause them to grow more slowly. Hormone therapy is sometimes used at the same time as radiotherapy, and can involve medications or removal of the testicles (Mayo Clinic, 2022).

Other treatments for prostate cancer may include:

• Freezing or heating prostate tissue (cryotherapy, cryoablation, or High-intensity focused ultrasound)
• Immunotherapy
• Chemotherapy
• Targeted drug therapies

How quickly does prostate cancer spread?

In many cases, prostate cancer spreads very slowly. It can take years to become detectable and/or spread to other parts of the body. Often, prostate cancer will not affect a man’s life span. However, no two cases of prostate cancer are the same. Some grow slowly while others grow and spread rapidly (Mayo Clinic, 2022). This is why initial screening and monitoring is important if you are experiencing prostate-related symptoms. In this way, high risk cases can be detected and treated quickly, while lower-risk cases may opt to monitor their cancer before starting treatment.

What is the survival rate of prostate cancer?

The survival rate of prostate cancer is individual, and population-level statistics may not match your specific situation. The prognosis for prostate cancer depends on many factors, and your doctor will offer advice based on your specific circumstances. Prostate cancers that are localized to the prostate and the nearby areas have a very high survival rate. Based on American data, the 5-year survival rate of localized prostate cancer is nearly 100%, and the 15-year survival rate is 95% (Johns Hopkins, 2022). Many individuals diagnosed will also be cured.

Prostate cancer that has spread to other parts of the body (metastasized) have a much lower survival rate than local or regional cancer. However, through screening measures, the majority of prostate cancers are curable before this stage is reached.

Can prostate cancer be cured?

Yes, most prostate cancers are curable due to early detection through screening. This is why the long-term survival rates of prostate cancer are quite high (Johns Hopkins, 2022).

Who is at risk of prostate cancer?

Anyone with a prostate gland is at risk of prostate cancer. This is primarily men, but also includes transgender women and non-binary people with a prostate gland. A person’s risk of developing prostate cancer depends on several different factors. These include:

• Age: prostate cancer is more common in older individuals.
• Ethnicity: prostate cancer is more common in black people as compared to white people, and least common in Asian individuals.
• Genetics and family history: Your risk of prostate cancer is higher if you have a close relative, such as a brother or father, who has had prostate cancer. Some inherited genes can also increase your risk of prostate cancer. These inherited genes are rare and account for only a small number of prostate cancers.

Source: Cancer Research UK, 2022

What is the main cause of prostate cancer?

It’s not known what causes prostate cancer. It is likely a combination of factors that are different between individuals. It is known that prostate cancer begins when cells in the prostate develop changes in their DNA. These changes tell the cells to grow and divide more rapidly than normal cells do. These are known as cancer cells (Johns Hopkins, 2022).

How can I prevent prostate cancer?

In individuals not at high risk of prostate cancer, it is recommended to follow a healthy lifestyle to prevent future disease. This includes a healthy diet containing fruits and vegetables, regular exercise, and maintaining a healthy weight. Furthermore, speak to your doctor about prostate cancer screening, and seek medical care if you are experiencing prostate-related symptoms. If you have a high risk of prostate cancer, speak to your doctor about early or more frequent screening and preventive measures (Mayo Clinic, 2022).

It is now possible to screen for prostate cancer from home using Homed-IQ’s PSA Blood Test. While not all prostate cancers cause high PSA and it is possible to have high PSA without cancer, PSA testing can be used to detect early-stage prostate cancers and receive follow-up screening and/or diagnosis. Read more here about the test, its risks and benefits, and to decide if it is right for you.

References

New Guidelines for the detection of prostate cancer – MRI instead of tissue samples. (n.d.). Retrieved September 16, 2022, from https://www.radboudumc.nl/en/news/2020/new-guidelines-for-the-detection-of-prostate-cancer

NHS website. (2021, November 18). Prostate Cancer. nhs.uk. Retrieved September 16, 2022, from https://www.nhs.uk/conditions/prostate-cancer/living-with/

Prostate cancer – Outcomes & ratings. (2022, May 25). Mayo Clinic. Retrieved September 16, 2022, from https://www.mayoclinic.org/diseases-conditions/prostate-cancer/outcomes/gnc-20515078

Prostate Cancer Prognosis. (2021, August 8). Johns Hopkins Medicine. Retrieved September 16, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prognosis

Risk and causes | Prostate cancer | Cancer Research UK. (n.d.). Retrieved September 16, 2022, from https://www.cancerresearchuk.org/about-cancer/prostate-cancer/risks-causes