Prostate cancer is a common type of cancer in males, but it is highly treatable in the early stages. It begins in the prostate gland, which sits between the penis and the bladder. Experts do not know what causes it, but the risk increases with age.
The prostate has various functions. These include producing the fluid that nourishes and transports sperm, secreting prostate-specific antigen (PSA), a protein that helps semen retain its liquid state, and helping aid urine control.
Other than skin cancer, prostate cancer is the
Around 1 in 8 males will receive a diagnosis of prostate cancer at some point in their life. However, only 1 in 41 of these will die as a result. This is because of effective treatments in the early stages and the slow-growing nature of the cancer in later stages. Routine screening enables doctors to detect many cases of prostate cancer before they spread.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
There are often no symptoms during the early stages of prostate cancer, but screening can detect changes that may indicate cancer.
Males who do experience symptoms
- difficulty starting and maintaining urination
- a frequent urge to urinate, especially at night
- a weak urine stream
- blood in the urine or semen
- painful urination or ejaculation
- pain in the back, hips, or pelvis
People with advanced prostate cancer may also show no symptoms. Potential signs will depend on the size of the cancer and where it has spread in the body. In addition to the above, advanced prostate cancer can involve the following symptoms:
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At first, the changes will be slow, and the cells will not be cancerous. However, they can become cancerous with time. Cancer cells can be high or low grade. High grade cells are more likely to grow and spread, while low grade cells are not likely to grow and are not a cause for concern.
While doctors do not know exactly why prostate cancer occurs, the following
- Age: The risk of prostate cancer increases after the age of 50, but it is rare before 45.
- Race or ethnicity: The condition is more common in Black people than in white people. Asian and Hispanic people have a lower risk than Black or white people.
- Family history: A person with a close relative with a history of prostate cancer has a higher chance of developing it.
- Genetic factors: Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk. Mutations in these genes also increase the chance of breast cancer. Men born with Lynch syndrome also have a higher risk of prostate and other cancers.
- Diet: Some
evidencesuggests that high fat diets may increase the risk of prostate cancer.
Other possible factors
While more research is necessary to confirm their involvement, other factors that may influence prostate cancer risk include:
- alcohol consumption
- exposure to chemicals, such as the herbicide Agent Orange
- inflammation of the prostate
- sexually transmitted infections
Click here to learn more about the links between alcohol and prostate cancer.
What about trans people?
People born with a prostate can develop prostate cancer. Individuals born without a prostate cannot develop prostate cancer.
Trans women who use hormone therapy such as estrogen may have a lower risk, but the risk is still present.
Anyone born with a prostate should speak to their doctor about screening for prostate cancer.
In the sections below, we list some
Early stage prostate cancer
If the cancer is small and localized, a doctor may recommend:
Watchful waiting or monitoring
The doctor may check PSA blood levels regularly but take no immediate action or rebiopsy the prostate to see if the cancer has progressed, warranting action/treatment. Prostate cancer grows slowly, and the risk of treatment side effects may outweigh the need for immediate treatment.
Should a person require surgery, a urologist will carry out the procedure. This is a surgeon who specializes in the treatment of urinary system disorders.
They may perform a radical prostatectomy to remove the tumor. In addition to removing the prostate, the procedure may also involve the removal of the surrounding tissue, seminal vesicles, and nearby lymph nodes. A doctor can perform this procedure using either open, laparoscopic, or robot-assisted laparoscopic surgery.
This treatment uses radiation to kill cancer cells or prevent them from growing. Options for early stage prostate cancer
- External radiation therapy: This method uses a machine outside the body to send radiation toward the cancer cells. Conformal radiation therapy is a type of external radiation that uses a computer to help guide and target a specific area, minimizing the risk to healthy tissue and allowing a high dose of radiation to reach the prostate tumor.
- Internal radiation therapy: Also known as brachytherapy, this method uses radioactive seeds that a doctor implants near the prostate. A surgeon uses imaging scans, such as ultrasound or computed tomography to help guide the placement of the radioactive substance.
Treatment will depend on various factors. A doctor will discuss the best option for the individual.
A medicinal hormonal blockade may also be part of treatment in the localized prostate cancer setting. Hormone therapy decreases the levels of androgens (male sex hormones) in the body or blocks their production. The main androgens in males are testosterone and dihydrotestosterone.
These androgens aid the development of the prostate and are necessary
Doctors may prescribe this for a fixed time after the radiation therapy to decrease the chance of prostate cancer recurrence.
Advanced prostate cancer
As cancer grows, it can spread throughout the body. If it spreads, or if it comes back after remission, treatment options will change. Options can include:
- Chemotherapy: This option uses drugs to help stop the growth of cancer cells. While it can kill cancer cells around the body, it
may causeadverse effects.
- Hormonal therapy:
Blocking or reducingspecific androgens appears to stop or delay the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most testosterone, or to take an injection or pill that biochemically mimics the removal of the testicles, causing a similar effect in testosterone depletion.
- Targeted therapy: This method uses drugs or other substances that identify and attack specific cancer cells. For example, if somebody harbors a BRCA mutation, then a PARP inhibitor oral medication can target the mutation and kill cancer cells
- Immunotherapy: This method uses a person’s immune system to help fight cancer. Scientists can use substances the body produces, or create them in a lab, to help boost or restore the body’s natural defenses against cancer.
Effects on fertility
The prostate gland plays a role in sexual reproduction. Prostate cancer and many of its treatments affect fertility in several ways.
For example, surgery to remove either the prostate gland or the testicles will affect semen production and fertility. Also, radiation therapy can affect prostate tissue, damaging sperm and reducing the amount of semen for transporting it. Hormonal treatment can also affect fertility.
However, some options for preserving these functions include banking sperm before surgery or extracting sperm directly from the testicles for artificial insemination.
There is no guarantee that fertility will remain intact after treatment for prostate cancer. Anyone who would like to have children after treatment should discuss fertility options with their doctor when they devise their treatment plan.
Staging typically describes how much cancer is present in the body and how serious the cancer is. Knowing the stage of prostate cancer can help a person understand what to expect and will inform decisions about treatment.
Medical professionals often refer to cancer as either non-metastatic or metastatic. Non-metastatic cancer is
Cancer staging is complex and accounts for many different factors. Usually, the lower the number, the less the cancer has spread. Stages
- Stage I: Cancer is only present in the prostate gland.
- Stage II: Cancer has not yet spread from the prostate, but a person will have a higher PSA level.
- Stage III: Cancer may have spread to nearby tissues.
- Stage IV: Cancer may have spread to distant parts of the body.
If a person has symptoms that may indicate prostate cancer, a doctor
- ask about symptoms
- ask about personal and medical history
- conduct a blood test to assess PSA levels
- perform imaging tests
- carry out a urine test to look for other biomarkers
- carry out a physical examination, which may include a digital rectal exam (DRE)
During a DRE, the doctor will check manually for any abnormalities of the prostate with their finger.
Click here to learn more about prostate exams.
If a doctor suspects cancer, they may recommend further tests,
- Transrectal ultrasound: This involves inserting a probe with a camera into the rectum.
- Biopsy: A doctor will take a tissue sample for examination under a microscope.
Only a biopsy can confirm the presence and type of cancer. A person who needs monitoring rather than treatment may need a routine MRI or CT scan.
While prostate cancer is relatively common, doctors can detect most cases early and provide effective treatment. The
The best way to detect prostate cancer in its early stages is to attend regular screening. Depending on risk factors, it may be advisable for people to begin screening at 40. Anyone who has not yet attended screening should speak with a doctor about their options.