Dr Bilawal Kamran

Prostate cancer is a type of cancer that begins in the prostate, a small gland located just below the bladder in men and people assigned male at birth (AMAB). This walnut-shaped gland plays an essential role in the reproductive system, producing fluid that nourishes and transports sperm. Although prostate cancer is a serious disease, most cases are diagnosed early, before the cancer spreads beyond the prostate, making it highly treatable.

Types of Prostate Cancer

The most common form of prostate cancer is adenocarcinoma, which originates in the glandular cells that secrete fluids, similar to the prostate’s normal function. While rare, prostate cancer can also develop from other types of cells, including:

• Small cell carcinomas
• Transitional cell carcinomas
• Neuroendocrine tumors
• Sarcomas

How Common is Prostate Cancer?

Prostate cancer is one of the most common cancers affecting men and people AMAB, second only to skin cancer. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 13 out of 100 individuals with prostates will develop prostate cancer during their lifetime. While many people live normal lives and die from causes unrelated to prostate cancer, about 34,000 individuals in the United States succumb to the disease each year.

Symptoms and Causes of Prostate Cancer

In its early stages, prostate cancer often does not present noticeable symptoms. As the disease progresses, some common symptoms may develop, including:

• Frequent or urgent need to urinate, especially at night
• Weak or interrupted urine flow
• Pain or burning sensations during urination
• Urinary incontinence (loss of bladder control)
• Painful ejaculation or erectile dysfunction (ED)
• Blood in semen or urine
• Persistent pain in the lower back, hips, or chest

However, not all prostate problems are indicative of cancer. Conditions such as benign prostatic hyperplasia (BPH) and prostatitis can cause similar symptoms without being cancerous. BPH is a non-cancerous enlargement of the prostate, while prostatitis is an inflammation caused by infection, more commonly seen in younger individuals.

What Causes Prostate Cancer?

The exact cause of prostate cancer remains unknown, but it develops when cells in the prostate grow uncontrollably, forming a tumor. Unlike normal cells, cancer cells continue to divide and resist death, allowing the tumor to expand. As the tumor grows, some cancer cells may break off and spread to other parts of the body, a process called metastasis.

Prostate cancer generally progresses slowly, and most patients are diagnosed before the cancer has spread, making early treatment highly effective.

Risk Factors for Prostate Cancer

Several risk factors increase the likelihood of developing prostate cancer, including:

1. Age: The risk of prostate cancer rises with age, especially after 50. Approximately 60% of cases occur in individuals over 65.
2. Race and Ethnicity: Black individuals or those of African ancestry face a higher risk, and prostate cancer tends to develop earlier and spread more quickly in this group.
3. Family History: A close relative with prostate cancer can increase your risk by two to three times.
4. Genetic Factors: Inherited genetic mutations, such as those linked to Lynch syndrome or BRCA1 and BRCA2 (commonly associated with breast cancer), can raise prostate cancer risk.
5. Lifestyle Factors: Smoking, obesity (BMI > 30), and certain sexually transmitted infections (STIs) may also contribute to the risk of prostate cancer.

Pl subscribe to the YouTube channel of republicpolicy.com for quality podcasts:

How is Prostate Cancer Diagnosed?

Screening plays a critical role in identifying prostate cancer early. Men of average risk are typically advised to begin screenings at age 55, with more frequent testing for those at higher risk. These screenings often include:

• Digital Rectal Exam (DRE): A healthcare provider manually examines the prostate via the rectum to check for lumps or hard areas.
• Prostate-Specific Antigen (PSA) Blood Test: Elevated PSA levels may indicate prostate cancer, though benign conditions such as BPH or prostatitis can also cause an increase.

If screening tests suggest cancer, further diagnostic procedures may be required:

• Imaging Tests: MRI or transrectal ultrasound scans can identify abnormal areas in the prostate.
• Biopsy: A needle biopsy is the definitive method for diagnosing prostate cancer. A small sample of prostate tissue is removed for laboratory analysis to determine if cancer cells are present and to assess their aggressiveness.

Gleason Score and Staging of Prostate Cancer

Once diagnosed, prostate cancer is graded and staged to determine its severity:

• Gleason Score: This score helps assess the aggressiveness of cancer based on how abnormal the cells appear. A higher score indicates more aggressive cancer.
• Staging: Staging describes the extent of cancer spread. Localized prostate cancer remains confined to the prostate, while regional cancer may invade nearby structures. Metastatic cancer spreads to other organs, such as the bones or lymph nodes.

Treatment Options for Prostate Cancer

Prostate cancer treatment depends on factors like the cancer’s stage, the patient’s overall health, and how fast the cancer is progressing. Common treatment approaches include:

1. Surveillance:
   • Active Surveillance: Monitoring the cancer with regular screenings and biopsies, often used for slow-growing cancers that have not spread or caused symptoms.
   • Watchful Waiting: For frail individuals or those with non-aggressive cancer, this approach involves less frequent monitoring and focusing on symptom management rather than treating the cancer aggressively.
2. Surgery:
   • Radical Prostatectomy: Surgical removal of the prostate gland is often effective for localized cancers.
   • Robotic-Assisted Prostatectomy: A minimally invasive surgery using robotic technology allows for precise removal of the prostate through small incisions.
3. Radiation Therapy:
   • Brachytherapy: Internal radiation involves placing radioactive seeds directly into the prostate to target cancer cells.
   • External Beam Radiation Therapy (EBRT): High-energy X-rays are directed at the tumor to kill cancer cells.
4. Systemic Therapies:
   • Hormone Therapy: Reduces testosterone levels or blocks its effects, as testosterone fuels the growth of prostate cancer.
   • Chemotherapy: Used for advanced prostate cancer that has spread outside the prostate.
   • Immunotherapy: Enhances the body’s immune system to fight cancer cells.
   • Targeted Therapy: Focuses on specific genetic mutations in cancer cells to stop their growth.
5. Focal Therapy: This is an emerging treatment that targets tumors without affecting the entire prostate, including methods like high-intensity focused ultrasound (HIFU), cryotherapy, and laser ablation.

Side Effects of Prostate Cancer Treatment

Treatment for prostate cancer can cause various side effects, including:

• Incontinence: Urinary leakage may occur, but it typically improves over time.
• Erectile Dysfunction (ED): Treatments may damage nerves that control erections, but function can often be restored with time or medications.
• Infertility: Some treatments may affect the ability to father children, but sperm preservation before treatment is an option.

Prevention and Risk Reduction

Although prostate cancer cannot be fully prevented, several lifestyle changes may reduce the risk:

• Regular Screenings: Consult your healthcare provider about appropriate screening based on your risk factors.
• Healthy Weight: Maintaining a healthy weight reduces the risk of many cancers, including prostate cancer.
• Exercise: Aim for at least 150 minutes of moderate-intensity exercise per week.
• Nutritious Diet: A balanced diet rich in fruits, vegetables, and whole grains may support overall health.
• Quit Smoking: Avoid tobacco use to lower your cancer risk.

Prostate cancer is a serious but treatable condition. Early detection through screening, understanding risk factors, and choosing appropriate treatment can significantly improve outcomes. If you’re at higher risk or showing symptoms, consult your healthcare provider for timely testing and management options. With advancements in treatment, many individuals with prostate cancer can live long, healthy lives.