What is prostate cancer?
Prostate cancer develops in the prostate gland, a walnut-shaped organ in the male reproductive system that surrounds the urethra just below the bladder. It is the second most common cancer in men after skin cancer. Most prostate cancers are adenocarcinomas, arising from glandular cells that produce prostate fluid.
Early stages often have no symptoms. As it advances, common signs include difficulty urinating, blood in urine or semen, pelvic discomfort, bone pain, and erectile dysfunction. It typically affects men over 50 and those with a family history of prostate or breast cancer.
Types of prostate cancer
- Adenocarcinoma: the most common form, arising from gland cells
- Small cell carcinoma: a rare, aggressive type
- Transitional cell carcinoma: begins in cells lining the urethra
- Sarcoma: develops in prostate muscle or connective tissue (very rare)
- Carcinoid tumors: slow-growing and uncommon
Causes and risk factors
- Age: risk increases after age 50
- Family history of prostate or breast cancer
- Inherited gene mutations such as BRCA1 and BRCA2
- Race: more common in African American men
- Hormonal influences involving testosterone and DHT
- Diet high in red meat and high-fat dairy products
- Obesity and exposure to certain chemicals
Symptoms
- Weak or interrupted urine flow
- Urgency or difficulty starting/stopping urination
- Frequent nighttime urination
- Painful or burning sensation during urination
- Blood in urine or semen
- Persistent pelvic or back pain
- Unexplained weight loss and fatigue
Diagnosis
- Medical history and physical exam including digital rectal exam (DRE)
- Prostate-specific antigen (PSA) blood test
- Transrectal ultrasound (TRUS) to visualize the gland
- Prostate biopsy to confirm cancer cells
- Magnetic resonance imaging (MRI) for detailed imaging
- Bone scan or CT/PET scans if metastasis is suspected
- Gleason score and TNM staging to assess aggressiveness and spread
Treatment options
- Active surveillance for low-risk, slow-growing cancers
- Surgery: radical prostatectomy to remove the prostate
- Radiation therapy: external beam or brachytherapy
- Hormone therapy to lower or block testosterone
- Chemotherapy for advanced or hormone-resistant cases
- Targeted therapy such as PARP inhibitors
- Immunotherapy including cancer vaccines and checkpoint inhibitors
- Minimally invasive options: cryotherapy, high-intensity focused ultrasound
Sources
- American Cancer Society. “What is Prostate Cancer?” Accessed May 14, 2024.
- Urology Care Foundation. “Advanced Prostate Cancer.” Accessed May 14, 2024.
- National Comprehensive Cancer Network. “Prostate Cancer Guidelines.” Accessed May 14, 2024.
- Prostate Cancer Foundation. “About Prostate Cancer.” Accessed May 14, 2024.