Prostate Cancer

Overview

Prostate cancer is cancer that occurs in the small walnut-shaped gland in men called prostate that generates seminal fluid that nourishes and transports sperm.

Prostate cancer is the most common cancer in men, especially in Africa. It usually grows slowly and confines in the prostate glands in the first stages where it rarely causes serious harm.

Whereas certain types of prostate cancer grow slowly and may require little or no treatment, other types are aggressive and can spread swiftly to other organs.

According to the World Health Organization, about 9.6 million deaths associated with cancer were reported in 2018. The list of common cancers included prostate cancer listed as position 4 after lung, breast, and colorectal cancers.

In the US, 1 out of 9 men is diagnosed with prostate cancer while in Kenya, it is the leading type of cancer among men with 17 per 100,000 diagnosed.

The Ministry of Health in Kenya reported in 2015 that about 1,000 new cases of prostate cancer are reported every year with deaths standing at 850 every year.

About 6 out of 10 cases of prostate cancer are diagnosed in elderly men aged 65 or older, and the disease is rare before the age of 40. Generally, prostate cancer occurs in men aged 50 and above.

Symptoms

There are normally no symptoms during the early stages of prostate cancer. One of the reasons is that men will only get early symptoms if cancer grows near the urethra and presses against it.

This way, the person will likely experience changes in how they urinate. However, since prostate cancer normally begins to grow in a different section of the prostate, early prostate cancer does not press on the urethra and cause symptoms.

When the symptoms appear, they include:

  • Painful or burning urination
  • Urge to urinate frequently particularly at night, sometimes urgently
  • Painful ejaculation
  • Difficulty in having an erection
  • Bone pain
  • Weak, dribbling, and/or interrupted the flow of urine blood in the semen or sometimes in the urine
  • A decrease in the amount of fluid ejaculated
  • Difficulty starting or holding urination
  • Stiffness or pain in the lower back, thighs, hips, or pelvis

Note that urinary symptoms do not necessarily mean you have cancer. They may be symptoms for prostatitis or even Benign Prostatic Hypertrophy (BPH).

Similarly, difficulty in having an erection does not necessarily mean you have cancer. It might be caused by other factors such as smoking, diabetes, cardiovascular disease, or just plain getting older.

Causes

The main cause of prostate cancer is not known. Doctors understand that prostate cancer begins when certain cells in your prostate become abnormal.

Mutations in the DNA of abnormal cells cause the cells to grow and multiply more rapidly than normal cells.

The abnormal cells continue living when other cells would die, and the accumulation of these cells form a tumor that can grow to attack the surrounding tissue.

Some abnormal cells may also break off and metastasize (spread) to other organs and parts of the body.

Risk Factors

Factors that can increase the risk of prostate cancer include:

  • Age: The more you age, the higher the risk of prostate cancer: Those over 50 are at the highest risk
  • Race: Even though it is not clear why black men are at increased risk of prostate cancer than do men of other races. Prostate cancer is also likely to be more aggressive or advanced compared to other races. 
  • Obesity: Obese men diagnosed with prostate cancer may be more likely to have advanced cancer that is difficult to treat.
  • Family history: If you have family history men who have had prostate cancer, your risk is increased. Also, if you have a family history of genes that increase the risk of breast cancer, or a very powerful family history of breast cancer, your risk of prostate cancer may be higher.

Diagnosis

A doctor will conduct a physical examination and enquire about any ongoing medical history. If the patient shows symptoms or if a routine blood test shows abnormality in the PSA levels, further examination may be required.

The tests may include:

  • Digital rectal examination (DRE): A doctor will check for any abnormalities of the prostate with their finger.
  • Biomarker Test: It is used to check urine, blood, or body tissues of a person with cancer for chemicals exceptional to people with cancer.

In case the results show abnormal cells, further tests may include:

  • PCA3 test examining the urine for the PCA3 gene that is only present in prostate cancer cells
  • Transrectal ultrasound scan: Provides imaging of the affected area using a probe that produces sounds
  • Biopsy/Removal of 12 to 14 small pieces of tissue from many regions of the prostate for examination under a microscope

The 3 further tests help to confirm the stage of cancer, whether it has spread, and the appropriate treatment to apply. To track metastasis, or spread, doctors may use a CT scan, bone, or MRI scan. 

Treatment

Treatment is different for early prostate cancer is different from advanced prostate cancer.

Early Stage Prostate Cancer

If the cancer is localized and has not spread, it is normally managed by one of the following treatments:

  • Watchful waiting or monitoring: It is checking PSA blood levels regularly
  • Radical prostatectomy: It is surgical removal of the prostate. It may require a hospital stay of about ten days with a three months recovery time.
  • Brachytherapy: radioactive seeds are implanted into the prostate to deliver targeted radiation treatment
  • Conformal radiation therapy: It is the shaping of the radiation beams to make the area where they overlap to be the same shape as the organ or region that requires treatment.
  • Intensity modulated radiation therapy: It is the use of beams with variable intensity. It is an advanced type of conformal radiation therapy.

The patient must discuss all available options with the oncologist or urologist handling them.

Advanced prostate treatment may utilize chemotherapy to kill cancer cells around the body or use androgen deprivation therapy (ADT), which is a hormone treatment that minimizes the effect of androgen.

Prevention

Preventive measures that reduce the risk of prostate cancer include:

  • Choosing a healthy diet full of vegetables and fruits
  • Exercising most days of the week
  • Choosing healthy foods over supplements
  • Maintaining a healthy body weight

For more information on treatment, speak to a doctor, or get access to a hospital near you through the Uzima Health App.

Sources

https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

https://www.who.int/cancer/en/

https://www.medicalnewstoday.com/articles/150086.php