Prostate Cancer, Symptoms, Causes, Treatment, and Prevention

Posted by Medical Board on September 16, 2017 in Men
Prostate Cancer, Symptoms, Causes, Treatment, and Prevention

In 2017, the projected number of new prostate cancer cases is estimated to be 161,360. Of those individuals, 26,730 will die from the disease.[1] Not a big number compared to other deadly cancers…unless of course it happens to you, or someone you love. Every day in the United States, prostate cancer changes lives. Fortunately for many, doctors and researchers know more now than ever about causes, treatment protocols, and prevention.

WHAT IS PROSTATE CANCER?

The prostate, located directly below the bladder and in front of the rectum is a small, walnut-sized gland that produces fluid contributing to semen.[6] Outside of skin cancer, prostate cancer is the number one cancer in men in the United States, and is the second leading cause of cancer-related death for males as well. Nearly all prostate cancers are considered “adenocarcinomas”(cancers originating in cells that produce/release fluids). The majority of prostate cancers are slow growing, and produce few symptoms in the earliest stages.[3]

PROSTATE CANCER SYMPTOMS

While other non-cancerous prostate-related medical conditions are common in men and may present with similar symptoms, the following signs may be present in prostate cancer.

  • Decrease or interruption of urine flow
  • Urinating frequently
  • Trouble/inability to urinate
  • Burning sensation/pain during urination
  • Presence of blood in urine/semen
  • Difficulty producing erection
  • Pain in hips, back, pelvis[3]

*It is important to note that aging men often report the above symptoms due to an enlarged prostate or other prostate condition that is non-cancerous.

PROSTATE CANCER CAUSES

Changes in the DNA of a healthy prostate cell are responsible for prostate cancer. Genes that control cellular activity called, oncogenes determine when cells live, grow and divide. Tumor suppressor genes, on the other hand keep cell growth under control, repair DNA mistakes, and cause cells to die at the right time. Cancer can be caused partially by DNA mutations that activate oncogenes and turn off tumor suppressor genes. These DNA changes may either be inherited from a parent, or naturally acquired.

While scientists aren’t entirely sure just what causes prostate cancer, they do know that it affects more often, individuals who exhibit certain risk factors.

These include:

Age—As men age, their chances of getting prostate cancer increase. In fact, 60% of all diagnosed cases occur in men age 65 or older.

Family History of Prostate Cancer—While no specific gene has been isolated as of yet, studies show that a man is 2 to 3 times more likely to get prostate cancer if he has a brother, father, or son with the disease.

Race—While scientists aren’t sure why, African-American men are more likely to get prostate cancer than men of other races.[11]

While studies at this time are still inconclusive, some research indicates there may be some association between a diet high in fat, and prostate cancer.[2]

PROSTATE CANCER TEST, PSA Test, PSA Levels

Diagnosing Prostate Cancer

Many times, localized prostate cancer does not present any obvious physical symptoms. Once cancer has metastasized however, (grown outside local area) some men suffer weight loss or bone pain. Historically, many individuals were not diagnosed until the cancer advanced.
Screening For Prostate Cancer

Screening tests that identify the possibility of prostate cancer include the PSA (prostate-specific antigen) and the DRE (digital rectal examination). Both are important in identifying the possible presence of cancer.

PSA Test

The PSA, or prostate-specific antigen test is a blood test that identifies the presence of specific enzymes produced by the prostate. These enzymes leak into the blood vessels and can be identified in the blood. A man’s PSA levels can be high for a number of reasons other than cancer however, including an enlarged prostate, prostate inflammation, or idiopathic reasons (no known cause/reason). Prostate cancer is detected in about 30% of PSA screenings.[2]

PSA Levels—What’s Normal?

Historically, doctors considered PSA levels of 4.0 ng/ml and below normal. Further research indicates however, that prostate cancer may be present at lower PSA levels, and non-existent at higher PSA levels. Many factors can also cause PSA levels to fluctuate. Prostatitis (prostate inflammation), a urinary tract infection, a prostate biopsy and many medications can produce irregular results on a PSA test. Different laboratories may also produce slightly varied test results as well.

DRE—Digital Rectal Exam

Most doctors will also perform a digital rectal examination to screen for prostate cancer. This involves physically feeling the surface of the prostate gland by inserting a finger into the rectum. The physician will then note any hard or soft spots, enlargement, or bumps on the gland.
Today, 90% of all prostate cancers are diagnosed in the early stages due to PSA screenings.

What if my PSA level is high, or my doctor feels an abnormality?

If a doctor suspects the possibility of cancer, they will perform 12-16 prostate biopsies with guided transrectal ultrasound. An ultrasound probe is inserted into the rectum and local anesthesia is used to numb the gland. Core cross-sections of prostate tissue are obtained through a thin needle. A pathologist will then evaluate these cores and determine if cancer is present. If it is, he/she will assign the growth a Gleason score. This is a standard grading method used to evaluate the aggressiveness of the cancer. It will help determine the course of treatment.[9]
Other tests and technologies may also be used to evaluate prostate cancer including:

COMPUTED TOMOGRAPHY (CT)—CT scans show highly detailed images of the prostate gland using x-ray technology. Scans may be ordered to determine cancer stage upon diagnosis.

RADIONUCLIDE BONE SCAN—This nuclear imaging technology reveals whether or not cancer has spread to the bone.

URONAV FUSION BIOPSY SYSTEM—UroNav guides the doctor to pinpoint cells within specific lesions using MR and ultrasound images.[3]

PROSTATE CANCER TREATMENT

There are a number of treatment options available for men with prostate cancer. The type of treatment received is dependent on the stage of cancer diagnosed, whether the cancer has metastasized outside the prostate gland, the age and life expectancy of the individual, and personal wishes of the patient.[5] The availability of specific treatment methods also varies depending on medical facilities and individual health insurance plans. Where once treatment options were limited and removal of the prostate was standard practice, now men have more choices with the possibility of preserving nerves for continence and sexual activity.

Some treatment options include one or more of the following:

Early stage cancer contained within prostate gland

  • Active Surveillance
  • Robotic Radical Prostatectomy
  • Radiation Therapy
  • MRI-Guided Focal Laser Ablation Therapy

Returning cancer

  • Salvage Prostatectomy
  • Radiation Therapy
  • Systemic Therapies
  • Hormone Therapy
  • Immunotherapy

Cancer that has metastasized

  • Systemic Therapies
  • Hormone Therapy
  • Immunotherapy/Vaccine Treatment
  • Chemotherapy
  • Radium-223
  • Radiation Therapy[7]

PROSTATE CANCER PREVENTION

Preliminary research suggests that diet and exercise may have some effect on prostate cancer. Though more studies are needed to substantiate this theory, many doctors encourage their male patients to maintain a healthy weight and decrease excess body fat, especially in the midsection. Men with a BMI (body mass index) of 30 or higher may be at increased risk for prostate cancer. Extra body fat secretes proteins and hormones that contribute to inflammation and oxidation of cells that may aid in the development and growth of prostate cancer. In laboratory studies where cancerous prostate tissue is removed, inflammatory cells are found that atrophy healthy prostate tissue.

Prostate Cancer Prevention—What should I eat?

A diet rich in anti-inflammatory foods such as fruits, vegetables, whole grains, and ocean-caught fish is optimal for a healthy prostate. Because of their carcinogenic effects, charbroiled meats (especially red meat and chicken) should be limited. Processed foods, and foods high in sugar should also be avoided to slow growth of cancerous tumors, and support a healthy immune system.
Consuming fatty fish that contain omega-3 fatty acids such as tuna, salmon, and herring has also been linked to a reduced risk of prostate cancer.[8]
Vigorous Exercise

In a university study published in the Journal of Clinical Oncology, men who exercised vigorously (more than three hours per week) had a 61% lower risk of prostate cancer-related death than other men diagnosed with the disease who were less active, or not active at all.[4]

Healthy Sexual Activity

Based on research, including one large, 8-year Harvard University study, men who experienced a greater number of ejaculations per month (21 vs. 4 to 7) had one-fourth the risk of prostate cancer than those with fewer ejaculatory events. The correlation between sexual activity and prostate cancer has yet to be determined, however, there appears to be a connection between frequency and the role that inflammation plays in the disease process.[10]

While prostate cancer deaths have steadily declined over the past 25 years, due to PSA screening and advanced treatment methods, many men are still at risk for getting the disease in their lifetime. Healthy lifestyle choices, regular doctor visits, and periodic prostate screenings may reduce the likelihood of advanced prostate cancer or development of the disease altogether.

References

1Surveillance, Epidemiology, and End Results Program, seer.cancer.gov/statfacts/html/prost.html. Accessed 16 Sept. 2017.
2Department of Urology, urology.med.miami.edu/specialties/urologic-oncology-robotics/prostate-cancer. Accessed 16 Sept. 2017.
3“Diagnosis.” Diagnosis – Prostate Cancer – Cancers We Treat – Wilmot Cancer Institute – University of Rochester Medical Center, www.urmc.rochester.edu/cancer-institute/cancers/prostate/diagnosis.aspx. Accessed 16 Sept. 2017.
4“Exercise may lower risk of death for men with prostate cancer.” News, 13 Jan. 2014, www.hsph.harvard.edu/news/press-releases/exercise-prostate-cancer-death/. Accessed 16 Sept. 2017.
5“Our Approach – Prostate Cancer.” Siteman Cancer Center, siteman.wustl.edu/treatment/cancer-types/prostate/our-approach/. Accessed 16 Sept. 2017.
6“Prostate Cancer.” National Cancer Institute, www.cancer.gov/types/prostate. Accessed 16 Sept. 2017.
7“Prostate Cancer Treatment.” UChicago Medicine, www.uchospitals.edu/specialties/cancer/urologic/prostate/treatment/index.html. Accessed 16 Sept. 2017.
8“Prostate cancer: Ways to reduce your risk.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 7 Oct. 2014, www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/prostate-cancer-prevention/art-20045641. Accessed 16 Sept. 2017.
9“Prostate-Specific Antigen (PSA) Test.” National Cancer Institute, www.cancer.gov/types/prostate/psa-fact-sheet. Accessed 16 Sept. 2017.
10Urology, Hopkins. “The James Buchanan Brady Urological Institute.” PROSTATE CANCER UPDATE -The James Buchanan Brady Urological Institute – Urology at Hopkins, urology.jhu.edu/newsletter/prostate_cancer712.php. Accessed 16 Sept. 2017.
11“What Causes Prostate Cancer?” American Cancer Society, www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/what-causes.html. Accessed 16 Sept. 2017.

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