Prostate Cancer

Prostate cancer begins in the prostate gland when cells start to overproduce. The prostate gland is only found in males. Prostate cancer is the second most common cancer among men (with skin cancer being the first), but it can often be treated successfully. Prostate cancer starts when cells in the prostate (a gland found only in males) begin to grow out of control.

Most types of prostate cancers are adenocarcinomas, meaning that the cancer develops from gland cells. Other types of prostate cancer include small cell carcinomas, neuroendocrine tumors, transitional cell carcinomas, and sarcomas.

Prostate Cancer Symptoms

The prostate is largely made up of muscle fibers and glands, and its main function is to produce semen to deliver sperm. Prostate cancer is a malignant tumor that arises especially from the outer part of the prostate gland and spreads to the inner parts of the prostate as it grows.

There are many symptoms of advanced prostate cancer. The most common symptoms experienced by patients include:

• Intermittent flow during urination and the feeling that the bladder is not completely emptied
• Frequent urination at night and while asleep
• Burning and pain during urination
• Blood in the urine
• Feeling discomfort or pain when sitting due to enlargement of the prostate
• Blood in the seminal fluid released during intercourse or masturbation

If cancer spreads from the prostate gland to other organs, other symptoms may occur. Some of these symptoms include:

• Fatigue
• Difficulty with bowel movements and constipation
• Pain in the back, hips, thighs, shoulders, or other bones
• Unexplained weight loss
• Pain or swelling in the legs or feet

What Causes Prostate Cancer?

Prostate cancer usually shows no signs or symptoms in the early stages. It is one of the most common types of cancer in men after skin cancer. The diagnosis is usually made as a result of urination problems, the most common symptom.

The prostate is largely made up of muscle fibers and glands. Its main function is to produce semen to deliver sperm. Prostate cancer is a malignant tumor that occurs in the outer part of the prostate gland and spreads to the inner parts of the prostate as it grows.

As individuals get older, the risk of getting prostate cancer increases. If a family member carries the BRCA1 or BRCA2 gene, which increases the risk of breast cancer, or if there are individuals with breast cancer in the family, the risk of prostate cancer also increases. Obese men are also more likely to have advanced prostate cancer that is more difficult to treat.

Prostate Cancer Diagnosis

The prostate-specific antigen (PSA) blood test can be helpful in diagnosing men with prostate cancer. A PSA measures the levels in the blood. There are guidelines to determine if a man may have prostate cancer or needs further testing such as a prostate biopsy:

• PSA levels under 4 ng/mL are normal
• PSA levels between 4-10 ng/mL have a 25% chance of being diagnosed with prostate cancer
• PSA levels greater than 10 ng/mL have greater than a 50% chance of being diagnosed with prostate cancer

If a prostate biopsy is performed and a diagnosis is confirmed, the Gleason system is used to assign a grade in order to determine the severity of the cancer.

Prostate Cancer Risk Factors

There is no known cause of prostate cancer, but doctors have identified several risk factors. Family history plays a large role. If someone in your family has had prostate cancer, you are three times as likely to have prostate cancer at some point. Also, smoking makes you twice as likely to have prostate cancer as the average person. Other risk factors are:

• Being over the age of 50
• African Americans are more likely than white men to develop prostate cancer
• Taking the vitamin E independently

Diet can also play a role in the development of the cancer. Many doctors suggest that having a healthy heart means you will have a healthy prostate. There are protective factors you can take to decrease your chance of developing prostate cancer. They include:

• Folate
• Finasteride
• Dutasteride

Prostate Cancer Stages

• Stage 1: The tumor cannot be felt during examination or seen during imaging. It can be found when surgery is performed for another medical condition.
  • Stage 1a: The tumor is discovered incidentally during a surgical procedure used to treat prostatic hyperplasia, which is the abnormal growth of benign prostate cells. Cancer is found in only 5% or less of the tissue removed.
  • Stage 1b: The tumor is found accidentally during BPH surgery. Cancer cells are detected in more than 5% of the tissue removed.
  • Stage 1c: The tumor is found during a needle biopsy that was performed because of an elevated PSA level.
    
• Stage 2: The tumor appears to be confined to the prostate. Due to the size of the tumor, the doctor can feel it during the digital rectal exam. The cancer may also be seen with imaging.
  • Stage 2a: The tumor has invaded one-half (or less) of one side of the prostate.
  • Stage 2b: The tumor has spread to more than one-half of one side of the prostate, but not to both sides.
  • Stage 2c: The cancer has invaded both sides of the prostate.
    
• Stage 3: The tumor has grown outside the prostate. It may have spread to the seminal vesicles.
  • Stage 3a: The tumor has developed outside the prostate; however, it has not spread to the seminal vesicles.
  • Stage 3b: The tumor has spread to the seminal vesicles.
    
• Stage 4: The tumour has spread outside the prostate. It may have spread to areas such as the bladder or back passage (rectum). Or it may have spread further, for example to the bones.

Prostate Cancer Treatment

The treatment decision for prostate cancer patients depends on multiple factors including the PSA levels, stage of disease, patient’s age, and overall health. Treatment options for Prostate Cancer include:

• Watchful waiting or active surveillance, a preliminary waiting period for those who do not experience symptoms
• Surgery, for patients in early stages and good health
• Radiation therapy and radiopharmaceutical therapy, can be given adjuvant to other treatments
• Hormone therapy, removes or blocks hormones from driving cancer cell growth
• Chemotherapy, can be given adjuvant to other treatment options
• Immunotherapy, boosts the body’s natural defense against the cancer cells
• Bisphosphonate therapy, used for cases that have spread to the bones to prevent further metastasis

These treatment options are currently being evaluated within clinical trials and can be beneficial for those who don’t respond well to typical treatment methods:

• Cryosurgery
• High-intensity–focused ultrasound therapy
• Proton beam radiation therapy
• Photodynamic therapy

Prostate Cancer Clinical Trials

General treatment for prostate cancer includes hormone therapy, radiation therapy, chemotherapy, immunotherapy, and surgery. Clinical trial treatments may include screening procedures such as biopsies, MRI analysis, DBSI analysis, and PET scans. There are many clinical trials that perform different procedures for prostate cancer.

Prostate cancer drugs approved by clinical trials include:

• Erleada (apalutamide)
• Jevtana (cabazitaxel)
• Keytruda (pembrolizumab)
• Nubeqa (darolutamide)
• Provenge (sipuleucel-T)
• Xgeva (denosumab)
• Xofigo (radium 223 dichloride)
• Xtandi (enzalutamide)
• Zytiga (abiraterone)