Prostate cancer is the most commonly diagnosed cancer in American men, excluding skin cancer. It is the second most common cause of cancer death in American men.
The walnut-shaped prostate gland is an important part of the male reproductive system: it secretes fluids that keep sperm moving. It is located between the rectum and the pubis, below the bladder.
When prostate cancer is detected early and is located only in the prostate, the chances of successful treatment are greater. If cancer has spread to other parts of the body, treatment may be more difficult.
Cancerous tumors are formed by cells that have undergone genetic mutations. These genetic changes cause the cells to grow very quickly. Over time, they form a mass that continues to grow and is called a tumor.
In some cases, the genetic mutation is inherited. Some cases of prostate cancer occur in men who have certain genetic mutations, such as in families where there are people with breast or ovarian cancer. However, most genetic mutations associated with cancer do not develop until after birth.
There are genes that do not directly cause cancer but make cells more vulnerable to carcinogens outside the cell.
There are also several factors that can increase or decrease the risk of mutation and thus cancer. Scientists believe that the following factors increase the risk of prostate cancer:
- Age: Increasing age, especially after age 65, is associated with an increased risk.
- Family history: A direct family history (father or brother) of prostate cancer doubles the risk (some families carry genetic mutations that increase the risk of prostate cancer).
- Ethnicity: Men of African descent are more likely to develop prostate cancer, while East Asian men are less likely.
- Geography: Prostate cancer is rare in Asia, Africa, and South America.
- Diet: A diet high in red meat and fat and low in fruits, vegetables, and fiber is associated with an increased risk.
- Smoking: People who smoke have a higher risk of developing prostate cancer and a worse prognosis after diagnosis.
- Bodyweight, physical inactivity: Overweight and inactive men are more likely to develop prostate cancer.
Nutrition is considered a crucial factor in prostate cancer. The fact that African men are much less likely to develop prostate cancer than African-Americans suggests that diet and lifestyle play a role in the development of the disease. Research has shown a link between diets high in saturated fat and prostate cancer. Some experts believe that insufficient fruit and vegetable consumption is the cause; men who eat high-fat foods are more likely to develop cancer because they eat fewer vegetables. In addition to fat, a very high calcium intake has also been linked to prostate cancer.
On the other hand, certain foods are thought to protect against prostate cancer. Tomatoes, grapefruit, and watermelon all contain lycopene, a substance that has been conclusively linked to a lower risk of prostate cancer.
Numerous studies have also shown a protective effect from vitamin E, selenium, and cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and Chinese cabbage. If you are considering supplementing your diet with these elements, we recommend that you first consult your doctor or pharmacist. For example, taking high doses of zinc supplements (more than 100 mg per day) may increase the risk of developing the condition.
Symptoms and Complications
In general, prostate cancer tumors are small and produce no symptoms. Therefore, most of these tumors are not discovered until blood tests or surgical treatment of benign prostatic hyperplasia, which often has obvious symptoms.
Large tumors in advanced stages put pressure on other organs, such as the bladder, causing incontinence or making urination difficult or painful. The urinary problems associated with prostate cancer are due to the fact that the urethra (the tube through which urine leaves the bladder) passes through the prostate. These tumors also disrupt the activity of the nerves that initiate erection, causing erectile dysfunction.
At an advanced stage, tumors can also cause the following symptoms:
- Pain due to pressure on the spine or pelvis
- Pain or stiffness in the lower back, hips, or thighs.
- Pain or burning when urinating
- Frequent urination
- Pain with ejaculation
- Blood in urine or semen
When tumor cells enter the bloodstream, they can migrate to other parts of the body and begin dividing to form new tumors. This migration is called metastatic spread and the new tumors are called metastases. Metastatic cancer can cause pain in other parts of the body.
Cancer cells released by the tumor can travel in the bloodstream, but they can also travel in the lymphatic system, a network of vessels in which lymph, a clear fluid containing waste products and immune cells, circulates. This allows the cancer cells to reach the lymph nodes and other organs. In prostate cancer, the lymphatic system is the main vehicle for metastasis. Secondary tumors can form anywhere in the body, such as the lungs, brain, or lymph nodes. However, they are more likely to spread to the bones.
The test for prostate cancer is called the prostate-specific antigen (PSA) test. PSA is normally produced by prostate cells and PSA levels can be measured in a blood sample. Men with prostate cancer often have higher than normal PSA levels. However, it can be high in non-cancerous conditions, and low in prostate cancer. Therefore, the test may need to be repeated to confirm the results. If several tests show high PSA levels, the doctor may order a biopsy. As men age, the PSA test becomes less reliable for diagnosing prostate cancer. Ask your doctor if you should have a PSA test done.
The doctor may also perform another test, the digital rectal exam, in which the prostate is palpated with a gloved finger. If palpation reveals an abnormality or if the PSA level is high, the doctor will order a needle biopsy, in which cells are removed from the prostate using 10 to 12 punctures with a biopsy gun. Handling the biopsy gun is made easier by transrectal ultrasound, which provides an image of the prostate. The doctor may also order a biopsy of the lymph nodes to see if cancer has spread. This can cause severe but temporary pain. In some cases, the doctor may freeze the area to reduce the pain.
If the results indicate cancer, a urologist will evaluate the size, stage, and grade of the tumor. This information will guide the choice of cancer treatment.
Treatment and Prevention
Compared to most other cancers, prostate tumors grow slowly, often over a period of 10 years or more, and in a non-aggressive way. They also often appear late in life. Especially in older men, small tumors are left untreated. The doctor then has to check regularly to make sure that the cancer is not developing faster than expected. This process is called “active surveillance.”
However, when cancer invades structures other than the prostate, anti-cancer drugs and painkillers should be given.
When the cancer is still confined to the prostate, surgical treatment or radiation therapy is used.
Radiation therapy is often a treatment option. Your doctor may use an external beam of radiation or radioactive seed implants that are inserted into or near the prostate through surgery to destroy cancer cells. Experts are investigating new ways to use radiation therapy, as well as new treatments that use hormones and radiation therapy at the same time.
If surgery is recommended, the classic procedure is a radical prostatectomy, which is the total removal of the prostate gland. The surgeon makes an incision in the abdomen or between the anus and scrotum to remove the prostate. This method has the best chance of curing prostate cancer.
Prostate removal can have significant consequences, including impotence and incontinence. After surgery, the ability to have an erection depends on whether there is damage to the nerves around the prostate. Sometimes the nerves are affected by cancer and need to be cut. Sometimes the doctor decides to leave these nerves in place, but impotence still occurs. You should discuss the possibility of nerve-sparing surgery with your doctor.
When choosing the best treatment, your doctor and patient should discuss the risks and benefits of each option. Both treatment options can cause complications such as bladder irritation, sexual dysfunction, and anal incontinence, and the decision should be based on the extent of cancer, the patient’s health condition, and his or her preferences.
Sometimes cancerous tissue is destroyed with a cold probe (cryosurgery) that freezes the tissue. This technique can also lead to impotence. This procedure is fairly new, and it is not yet known whether its long-term effectiveness is as good as that of radical prostatectomy.
Hormone therapy is used to lower levels of the male hormones, particularly testosterone, or to prevent these hormones from acting on cancer cells. Prostate cancer cells need androgens to multiply. Hormone therapy also helps reduce the size of the prostate. This method does not cure cancer, but it can slow the growth of the tumor and may be helpful before surgery, especially cryosurgery. Instead of drug treatment, some men opt for orchiectomy (removal of the testicles) to lower their testosterone levels.
Hormone and radiation therapy are often given together to patients whose cancer continues to spread or recurs after surgery. Chemotherapy may be used to treat prostate cancer when hormone therapy is no longer effective.
Your doctor will explain the different treatment options, depending on the size, type, and location of the tumor.
If you are worried about having prostate cancer, see your doctor for a PSA test and digital rectal exam.
Our Doctor’s Opinion
Screening for prostate cancer by digital rectal examination (DRE) and prostate-specific antigen (PSA) testing is a highly controversial topic in the medical community.
This controversy is fueled primarily by the fact that studies have not shown that screening increases life expectancy or reduces prostate cancer mortality.
The PSA test result is difficult to interpret, especially if it is positive. Therefore, an abnormal result almost always means that a biopsy is needed, with all the possible concerns and complications that it could lead to, not the least of which is the pain associated with the procedure.
The results of the biopsy can be used to assess whether or not the tumor is developing rapidly. In most cases, the biopsy will find a tumor that is growing slowly. In this situation, many men still opt for a total prostatectomy, exposing themselves to significant complications such as urinary incontinence and impotence. Several studies have confirmed that the risks of overdiagnosis and overtreatment of the disease are real. However, in rare cases where the tumor is likely to develop rapidly, early detection can have significant benefits.
Of course, if you are faced with the difficult question of whether or not to screen, you must consider your own values and risk tolerance.
My advice is that if you don’t have symptoms of prostate disease (such as difficulty urinating, a decreased urine flow, or getting up several times a night to urinate) and don’t have a family history of prostate cancer, you should discuss the pros and cons of screening with your doctor. But if you have symptoms, I think it’s clear that you should get tested.
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