Prostate cancer, everything you need to know

9 July 2021 Leave your Thoughts

What is the prostate?

The prostate is a gland that is part of the male reproductive system, which is also formed by the penis, seminal vesicles and testicles. The function of this gland is to produce the prostatic fluid that forms part of the semen. The prostate is located below the bladder and in front of the rectum. It also surrounds the urethra, the tube that carries urine from the bladder to the outside of the body. The approximate size of the prostate is that of a walnut, although, as men age, it tends to increase in size, being approximately the size of an apricot at age 40, and the size of a lemon at age 60.

 

Changes in the prostate

As the prostate increases in size with age, it can compress the urethra, complicating the passage of urine. In addition, aging increases the risk of various prostate problems. The most common problems are:

  • Prostatitis: Prostatitis is an inflammation of the prostate that is usually caused by a bacterial infection. This pathology affects about 50% of men throughout their lives. Frequent symptoms of prostatitis include: Trouble urinating, burning sensation or pain when urinating, strong and frequent urge to urinate….
  • Benign prostatic hyperplasia (BPH): The term BPH is made up of 3 words. Hyperplasia – increased cell production, Prostatic – of the prostate, and Benign – non-cancerous. BPH is a relatively common condition as men age. The most common symptoms of BPH are: Frequent urgency to urinate, increased frequency at night, difficulty in starting to urinate, inability to empty the bladder completely….
  • Prostate Cancer (PCa): Prostate cancer is the formation of cancerous cells in the tissues of the prostate. PCa is the most common tumor in men and is the third leading cause of cancer mortality in men (after lung and colorectal cancer). Its incidence increases with age, with about 1,410,000 new cases diagnosed each year worldwide. The symptoms associated with prostate cancer are similar to those described in the previous pathologies, which makes it difficult to diagnose.

 

What do we know about prostate cancer?

The main risk factors for prostate cancer are:

  • Age: This is the main risk factor for prostate cancer. The risk of developing it begins to increase from the age of 50 in white men, and from the age of 40 in black men or men with a family history of PCa. The average age of presentation is 65 years.
  • Race: Prostate cancer is more frequent in black men than in other races. In addition, black men are more likely to be diagnosed at an advanced stage and more than twice as likely to die beacuse of it compared to white men. The lowest rate of PCa is seen in the Asian race.
  • Family history: Prostate cancer has a genetic component. Men who have a first-degree relative (father or brother) who has had prostate cancer are more likely to develop the disease.
  • Prostatitis: Some studies have suggested that prostatitis may be associated with an increased risk of developing CaP.

Clinical presentation:

In the early stages of CaP, when the tumor is confined to the prostate, it may be asymptomatic or present with mild symptomatology that is often mistaken for benign prostatic hyperplasia. Some of these symptoms are:

  • Difficulty urinating
  • Decreased caliber or cessation of urination
  • Frequent urgency to urinate (especially at night)
  • Pain or burning with urination

When the tumor is somewhat more advanced, it may be accompanied by clear obstructive symptoms such as:

  • Hematuria (blood in the urine).
  • Painful ejaculation

In more advanced stages of the disease, the following symptoms may appear:

  • Edema or swelling of the legs
  • Bone pains (back, hips and/or pelvis)
  • Weakness or loss of strength in the legs

 

How is prostate cancer diagnosed?

Currently, in most European countries, when a man reaches the age of 50, screening tests for prostate cancer are included in his medical check-ups. The aim of these tests is to detect cancer at an early and treatable stage, which increases the chances of successful treatment of diagnosed patients. These tests are:

  • Rectal examination: This is an examination in which the physician feels the prostate through the rectal wall in search of nodules or abnormal areas.
  • PSA: PSA, or prostate-specific antigen, is a substance produced naturally by the prostate and is measured in a blood sample from the patient. An increase in PSA can indicate the presence of prostate cancer, although it can also be indicative of prostatitis or benign prostatic hyperplasia (BPH). There is much controversy about the appropriateness of including PSA testing in screening for early detection of prostate cancer.
  • Biomarkers: Biomarkers are becoming increasingly important in the diagnosis and screening of prostate cancer.

In addition, there are tests that offer a more detailed analysis and more information about the patient’s condition:

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  • Transrectal ultrasound: a small probe is inserted into the rectum to generate an image of the prostate gland.
  • Magnetic Resonance Imaging (MRI): MRI provides more detailed images of the prostate. In addition, it can help the physician locate the tumor in case the patient needs surgery.
  • Prostate biopsy: The purpose of the biopsy is to determine if cancerous cells are present in the prostate. Using a needle, a sample of prostate tissue is collected and sent to the laboratory for analysis.

Currently, in most cases, when there is a suspicious digital rectal examination and/or a PSA greater than 3 or 4 ng/ml, further tests are recommended, including a biopsy, to determine if the origin of these alterations may be prostate cancer. This methodology often results in unnecessary biopsies. The biopsy is an expensive procedure, worrying for the patient and more invasive and dangerous than any other test.

Life Length has developed ProsTAV, a prostate cancer risk biomarker that, combined with the current screening method and using only a blood sample from each patient, can potentially spare hundreds of thousands of men a year from unnecessary biopsies, surgeries and complications.

In the event that the biopsy confirms the presence of cancer, the aggressiveness of the tumor must be determined. To do this, a scale is used which evaluates the degree of cancerous cells in the prostate called the “Gleason scale”. This scale classifies the cells between 2 and 10, from the least to the most aggressive, and in turn divides the tumor into different grades:

  • Grade 1: Gleason score of 6 or less (low grade cancer).
  • Grade 2: Gleason score of 7 – higher presence of cells with Gleason 4 – (medium grade cancer)
  • Grade 3: Gleason score of 7 – increased presence of cells with Gleason 3 – (medium grade cancer)
  • Grade 4: Gleason score of 8 – (high grade cancer)
  • Grade 5: Gleason score of 9 to 10 (high grade cancer)

Once the diagnosis is confirmed, the physician will need to determine the stage of the cancer and check for the presence of metastases, with the tumor having spread beyond the prostate. For this purpose the physician may recommend tests such as:

  • Bone scan
  • Ultrasound
  • Computerized axial tomography (CAT scan)
  • Magnetic resonance imaging (MRI)
  • Positron Emission Tomography (PET).

 

Are there treatments for prostate cancer?

Treatment for prostate cancer should always be prescribed and recommended by a physician. Low grade prostate cancer may not need treatment, although active surveillance should always be maintained.

There are three strategies considered standard for the management of localized prostate cancer:

  • Surgery
  • Radiation therapy with/without hormone therapy
  • Watchful waiting or active surveillance

The choice of treatment depends on several factors:

  • The likelihood that the tumor is confined to the prostate gland and therefore potentially curable.
  • Tumor size and histological grade (degree of aggressiveness of the tumor).
  • The patient’s age and general condition, as well as associated diseases.

Among the different treatments, the following options stand out:

  • Radical prostatectomy: This is surgery to remove the prostate. It is an option when the cancer is present only in the prostate gland.
  • Radiation therapy: Uses high-powered energy to destroy cancer cells.
  • Ablative therapies: Freezing or heating of prostate tissue to destroy malignant tissue.
  • Hormone therapy: Prostate cancer cells depend on testosterone to grow. Hormone therapy is a treatment to stop the patient’s body from producing testosterone so that the cancer cells die or grow more slowly.
  • Immunotherapy: The immune system may not attack the tumor properly because the tumor produces proteins that prevent it from doing so. Immunotherapy interferes with this process so that the immune system can properly attack the cancer cells.
  • Targeted drug therapy: Targeted therapy drugs may be recommended to treat advanced or recurrent prostate cancer. 

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