Prostate Cancer: Causes, Diagnosing and Treating
General Description and Symptoms
Prostate is a small gland in a man’s body that is shaped like a walnut. It fulfils the purpose of producing seminal fluid. Prostate cancer is known as one of the most common cancer types in men. Normally, the progression of cancer is rather slow and it is limited to the interior of the gland for a long time. However, sometimes it further develops and spreads very quickly. In such cases, prostate cancer demands urgent treatment, as it poses a great amount of danger. When it is discovered in its early developmental stages, there is a high possibility of successful treatment. If the cancer has already spread outside the prostate, it is more dangerous, and potential treatment might not be as effective.
Sometimes prostate cancer is not easy to diagnose, as it doesn’t show any initial (early) symptoms. When a patient starts to feel symptoms, the cancer will often have progressed to its late developmental stages, when treating it becomes more difficult and less likely to succeed.
If you find yourself experiencing one or more of the symptoms below, do not hesitate to consult your medical practitioner, as it might be prostate cancer:
- erectile dysfunction
- difficult or painful urination
- the stream of urine has become smaller and slower
- aching bones
- blood in the semen
- discomfort or pain in or around your pelvis
What Causes Prostate Cancer?
Unfortunately, modern medical science is still unable to give a full answer to this question. It is known that at some point, a number of cells in a man’s prostate become abnormal due to mutations that occur in their DNA. They grow and multiply much faster than normal cells do. They can also function longer than normal cells. As a result, the number of such mutated cells increases, sometimes very rapidly. After some time, they grow into a separate formation which then becomes a tumor. It is capable of invading other, normal tissues and doing damage to them. Some mutated cells will separate from the tumor and move around the body with the blood flow. They act in the same way as the original mutated cells do, forming new tumors in other organs.
Through observation of numerous patients, medical practitioners have been able to define some risk factors, which increase the probability of a man experiencing prostate cancer:
Prostate cancer is not very common in men aged under 40. However, it becomes rather prevalent in the 50+ age group.
If your father or brother is/was suffering from prostate cancer, you’re more likely to have it too. The probability increases even more if it is your twin brother who was diagnosed with prostate cancer. In some recent studies, medical scientists were able to identify the gene that is responsible for faster prostate cancer development in men. However, there is heated debate as to whether these men should be given more intense treatment than those who don’t have the gene, as it is still unknown whether it has any substantial impact or not. Having women who suffered from breast cancer in your family increases your risk as well.
If your skin is black, you’re at a higher risk of developing prostate cancer later in life than white men. Chances also are that the cancer will be more aggressive and spread faster than in white men. The reason behind this phenomenon remains unclear.
Obesity and diet
It has been observed that obese men are more likely to have aggressive, dangerous prostate cancer than thin men. This was proved by a study, which also found that obese prostate cancer patients usually outnumber thinner ones. Obesity is closely linked to another significant factor – diet. Studies have found that certain diets, such as the Mediterranean diet, are capable of reducing the risk of experiencing prostate cancer. Medical practitioners recommend eating large amounts of fruit and vegetables while avoiding too much red meat, as well as exercising regularly. That contributes to a healthy lifestyle, which is beneficial both to those who already suffer from prostate cancer and those who want to minimize their chances of developing it.
It is often observed that prostate cancer patients had been previously diagnosed with gonorrhoea or, less frequently, with other sexually transmitted diseases. Consequently, you’re facing a bigger risk of prostate cancer if your medical history features one or more STD. What’s more, certain medicines are known to reduce or increase a man’s chances of developing prostate cancer. For example, regular usage of anti-inflammatory medications can contribute to prostate cancer, while pharmaceuticals that reduce the amount of cholesterol in blood have the additional benefit of lowering one’s chances of being diagnosed with prostate cancer.
There are also some additional factors, which haven’t been studied well. For instance, according to statistic data, Vietnam War veterans who were exposed to Agent Orange are at greater risk of developing prostate cancer than those who had no contact with the chemical. Furthermore, if such veterans have recurring prostate cancer, it is a lot more likely to be more aggressive and develop much faster than in people who weren’t exposed to Agent Orange.
Diagnosing Prostate Cancer
It is possible to screen men for prostate cancer by implementing two tests which give rather precise results. However, there is no evidence that screening is capable of reducing one’s risk of dying of prostate cancer. At the same time, there are claims of men dying from complications after screening procedures (for example, biopsy). Because of those claims, some medical organizations are reluctant to recommend prostate cancer screening for all men. It is sometimes recommended for those men who are older than fifty and those who are at greater risk from one of more factors.
It is essential that you discuss the issue with your healthcare provider and make a conscious decision whether you’d like to be screened for prostate cancer on a regular basis or not. The most commonly used screening procedure is digital rectal exam (or DRE). During the exam, the doctor inserts a finger into the patient’s rectum to gain access to the prostate and examine (palpate) it. Should the doctor detect any abnormalities, a prostate-specific antigen (PSA) test might be recommended. Normally, the prostate produces a small amount of PSA. An increase in the amount means that there is a risk of prostate cancer or prostate inflammation. To detect the PSA in a man’s body, a sample of blood is taken from the vein in his arm.
If both tests show positive results, the healthcare provider should consider additional tests, such as an ultrasound test or biopsy. During the ultrasound test, a special device that resembles a cigar in size and shape will be inserted into your rectum, so that it can produce an image of your prostate using ultrasound waves. Biopsy is usually done by means of inserting a thin needle into the prostate to collect tissue samples for further analysis.
Should biopsy give affirmative results, a further set of tests is needed to determine how far the cancer has already spread and how aggressive it is. The aggressiveness of cancer is most commonly determined using the Gleason score, which can range from 2 (cancer is not aggressive at all) to 10 (cancer is very aggressive). The data for aggressiveness analysis usually comes from a comparison of cancer cells with normal cells under a microscope. Their behavior is taken into account, too. Based on the difference, a Gleason score for every particular patient is produced.
Considering the results of all previous tests, your healthcare provider might suggest that you do some further tests to determine whether the cancer has already spread beyond the prostate, and if so, how far. These procedures include an ultrasound test of other internal organs, magnetic resonance imaging, and various scans. Once your medical practitioner has obtained the results of your test, he or she should be able to define the stage of your prostate cancer.
There are four stages:
It is the safest stage, as cancer cells aren’t numerous yet and they are only found in a small area of the gland. They aren’t aggressive either.
Cancer cells are either spread throughout the prostate, but nonaggressive, or still confined to a small amount of tissue yet showing signs of aggression.
Cancer cells are aggressive, and they have already made their way out of the prostate into adjacent tissues.
Cancer cells have already contaminated not only tissues near the prostate, but also other organs.
Depending on the stage assigned to your prostate cancer, your medical practitioner will decide from which treatment you would benefit the most.
Treating Prostate Cancer
Depending on the stage of your prostate cancer, your general health condition, and some other factors, your medical practitioner will choose a treatment that is suitable for you. In some cases, patients with nonaggressive cancer won’t need any treatment at all, but they will have to do some tests on a regular basis to determine whether cancer cells are changing their behavior patterns (this approach is known as active surveillance). It is also recommended for patients who already suffer from a serious medical condition that could complicate the treatment of prostate cancer. The drawback of active surveillance lies in the possibility of rapid cancer cell development between tests.
If your prostate cancer requires immediate treatment, there are multiple options available:
It uses high-powered energy, which can be delivered to the body from an external or internal source. External radiation comes from a special machine that moves over the patient while he is lying on a table. Internal radiation comes from special radioactive seeds that are implanted into the prostate tissues through a special needle. They stop emitting radiation after a certain period of time, so they don’t need to be surgically removed. Side effects from radiation treatment include painful urination, urgent urination and erectile dysfunction.
Since prostate cancer cells use testosterone to support their development, various forms of hormone therapy are used, aimed at preventing testosterone from reaching cancer cells. This can be achieved in three ways: taking medications that interfere with testosterone production in the body, taking medications that block testosterone from reaching cancer cells, or surgically removing the testicles so that testosterone can no longer be produced. The side effects of this therapy are typical symptoms of low testosterone: obesity, erectile dysfunction, loss of muscle and bone mass.
There is a variety of methods that can be used to surgically remove the prostate. Some of them allow the patient to recover more quickly while carrying a higher risk of damaging nerve tissue. Other methods, such as retropubic surgery (through an incision in a man’s abdomen) are safer and less likely to trigger any consequences, but the patient will usually need more time to make a full recovery. Erectile dysfunction is a rather common side effect of these methods.
In this method, cold gas is delivered into the prostate through a special needle. It is followed by hot gas, which creates a contrast of temperatures that is deadly for cancer cells. Cryosurgery is recommended for patients whose condition wasn’t improved by radiation therapy.
This method involves using drugs to kill cells that grow and multiply rapidly, including cancer cells. The medications are delivered into the body orally, through a vein or sometimes through a combination of both. It is recommended when cancer cells have already started spreading in the body or when hormone therapy has failed.
This is a rather expensive method that doesn’t necessarily bring improvement to a patient’s condition. Immune cells are taken from a patient’s body, “trained” to destroy cancer cells through genetic modification, and placed back inside the body. Normally, several attempts are required for the treatment to be effective.
Choosing among such a range of options isn’t always easy, so it is advisable that prostate cancer patients find out as much as possible about what can be done to improve their condition. Then, they are able to make a conscious contribution to their healthcare provider’s decision.