OverviewProstate cancer is a cancer that develops in a man’s prostate, a gland located under the bladder and involved in the formation of seminal fluid. Although there are records of aggressive prostate cancers that spread quickly, the majority of these tumours grow very slowly, to the point that a man can die of old age without ever knowing he had it.
Prostate cancer is one of the most common types of cancer in men and it usually develops after the age of 50. It is more frequent in the developed countries, with rates of occurrence increasing in the developing countries as well. The causes underlying the prostate cancer are not known with certainty, but a number of risk factors have already been identified.
In its early stages, prostate cancer presents with no symptoms at all and the diagnosis at this point is often incidental, usually happening after a routine blood or urine tests. However, the symptoms of prostate cancer do exist but they may be mistakenly taken for by symptoms of benign prostatic hyperplasia, a non-cancerous disease of the prostate. Such symptoms include:
- A need to urinate more often than usual. The patient even wakes up frequently at night to urinate
- Trouble to start urinating and to keep urinating once it has started
- Decreased force in the stream of urine
- Pain during urination
- Blood in urine
- Blood in semen
- Erectile dysfunction
- Bone pain
- Pain in the lower back, thighs or hips
- Discomfort in the pelvic area
All men are at risk for developing the prostate cancer and about 80% of men with 80 years of age or older will have cancerous cells in their prostate. Risk increases greatly after the age of 50 for men with no family history of the disease. Several other factors contribute to the risk of having prostate cancer:
- Family history: the risk for prostate cancer may be higher if there is a family history of this disease
- Being of black ethnicity: the risk for developing the prostate cancer and/or having a more aggressive cancer is higher in black men, although there is no explanation for this yet
DiagnosisIn the absence of symptoms, the diagnosis of prostate cancer can be made in the sequence of routine examinations. The doctor may perform a digital rectal exam, in which he feels the prostate through the rectum to identify the presence of any nodules or lumps. He can also order blood tests for the quantification of a substance produced by the prostate, the prostate-specific antigen (PSA).
Abnormal findings in these procedures can suggest the presence of cancer, which must be confirmed using other techniques.
Imaging methods, such as the ultrasound and the MRI, are used to locate and characterize the tumour. These tests are usually paired up with a biopsy, which involves taking a small sample of prostate tissue. Prostate cells are analyzed under a microscope for the presence of cancer-like features and this is the only way the diagnosis of prostate cancer can be confirmed.
If the cancer is small and confined to a specific area, the following approaches can be used:
- Surveillance - Active surveillance, in which no treatment is employed and close observation and testing of the patient is maintained. The goal of this approach is to avoid overtreatment in cases that don’t cause any serious problems to the patient. Many prostate tumours take decades to reach the stage when they really become dangerous.
- Surgery - Surgical removal of the prostate (a procedure called radical prostatectomy)
- Radiotherapy - Radiotherapy, including traditional radiotherapy and brachytherapy, in which the source of radiation is placed directly in the prostate to avoid unnecessary damages to the surrounding healthy tissues
The best course of treatment depends on the stage of the disease and the general health of the patient. Nowadays, the treatment and management of prostate cancer is much more successful than it used to be in not so distant past, and the majority of patients can expect to live a long and healthy life upon the treatment completion.