What is Prostate Cancer?
Prostate cancer develops in the prostate gland, a walnut-shaped organ below the bladder that surrounds the urethra. It is the second most common cancer in men after skin cancer and is almost always an adenocarcinoma (arising from glandular cells). Most prostate cancers grow slowly and may not cause symptoms until advanced stages.
Risk Factors
- Age: Risk increases after age 50, with most cases diagnosed over age 65.
- Family history: Having a father or brother with prostate or breast cancer raises risk.
- Genetic mutations: BRCA1 and BRCA2 gene mutations also contribute.
- Race and ethnicity: African American men have higher incidence and mortality.
- Hormones: Higher levels of testosterone and dihydrotestosterone (DHT) can promote growth.
- Diet and lifestyle: High intake of red meat or high-fat dairy, obesity, and chemical exposures may increase risk.
- Chronic inflammation: Prostatitis and certain infections may play a role.
Symptoms
- Weak or interrupted urine flow, difficulty starting or stopping.
- Frequent urination, especially at night.
- Pain or burning with urination, incomplete bladder emptying.
- Blood in urine or semen.
- Difficulty achieving or maintaining an erection.
- Persistent pelvic or back pain, which may indicate bone spread.
- Unexplained weight loss and fatigue in advanced disease.
Diagnosis
- Medical history and digital rectal exam (DRE) to palpate prostate for abnormalities.
- Prostate-specific antigen (PSA) blood test to screen for elevated levels.
- Transrectal ultrasound (TRUS) to image the prostate and guide biopsies.
- Magnetic resonance imaging (MRI) for detailed visualization and biopsy planning.
- Prostate biopsy (core needle) to confirm cancer and determine grade (Gleason score).
- Staging scans (bone scan, CT, PET-CT) if metastatic spread is suspected.
Treatment
Active Surveillance
Regular monitoring with PSA tests, DREs, and periodic biopsies for low-risk, slow-growing tumors.
Surgery
- Radical prostatectomy: Removal of the prostate and surrounding tissue via open or robotic approaches.
- Orchiectomy: Removal of testes to reduce testosterone production in advanced cases.
Radiation Therapy
- External beam radiation therapy (EBRT) over several weeks.
- Brachytherapy: Radioactive seed implants delivering localized radiation.
Hormone Therapy
- LHRH agonists/antagonists (e.g., leuprolide, relugolix) to lower testosterone.
- Anti-androgens (e.g., abiraterone) to block hormone effects on cancer cells.
Chemotherapy
Systemic drugs (e.g., docetaxel, mitoxantrone) for advanced or hormone-resistant disease.
Targeted & Immune Therapies
- PARP inhibitors (e.g., olaparib) for tumors with specific genetic mutations.
- Immunotherapy (e.g., sipuleucel-T vaccine, checkpoint inhibitors) to boost anti-cancer immunity.
- Radiopharmaceuticals (e.g., radium-223) for bone-metastatic disease.
Ablative Techniques
- Cryotherapy: Freezing of prostate tissue to destroy cancer cells.
- High-intensity focused ultrasound (HIFU) to thermally ablate tumor areas.
Prognosis
Early detection through PSA screening and improved treatments yield high survival rates. Prognosis depends on stage, grade (Gleason score), and patient health. Regular follow-up is essential to monitor for recurrence or progression.
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.