Where is the prostate located and what does the prostate do?

The prostate is a vital part of the male reproductive system located in front of the rectum and below the bladder. It surrounds the urethra and produces fluid that contributes to semen during ejaculation. As men age, the prostate often increases in size, leading to benign prostatic hyperplasia (BPH) and reduced urine flow. It is important to note that BPH is not the same as prostate cancer.

What exactly is Prostate Cancer?

Prostate cancer is a common cancer that occurs when cancerous cells are formed in the prostate gland. While some prostate cancers develop slowly and remain confined to the prostate gland without causing significant harm, others can grow quickly and spread aggressively. Early detection is the best chance for successful treatment while the cancer is still limited to the prostate gland. Fortunately, many cases of prostate cancer are diagnosed before it spread beyond the gland, and treatment at this stage can often eliminate the cancer.

What are the symptoms of Prostate Cancer?

In its early stages, prostate cancer typically does not cause any noticeable symptoms. However, as the disease progresses, certain issues may arise, which include

  • Frequent urination and urgency, especially at night.
  • Weak urine flow and incomplete bladder emptying.
  • Pain or burning during urination (dysuria).
  • Painful ejaculation and erectile dysfunction (ED).
  • Loss of bladder and bowel control (urinary and faecal incontinence).
  • Blood in semen (hematospermia) or urine.

Symptoms, when prostate cancer is detected in an advanced stage, include:

  • Pain in the back, hips, or pelvis that does not go away.
  • Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anaemia

What are the risk factors for developing Prostate Cancer?

The likelihood of developing prostate cancer rises with age, although cancer’s aggressiveness often decreases with advancing age.

Risk factors for prostate cancer include advanced age, having a family history of the disease, increased height, being obese, having hypertension, being physically inactive, and having persistently high testosterone levels.

Additionally, lesser-known risk factors include vasectomy, sexually transmitted diseases, poor diet, obesity with a body mass index (BMI) above 30, smoking, exposure to certain chemicals, and prostate inflammation (prostatitis).

How is Prostate Cancer diagnosed?

The following tests and procedures may be used:

  • Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The patient’s history is also considered, along with his health habits.
  • Digital rectal exam (DRE): An exam of the rectum. A lubricated, gloved finger is inserted into the rectum by the doctor or nurse to feel the prostate through the rectal wall for lumps or other abnormalities.
  • Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood. High PSA levels may indicate cancer; however, PSA levels are also elevated in people with BPH, prostate inflammation, or infection.
  • PSMA PET scan: An imaging procedure to help find prostate cancer cells that have spread outside the prostate into bone, lymph nodes, or other organs. Using a PET scanner makes it possible to detect high concentrations of radioactive molecules that can help identify the location of prostate cancer cells in the body.
  • Transrectal ultrasound: A procedure in which a probe about the size of a finger is inserted into the rectum to check the prostate. It may be used during a biopsy procedure. This is called a transrectal ultrasound-guided biopsy.
  • Transrectal magnetic resonance imaging (MRI): A procedure that uses a strong magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This test is a painless test and produces highly detailed and precise images of the organs and structures within your body. It also aids in evaluating whether cancer has spread to adjacent tissues from the prostate.   

What are the stages of Prostate Cancer?

Here are the general stages of prostate cancer:

Stage I: The cancer is localized within the prostate gland and cannot be felt during a digital rectal exam (DRE). It is usually detected incidentally during a biopsy or surgery for other prostate conditions. The tumor is small and confined to a small part of the prostate.

Stage II: The cancer is still confined to the prostate gland but may be slightly larger and more aggressive than in Stage I. It may be felt during a DRE or detected through imaging tests.

Stage IIA: The tumor is still confined to one side (left or right) of the prostate.

Stage IIB: The tumor may involve both sides of the prostate.

Stage III: The cancer has spread beyond the prostate gland but remains within the nearby tissues.

Stage IIIA: The cancer has spread to the seminal vesicles (small glands that produce semen).

Stage IIIB:  The cancer has invaded nearby structures such as the bladder neck, the external sphincter (muscle controlling urine flow), or the rectum.

Stage IV: The cancer has spread to distant sites in the body, such as lymph nodes, bones, liver, or lungs. This is also known as metastatic prostate cancer.

Stage IVA: The cancer has spread to nearby lymph nodes.

Stage IVB: The cancer has spread to distant organs or bones.

How is Prostate Cancer managed or treated?

  • Surgery: A radical prostatectomy is a surgery to remove the diseased prostate gland and tissue surrounding it.
  • Radiation therapy: Radiation therapy can be used as a single treatment for prostate cancer or combined with other therapies. Radiation can also provide symptom relief.
  • Systemic therapies: If cancer has spread beyond the prostate gland, healthcare providers may suggest systemic treatments, which involve administering substances throughout the body to destroy cancer cells or hinder their growth.
    • Hormone therapy: Hormone therapy is a common treatment approach. Prostate cancer cells typically depend on the male hormone testosterone to grow and spread. Hormone therapy aims to suppress or block the production or action of testosterone, thereby inhibiting the growth of prostate cancer cells.
    • Chemotherapy: Chemotherapy uses medicines to destroy cancer cells. If your prostate cancer has spread beyond the prostate, your healthcare provider may recommend chemotherapy as a standalone treatment or combined with hormone therapy.
    • Immunotherapy: Your immune system is strengthened with immunotherapy to recognize and combat cancer cells more effectively.
    • Targeted therapy: To stop cancer cells from proliferating and reproducing, targeted treatment focuses on the genetic alterations (mutations) that transform healthy cells into cancer cells.
  • Focal Therapy:  Focal therapy is a more recent form of treatment that destroys tumors inside your prostate.
    • High-intensity focused ultrasound (HIFU): HIFU generates powerful heat which kills cancer cells within your prostate.
    • Cryotherapy: Cold gases freeze cancer cells in your prostate, eliminating the tumour.
    • Laser ablation: Intense heat directed at the tumour kills cancer cells within your prostate, destroying the tumour.
    • Photodynamic therapy: Medications increase the sensitivity of cancer cells to particular light wavelengths. Healthcare providers use these light wavelengths to eliminate cancer cells.

Are prostate problems always a sign of prostate cancer?

Not all growths in your prostate are cancer. Symptoms similar to prostate cancer can also be found in:

  • Benign prostatic hyperplasia (BPH): At some point, almost everyone with a prostate will develop benign prostatic hyperplasia (BPH). This condition causes the prostate gland to enlarge but does not elevate the risk of cancer.
  • Prostatitis: If you are younger than 50, an enlarged prostate gland is most likely prostatitis. It causes swelling and inflammation in your prostate gland. Bacterial infections are often the cause of prostatitis.

What is the prognosis (projection) for people with prostate cancer?

If your healthcare provider detects prostate cancer early, your prognosis is excellent. At least 99% of individuals who are diagnosed with cancer that has not spread beyond their prostate can expect to survive for at least five years after the diagnosis. Early detection allows for timely treatment, which can effectively control or even eliminate the cancer. The chances of successful treatment, cure, and long-term survival are significantly higher when prostate cancer is diagnosed in its initial stages.

When the disease has metastasized or spread outside of your prostate, your chances of surviving prostate cancer are less favourable. 32% of people with metastatic prostate cancer have a 5-year survival rate from the point of detection.

What are the preventive measures to reduce the risk of prostate cancer?

Preventing prostate cancer is not possible. Still, taking these steps may reduce your risk:

  • Choose a healthy diet full of fruits and vegetables.
  • Choose healthy foods over supplements.
  • Exercise most days of the week as it improves your overall health.
  • Maintain a healthy weight.
  • Get regular prostate screening – Talk to your healthcare provider about the increased risk of prostate cancer and how often you should be screened.

Conclusively, with early diagnosis and prompt treatment, prostate cancer is often highly curable. Many individuals who are diagnosed when the cancer is confined to the prostate gland can go on to live normal, cancer-free lives for many years after treatment. However, it is important to note that in a small number of cases, prostate cancer can be aggressive and have a tendency to spread rapidly to other parts of the body. The key to successful outcomes lies in timely detection and appropriate management. Regular screenings and discussions with your healthcare provider are crucial for assessing your risk factors and determining the most suitable screening schedule. Based on the characteristics of your cancer, such as its growth rate and aggressiveness, your healthcare provider can recommend the best treatment options available.

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