DR TARIQ JAGNARINE
Family Medicine, Endocrinology & Diabetes
Prostate cancer is a common type of cancer in males, but it is highly treatable in the early stages. It begins in the prostate gland, which sits between the penis and the bladder.
The prostate has various functions, including:
• Producing the fluid that nourishes and transports sperm.
• Secreting prostate-specific antigen (PSA), a protein that helps semen retain its liquid state.
• Helping aid urine control.
Prostate cancer is the most common cancer to affect males in the United States and Guyana.
Around 1 in 9 males will receive a diagnosis of prostate cancer at some point in their life. However, only 1 in 41 of these will die because of it. This is because treatment is effective, especially in the early stages. Routine screening enables doctors to detect many cases of prostate cancer before they spread.
CAUSES
Prostate cancer develops when specific changes occur, usually in glandular cells. Cancerous or precancerous cells in the prostate gland are called prostatic intraepithelial neoplasia (PIN). Nearly 50% of all males over the age of 50 years have PIN. At first, the changes will be slow, and the cells will not be cancerous. However, they can become cancerous with time. Cancer cells can be high or low grade. High grade cells are more likely to grow and spread, while low grade cells are not likely to grow and are not a cause for concern
RISK FACTORS
Doctors do not know exactly why prostate cancer occurs, but the following risk factors may make it more likely:
• Age: The risk increases after the age of 50, but it is rare before the age of 45.
• Race or ethnicity: It is more common in black males than white males. Asian and Hispanic males have a lower risk.
• Family history: If a male has a close relative with a history of prostate cancer, they have a higher chance of developing it themselves.
• Genetic factors: Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk. Mutations in these genes increase the chance of breast cancer in females, too. Men born with Lynch Syndrome also have a higher risk of developing prostate and other cancers.
There is some evidence to suggest that other factors may play a role, but research needs more evidence to confirm their involvement:
• Diet (fatty foods)
• Obesity
• Smoking
• Exposure to chemicals, such as the herbicide agents
• Inflammation of the prostate
• Sexually transmitted infections
• Vasectomy
SYMPTOMS
There are often no symptoms during the early stages of prostate cancer, but screening can detect changes that can indicate cancer. Screening involves a test that measures levels of PSA in the blood. High levels suggest that cancer may be present.
Males who do experience symptoms may notice:
• Difficulty starting and maintaining urination
• A frequent urge to urinate, especially at night
• Blood in the urine or semen
• Painful urination
• In some cases, pain on ejaculation
• Difficulty getting or maintaining an erection
• Pain or discomfort when sitting, if the prostate is enlarged
Advanced prostate cancer can involve the following symptoms:
• Bone fracture or bone pain, especially in the hips, thighs, or shoulders
• Edema, or swelling in the legs or feet
• Weight loss
• Tiredness
• Changes in bowel habits
• Back pain
Treatment
Treatment will depend on the stage of the cancer, among other factors.
Early stage prostate cancer
If the cancer is small and localised, a doctor may recommend watchful waiting or monitoring by checking PSA blood levels regularly, but taking no immediate action. Prostate cancer grows slowly, and the risk of side effects may outweigh the need for immediate treatment.
Surgery
A surgeon may carry out a prostatectomy. They can remove the prostate gland using either laparoscopic or open surgery.
Radiation therapy
A doctor will implant radioactive seeds into the prostate to deliver targeted radiation treatment. Conformal radiation therapy: This targets a specific area, minimising the risk to healthy tissue. Another type, called intensity modulated radiation therapy, uses beams with variable intensities. Treatment will depend on various factors. Doctors will discuss the best option for the individual.
Advanced prostate cancer
As cancer grows, it can spread throughout the body. If it spreads, or if it comes back after remission, the treatment options will change.
Options include:
Chemotherapy: This can kill cancer cells around the body, but it can cause adverse effects.
Hormonal therapy: Androgens are male hormones. The main androgens are testosterone and dihydrotestosterone. Blocking or reducing these hormones appears to stop or delay the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most of the body’s hormones. Various drugs can also help. Most doctors do not recommend surgery in the later stages, as it does not treat cancer that has spread to other parts of the body. However, some experts have suggested that it may help in some cases.
New treatments
Some newer approaches aim to treat prostate cancer without the side effects that other treatment options can bring.
These include:
• Cryotherapy
• High intensity focused ultrasound
After surgery, a doctor will continue to monitor PSA levels.
Effects on fertility
The prostate gland plays a role in sexual reproduction. Prostate cancer and many of its treatments affect fertility in several ways. For example, if a male has surgery to remove either the prostate gland or the testicles, it will affect semen production and fertility. In addition, radiation therapy can affect prostate tissue, damaging sperm and reducing the amount of semen for transporting it. Hormonal treatment can also affect fertility.
However, some options for preserving these functions include:
• Banking sperm before surgery
• Extracting sperm directly from the testicles for artificial insemination
However, there is no guarantee that fertility will remain intact after treatment for prostate cancer. Anyone who would like to have children after treatment should discuss fertility options with their doctor when they devise their treatment plan.
STAGES OF PROSTATE CANCER
Knowing the stage of prostate cancer can help a person understand what to expect, and it will inform decisions about treatment.
1. Stage 0: Precancerous cells are present, but they only affect a small area and are slow growing.
2. Localized (stage 1): Cancer is only present in the prostate gland. Effective treatment is possible at this stage.
3. Regional (stages 2–3): Cancer has spread to nearby tissues.
4. Distant (stage 4): Cancer has spread to other parts of the body, such as the lungs or bones.
DIAGNOSIS OF PROSTATE CANCER
If a male has symptoms that may indicate prostate cancer, doctors indicate the following:
• Review symptoms
• Explore personal and medical history
• Conduct a blood test to assess PSA levels
• Carry out a urine test to look for other biomarkers
• A physical examination, which may include a digital rectal exam (DRE) During a DRE, the doctor will check manually for any abnormalities of the prostate with their finger.
• A PCA3 test: This looks for the PCA3 gene in the urine.
• A trans rectal ultrasound: This involves inserting a probe with a camera into the rectum.
• A biopsy: A doctor will take a tissue sample for examination under a microscope. Only a biopsy can confirm the presence and type of cancer.
PROGNOSIS
Males with early stage prostate cancer have a good chance of effective treatment and survival.
LIFE STYLE CHANGES TO HELP PREVENT PROSTATE CANCER
The adherence to the new World Cancer Research Fund (WCRF) lifestyle recommendations has been found to significantly reduce the risk of developing highly aggressive prostate cancer.
• Be as lean as possible without becoming underweight.
• Be physically active for at least 30 minutes every day.
• Avoid sugary drinks and limit the consumption of energy-dense foods.
• Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
• Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
• If consumed at all, limit alcoholic drinks to two for men and one for women a day.
• Limit consumption of salty foods and foods processed with salt (sodium).
• Do not use supplements to protect against cancer.
The best way to detect prostate cancer in the early stages is to attend regular screening. Anyone who has not yet attended screening should ask their doctor about their options.
