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According to the World Cancer Research Fund International, prostate cancer is the second most common cancer in men worldwide and the 4th most common cancer overall. There were more than 1.4 million new cases of prostate cancer in 2020.
Unfortunately, many with this condition do not realise until it is too late, like my late uncle, Dickson Ayomide (pseudonym), who was unaware of his prostate cancer until it reached its final stage, ultimately leading to his death.
This article examines prostate cancer and its intricacies to mark Prostate Cancer Awareness Month (September).
What is Prostate cancer?
Prostate cancer is the abnormal and uncontrollable growth of the prostate. The prostate can be defined as a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm.
This common cancer does not cause noticeable symptoms in its early stages; however, as cancer progresses, it can lead to various symptoms such as trouble urinating, blood in the urine or semen, urgent need to urinate, especially at night, loss of bladder control, loss of bowel control, painful ejaculation and erectile dysfunction, pain in lower back, hip or chest, bone pain, unexpected weight loss and unexplained fevers.
While the exact cause of prostate cancer remains unclear, several risk factors, including age, family history, and genes, play a role.
What are the causes of prostate cancer?
Medical professionals are yet to pinpoint the exact triggers behind the transformation of prostate cells into cancerous ones. But like other cancers, prostate cancer happens when cells grow faster than they should. Unlike normal cells that eventually die off, cancer cells keep multiplying, reproducing and aggregating to form a lump called a tumour. As they grow, bits of the tumour can break off and spread to other body parts, known as metastasis.
Factors that can increase your risk of prostate cancer include
- Age
The risk of developing prostate cancer increases with age, and it becomes more common after the age of 50. Approximately 60% of prostate cancer cases are diagnosed in individuals over 65
- Ethnicity
Black or African individuals have a higher incidence of prostate cancer than individuals of other racial backgrounds. Moreover, this group is more prone to developing aggressive prostate cancer and may develop the disease before reaching the age of 50
- Family history
If you have a close blood relative (such as a parent, sibling or child) diagnosed with prostate cancer, your risk may be elevated. Additionally, if your family carries gentile mutilation associated with an increased risk of breast cancer, such as BRCA1 or BRCA2 or a strong family history of breast cancer, your likelihood of developing prostate cancer may be higher.
- Obesity
Obesity is associated with a potential increase in the risk of prostate cancer, although research findings in this regard have been somewhat inconclusive. In obese individuals, the cancer may be aggressive and more likely to recur following initial treatment.
What are the types of prostate cancer?
There are several types of prostate cancer, but most cases are adenocarcinomas. Here are some primary types of prostate cancer.
- Adenocarcinomas
The most common type of prostate cancer, accounting for approximately 95% of all cases. Adenocarcinoma is used as a classification for cancer. It is a type of cancer that occurs in the glands that line the insides of an organ. E.g. breast, prostate, Oesophagus etc. It originates in the gland cells that line the prostate gland and the tubes of the prostate gland. Gland cells make prostate fluid.
There are two types of prostate Adenocarcinomas: acinar adenocarcinomas of the prostate and ductal adenocarcinomas of the prostate. Acinar adenocarcinomas are the most common type of prostate cancer that develops in the gland cell that lines with the prostate gland. Ductal adenocarcinomas start with the cell that lines the ducts of the prostate gland. It tends to grow and spread more quickly than acinar adenocarcinoma.
- Transitional cell carcinoma of the prostate
Transitional cell carcinoma of the prostate starts in the cells that line the tube carrying urine to the outside of the body (the urethra). This type of cancer usually starts in the bladder and spreads into the prostate. But rarely, it can start in the prostate and may spread into the bladder entrance and nearby tissues. This is sometimes called urothelial carcinoma of the prostate. Between 2 and 4 out of 100 prostate cancers (between 2 and 4%) are this type. This classification is made because it may not originate in the prostate but ultimately spread there.
- Squamous cell carcinoma of the prostate
These cancers develop from flat cells that cover the prostate. They tend to grow and spread more quickly than adenocarcinoma of the prostate. These cells are of different types. The cell type in the prostate is called the squamous cell type. Gland cells are called squamous because they are flat.
- Small cell prostate cancer
This is a rare type of prostate. Less than 2 in every 100 prostate cancers (less than 2%) are small cell prostate cancer. They can also be classed as a type of neuroendocrine prostate cancer. Small cell prostate cancers are very different from the most common type of prostate cancer. They grow more quickly than other types. Most people with small cell prostate cancer have advanced cancer by the time they are diagnosed. This means the cancer has spread to other body parts, such as the bones.
What are the strategies for preventing prostate cancer?
- Diet
A diet rich in fruits, vegetables and lean proteins can significantly lower the risk of prostate cancer because they contain lycopene, a powerful antioxidant. Additionally, one should reduce the consumption of red and processed meat, as they have been linked to an increased risk. Also, maintaining a healthy weight through a balanced diet can lower this risk.
- Exercise
Regular physical activity helps maintain a healthy weight and reduces the risk of prostate cancer. Aim for at least 150 minutes of moderate weekly exercise, such as brisk walking and cycling.
- Avoid smoking and alcohol
It is good to avoid smoking as it increases the risk of aggressive prostate cancer. Limiting alcohol consumption is also advisable as excessive drinking can raise the risk of this common cancer.
- Testing and counselling
Men with a family history of prostate cancer should consider genetic counselling and screening, especially those with close relatives diagnosed at a young age. Men should discuss prostate cancer screenings with health care providers, typically starting at 50, and those with a family history of prostate cancer should consider screenings earlier, around age 45. Screenings often involve a Prostate- Prostate-specific antigen [PSA] blood test and a Digital Rectal Exam[DRE]. These tests can detect abnormalities in the prostate gland and help diagnose cancer at an early stage where treatment is most successful. Understanding your genetic risk can aid in adjusting prevention and screening strategies.
- Promoting awareness
It is essential to raise awareness about prostate cancer. This can be done by encouraging regular checkups and open discussions with healthcare providers. Also, sharing information about prevention strategies with friends and family to help others make informed choices.
- Dietary supplements
Some dietary supplements, such as vitamin D and selenium, have shown potential benefits in prostate cancer prevention. It is essential to consult with your healthcare provider before adding supplements to your routine, as they may have side effects.
What are the stages of prostate cancer?
There are four stages of prostate cancer, with stage one being the earliest and stage four being the most advanced. In stage one, the cancer is small and only present in the prostate gland. In stage two, the cancer has grown larger but remains confined to the prostate gland. In stage three, the cancer has spread beyond the prostate gland to nearby tissues, such as the seminal vesicles. In stage four, the cancer has spread to other body parts, such as the bones or lymph nodes. Treatment options for prostate cancer depend on the cancer stage and may include surgery, radiation therapy, chemotherapy, hormone therapy, or a combination of these approaches. Men need to talk to their healthcare provider about their risk for prostate cancer and the appropriate screening tests to detect it early.
How can prostate cancer be treated?
The treatment of prostate cancer depends on several factors, including the cancer stage, the tumour’s aggressiveness, the patient’s age, and overall health and personal preferences. Here are some standard treatment options for prostate cancer:
- Active surveillance
Active surveillance may be recommended for low-risk prostate cancer, especially in older men. This involves close monitoring of the cancer’s progression through regular prostate-specific antigen (PSA) tests, digital rectal exams, and periodic biopsies. Treatment is deferred until there is evidence that the cancer is becoming more aggressive. The treatments can cause side effects, such as erectile dysfunction, which is the inability to get and maintain an erection of the penis and incontinence, which is when urine flow or bowel cannot be controlled.
- Surgery:
Surgical removal of the prostate gland, a radical prostatectomy, is a common treatment option for localised prostate cancer. This can be done using traditional open surgery or minimally invasive techniques like laparoscopic or robot-assisted surgery.
- Radiation therapy
Radiation therapy uses high-energy X-rays or forms of radiation to target and kill cancer cells. There are several types of radiation therapy, including external beam radiation and brachytherapy ( implantation of radioactive seeds). Radiation therapy can be used as a primary treatment or after surgery to eliminate any remaining cancer cells.
- Hormone therapy
Male hormones, particularly testosterone, often drive prostate cancer growth. Hormone therapy, also known as androgen deprivation therapy (ADT), aims to reduce the levels of these hormones in the body or block their effects on cancer cells. It can be used alone or in combination with other treatments.
- Chemotherapy
Chemotherapy involves using drugs to kill cancer cells or slow their growth. It is typically used when prostate cancer has spread to other body parts or is no longer responsive to hormone therapy. It can be administered through a vein in your arm, in pill form or both.
- Targeted therapy
Targeted therapies are drugs that specifically target specific molecules or pathways involved in cancer growth. Some target therapies are used in advanced prostate cancer, especially when other treatments fail.
- Immunotherapy
Immunotherapy drugs stimulate the body’s immune system to recognise and attack cancer cells. Some immunotherapies have shown promise in the treatment of advanced prostate cancer.
- High-intensity focused ultrasound (HIFU)
This minimally invasive procedure uses focused ultrasound waves to heat and destroy prostate cancer cells. It is often considered for localised prostate cancer.
- Cryotherapy
This involves freezing and destroying the prostate tissue, including cancer cells. It may be an option for localised prostate cancer, particularly in patients who cannot undergo surgery or radiation therapy.
- Bone-Directed Treatment
If prostate cancer has spread to the bones, bone-directed treatments like bisphosphonates or denosumab may be used to reduce the risk of bone complications and relieve pain.
NOTE: Treatment choice depends on the individual patient’s circumstances and should be discussed with a multidisciplinary team of healthcare professionals, including urologists, radiation oncologists, medical oncologists, and other specialists. Patients need to consider each treatment option’s potential benefits, risks and side effects and make an informed decision based on their unique situation.
Expert opinion
A consultant urologist at Kirkland Lake and District Hospital, Ontario, Dr Emmanuel Abara, said prostate cancer can be asymptomatic even when advanced or has metastasised.
Besides the symptoms of obstruction, like frequent micturition, hesitancy, straining, poor urine stream, Nocturia, blood in urine, blood in semen, unexplained weight loss, erectile dysfunction, and low back pain, the cause of prostate cancer is unknown. Risk factors that can lead to prostate cancer include men 50 years and above, higher in blacks, Positive family history of prostate cancer, and Obesity.
Lifestyle changes that can reduce the risk of prostate cancer include healthy (fruits, vegetables ) eating, exercise, and Weight control, and some pills have been recommended (5-alpha reductase inhibitors). Complications can be from disease or treatment -metastasis, erectile dysfunction, urinary incontinence.
Laparoscopic surgery has fewer complications than open surgery, Gamma knife radiotherapy has fewer side effects than conventional radiotherapy, and Cytotoxic drugs affect other normal cells in the body.
Conclusion
Prostate cancer is a widespread and deadly condition, often presenting subtle symptoms or none in its early stages, thus requiring increased awareness, regular screenings, and a healthy lifestyle.
