Understanding Prostate Cancer: Causes, Symptoms, Diagnosis, and Management

Prostate cancer develops in the small, walnut-sized gland located in a man's pelvis. This gland produces seminal fluid that nurtures and transports sperm. Positioned near the bladder, it can be examined via a rectal check. Tumors in the prostate can be benign or malignant. Prostate cancer ranks among the most prevalent cancers in men, with statistics showing one in nine men diagnosed. It also stands as a leading cause of cancer-related fatalities among men.

Benign vs. malignant growths

Benign prostate growths are non-cancerous and do not threaten life. This condition, known as benign prostatic hyperplasia (BPH), does not invade nearby tissues or spread beyond the prostate. Such growths can often be surgically removed, and may grow back slowly or not at all. In contrast, malignant prostate tumors grow rapidly, have the potential to metastasize, and threaten life. Cancerous cells can detach, travel via blood or lymph, and form new tumors elsewhere, especially in bones, leading to severe health complications.

Metastatic prostate cancer occurs when cancer cells spread to other organs, adopting their original characteristics and forming new tumors, notably in bones. Although treatable, metastatic disease is often challenging to cure.

Causes of prostate cancer

The exact reasons behind prostate cancer remain unclear. It is believed to originate when certain prostate cells undergo DNA mutations, causing abnormal and uncontrolled growth. These transformed cells can form tumors, which may stay localized or metastasize to other regions.

Early signs and symptoms

Initially, prostate cancer may grow silently without symptoms. As it advances, signs may include:

• Difficulty urinating, frequent urination, or pain during urination
• Reduced urine flow
• Blood presence in semen or urine
• Painful ejaculation
• Erectile difficulties
• Persistent pain in the lower back, hips, or thighs
• Unintentional weight loss and loss of appetite
• Pelvic discomfort
• Bony pains indicating spread

Detection and diagnosis methods

Screening is essential for early detection. Experts debate the value of routine screening for all men, but those with risk factors should consider it after age 50 or earlier. Diagnostic procedures include:

• Digital Rectal Exam (DRE): A doctor palpates the prostate via the rectum for abnormalities.
• Prostate-Specific Antigen (PSA): A blood test measuring PSA levels; elevated levels may suggest cancer or other prostate issues.
• Ultrasound: Transrectal ultrasound visualizes the prostate for abnormalities.
• Biopsy: Tissue samples obtained via needle for laboratory analysis confirm cancer presence.
• MRI Fusion: Advanced imaging combining MRI to guide biopsy accuracy.

Once diagnosed, grading determines aggressiveness. The Gleason Score, ranging from 2 to 10, indicates how abnormal the cancer cells are, with higher scores being more aggressive.

Further imaging like bone scans, CT, MRI, or PET scans are performed to assess cancer spread.

Risk factors for prostate cancer

• Age: Men over 55 are at increased risk.
• Ethnicity: African-American men face higher susceptibility.
• Family history: A positive history doubles or triples risk.
• Obesity: Excess weight correlates with advanced disease stages.
• Smoking: Heavy smokers have doubled risk and higher mortality rates.
• Geographic location: Higher prevalence in North America and Northern Europe due to lifestyle and environmental factors.

Possible complications

• Metastasis: Cancer spreading to bones, organs, causing pain and fractures.
• Incontinence: Urinary control issues from the disease or treatment.
• Erectile dysfunction: A common side effect of treatments like surgery or radiation.

Treatment options

Depending on growth rate and spread, options vary:

• Active monitoring: For slow-growing tumors, watching without immediate treatment.
• Localized treatments: Surgery, radiation, cryotherapy, or focal therapy targeting the prostate.
• Systemic therapy: Hormonal therapy, chemotherapy, or immunotherapy for advanced disease.

Prevention tips

• Maintain a balanced diet rich in fruits, vegetables, and whole grains, reducing high-fat and sugar-laden foods.
• Engage in regular physical activity to maintain a healthy weight.
• Consult your doctor about preventive medications if at high risk, such as for those with family history or other risk factors.