Prostate Cancer: Risk Factors, Signs & Symptoms, Screening & Diagnosis, and Treatment

Prostate cancer is the second most commonly diagnosed cancer in men in the United States. It is also the third leading cause of cancer death in males. There are more than 27,000 deaths from this cancer annually. 

The primary tumor does not cause all these deaths. It is the formation of distinct metastatic tumors that cause them. That means that the prevention of metastasis is the best thing to do.

The risks in black men are about 74 percent higher than in Caucasian men. A recent analysis of prostate cancer autopsy discovered that among men aged between 70 and 79, the tumor was in 51 percent of Africa-Americans and 36 percent of Caucasians. 

What is Prostate Cancer?

The prostate is a walnut-sized gland in men that is next to the bladder. Cancer that develops in this gland is known as prostate cancer. Not all growth that begins in this gland causes cancer. It can either be Benign or Malignant. 

Benign growths are not cancerous and are rarely a threat to the patient’s life. They also don’t invade and spread to the tissues around. Benign growths usually don’t grow back after their removal.

Malignant growths in this gland are the ones that cause prostate cancer. They can be a threat to the patient’s life and can also invade and spread to the other parts of the body. When traveling through lymph nodes and blood vessels, the cancer cells attach to other tissues and grow to form new tumors. The new tumor has the same abnormal cells from the primary (prostate) tumor. If it spreads to the bones, the cancerous cells in the bones are prostate cancer cells. Cancer that forms in the bones from prostate cancer cells is known as metastatic prostate cancer, but not bone cancer. Doctors will also treat it as prostate cancer in the bone, but not bone cancer.

Causes & Risk Factors

No one knows the exact cause of prostate cancer or how it starts. Some autopsy studies are showing that one in every three men have some cancer cells in the prostate. Approximately 80 percent of all the autopsy cancers are small and less likely to cause any trouble. 

What are the risk factors of prostate cancer?

Even though the exact cause of prostate cancer is unknown, researchers are associating it with many risks. Any man can get prostate cancer, but some factors can increase the chances either directly or indirectly. Knowing these risk factors and talking about them if you have with your doctor can help you start making more informed lifestyle choices. Here are some of the factors that can increase a man’s risk of getting this type of cancer:

1. Age

Age is not just a number. The older you get, the more vulnerable you are to many chronic diseases. Prostate cancer risk also increases with age. These risks start doubling after you pass the 50 years mark. According to Cancer.Net, approximately 60 percent of all cases of this type of cancer are diagnosed in men above 65 years old.

2. Family history

Prostate cancer (familial prostate cancer) can run in family. Approximately 20 percent of all prostate cancer cases are familial prostate cancers. If three or more of your first-degree relatives have this type of cancer, your risk of developing it is three times higher than the average risk. The risk can increase as the number of your close relatives from the same side of the family who have prostate cancer and are below 55 years old increases. 

Men from families with Hereditary Breast and Ovarian Cancer (HBOC) syndrome cases are at a slightly higher risk of this cancer. Studies are associating HBOC syndrome with DNA repair mutations to the BRCA1 and BRCA2 genes. If you have  BRCA1 or BRCA2 mutations, you should consider screening for this type of cancer at an early age. Talk to a genetic counselor for more information.

3. Agent Orange Exposure

Agent Orange was a tactical chemical that was used in the Vietnam War. Veterans exposed to this chemical are at higher risks of developing prostate cancer and other types of cancer. If you are one of them, you should talk to your doctor in the VA system as soon as possible.

4. Race

More Black American men and other African ancestry men above 55 years old are diagnosed with this type of cancer than those in other races. Black men are also more likely to die from prostate cancer than Caucasian men.

5. Smoking

Prostate cancer risk is two times higher in heavy smokers. Smoking also increases the chances of dying from this disease. Quitting smoking can lower your prostate cancer risk to the same level of nonsmokers of your age.

6. Location

Prostate cancer cases are high in northern Europe and North America. These cases are also high in Asian men living in urbanized environments like Hongkong and Singapore. These cases are higher in men whose lifestyle doesn’t have many physical activities and don’t eat healthy diets.

Diet and lifestyle

Your diet and lifestyle can either increase or lower your cancer risk. If your diet is rich in refined sugar, animal fat, and cholesterol, your prostate cancer risk is higher than that of men who eat more fruits and vegetables. Obese men are also more likely to die from this cancer. Exercising regularly and losing excess weight can help lower the risks.

Signs & Symptoms 

Prostate cancer is less likely to show any symptoms during its early stages. If symptoms occur, they are similar to those of Benign Prostatic Hyperplasia (BPH) or an enlarged prostate. Not all signs of prostate cancer are similar to BPH. 

What are the common symptoms of prostate cancer?

Some of the symptoms and signs of advanced prostate cancer include:

  • Trouble urinating (weak urine flow, burning, or sensation)
  • Blood in semen
  • Blood in urine
  • Erectile dysfunction
  • Painful ejaculation
  • Bone pain (lower back, upper thighs, and hips)
  • Loss of appetite
  • Weight loss 

Screening & Diagnosis

Image result for prostate cancer screening

Screening refers to looking for cancer cells before you start getting symptoms. The primary goal of cancer screening is to lower the number of cancer deaths. Regular cancer screening can help find this type of cancer in its early stages, which increases the chances for a successful treatment. You should get screening for this type of cancer if you are a man:

  • With a family history of prostate cancer
  • African-American
  • Between 55 to 69 years old

The two screening for prostate cancer are:

  • PSA blood test: A PSA blood test can help detect prostate cancer in its early stages. That can help you get the treatment need before cancer spreads to other parts of the body. 
  • Digital Rectal Examination (DRE): Doctors insert a lubricated, gloved finger in the patient’s rectum. That helps them feel the surface of the prostate gland for any irregularity.

Diagnosing prostate cancer

There are many tests that doctors can perform to find or diagnose cancers. Apart from testing whether you have prostate cancer or not, doctors are also able to check whether it has spread to other parts of the body or not. 

If screening shows any abnormality, your doctor will recommend more tests to be sure whether you have the cancer or not. Some of these tests include:

1. Transrectal ultrasound

The doctor will insert a probe into your rectum. A probe is a small medical device (about the size of a cigar) that sends out high-energy sound waves. These sound waves are bounced off internal tissues to make echoes or a computer picture (sonogram) of the prostate gland. 

2. Biopsy

After a transrectal ultrasound, your doctor may order a biopsy. That does not mean that you have cancer. Your doctor wants to determine the cause of the irregularities in your prostate glands.

The doctor will give you local anesthesia and then insert an ultrasound tool before passing a thin needle through the rectum into the prostate glands to collect sample tissues. To avoid the risks associated with this transrectal biopsy, some doctors prefer transperineal prostate biopsy instead. In this case, the doctor will insert a thin needle into the prostate gland through the perineum to collect biopsy samples.

After sample collection, a pathologist analyses it under a microscope to determine the cause of the irregularities. The pathologist will be able to know whether cancer cells are present or not.

3. Imaging Tests

Imaging tests help determine whether cancer has spread to other parts of the body. Prostate cancer can spread into nearby tissues and organs like the bladder, seminal vesicle, lymph nodes, bones, lungs, and other organs. The doctor can also order a CT scan, bone scan, Computerized tomography (CT) scan, Positron emission tomography (PET) scan, and Magnetic resonance imaging (MRI) to determine whether prostate cancer has spread or not.

Determining whether prostate cancer is aggressive or not?

After biopsy tests confirm that you have prostate cancer, the next thing to determine its grade or aggressiveness. The pathologist examines the sample further to determine how many cells differ from healthy cells. The more abnormal cells in the biopsy sample, the more aggressive the cancer is or the higher the grade. 

Pathologists use two techniques to determine the aggressiveness of cancer cells:

  • Gleason score: This grading system is based on how many cancer cells look like healthy cells under a microscope. The less aggressive tumors look similar to healthy body tissues. Depending on cell arrangement in the sample, the pathologist will assign a score of 3 to 5. The pathologist also looks at the pattern of cell growth and assigns another score of 3 to 5. The pathologist then combines the two scores to get an overall score of between 6 to 10. The higher the overall score, the more aggressive the tumor. Low-grade scores also mean that the cancer is less likely to spread to other parts of the body.
  • A Gleason score of X means that the pathologist was unable to determine the score. A score below 6 means that the cells look similar to healthy cells. 
  • Genomic testing: A genomic test determines the gene mutations present in prostate cancer cells. The test result helps the doctor predict the development of the disease. Information about your prognosis can help when making treatment decisions. 

Treatment

There are many treatment options for prostate cancer. The best treatment depends on factors like:

  • the patient’s overall’s health
  • how fast the disease is growing or spreading
  • potential side effects of the treatment

Why you might not require immediate treatment

Some prostate cancer patients might not require immediate treatment. The treatment may also not be needed at all in some patients. It all depends on the patient’s Gleason score. 

If you have low-grade prostate cancer (Gleason 6 or 7), your doctor might recommend active surveillance. Your doctor will recommend active this if: 

  • the cancer is not showing symptoms 
  • doctors expect it to grow slowly and in a confined area

In active surveillance, your doctor will be performing regular rectal exams, blood tests, and biopsies to monitor the progression of the disease. The doctor will recommend surgery or radiation when the cancer starts progressing.

Prostate cancer treatment options

1. Radiation therapy

Radiation therapy is the use of high-powered energy to kill cancerous cells. There are two types of radiation therapy for prostate cancer treatment:

  • External beam radiation: In this type of radiation therapy, the patient lies on a table with a machine suspended on top. The machine directs energy beams (protons or X-tray) to the prostate glands to kill the cancerous cells. This type of radiation is the best for prostate cancer that is yet to spread to other parts of the body. If cancer has already spread to other parts of the body like bones, this type of treatment can only slow the growth and relieve the symptoms but not treat it. 
  • Brachytherapy: In this type of radiation therapy, doctors insert rice-sized radioactive seeds in prostate tissue. These seeds deliver a low dose of radiation to the tumor and can last for years. It is best if cancer has not spread to other parts of the body. 

2. Hormone therapy

Hormone therapy for this type of cancer stops the body from producing testosterone hormone. That helps slow the growth and development of prostate cancer. Doctors recommend this type of treatment to patients with a Gleason score of 8, 9, or 10. 

There are different hormonal therapy treatment options for prostate cancer. It can be drugs to prevent testosterone from reaching the cancerous cells, medications to stop the productions of testosterone hormone, or surgery to remove the testicles. 

3. Chemotherapy

Chemotherapy is the use of medications to kill rapidly growing cancerous cells. Your doctor can either prescribe certain pills or administer chemotherapy through a vein in your arm. Chemotherapy is one of the best options if cancer is spreading to nearby tissues or organs. Your doctor can also recommend chemotherapy if your cancer doesn’t respond to hormonal therapy. 

4. Targetted drug therapy

Targetted drug therapy works on specific abnormalities that are present in cancer cells. Blocking these abnormalities causes cancer cells to die. Your doctor will recommend this type of treatment if hormonal therapy is not working or you have recurrent cancer. 

5. Surgery

A radical prostatectomy (removal of the prostate gland) and the surrounding tissue can help treat cancer confined in the prostate. Prostatectomy can also be done in combination with other treatment options for advanced prostate cancers. 

Check out our article on better ways of preventing cancer

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