Prostate Cancer – All You Need to Know

Prostate Cancer – All You Need to Know

Prostate cancer (also known as Prostatic Carcinoma) is the second most common cancer in men.  Sometimes, it progresses very slowly and do not show any symptoms for years. Therefore, routine screening is necessary to detect prostate cancer in early stages.

What is Prostate Cancer?
Prostate cancer is a condition in which cancer arises in the prostate gland. Prostate gland is an essential organ of male reproductive system. It is located below bladder and in front of the rectum. It secretes the seminal fluid (liquid in semen), that is necessary for survival and transportation of sperm.

What Causes Prostate Cancer?

Prostate cancer may occur due to mutations in the DNA of prostate cells. These mutations lead to uncontrollable growth resulting in formation of mass or lesion called tumor. These cancerous cells can invade nearby tissues or distant parts through metastasis.

Symptoms of Prostate Cancer
Symptoms of prostate cancer include:

• Frequent urination
• Painful or burning micturition
• Decreased urine flow
• Hematuria (blood in the urine) or blood in semen
• Urinary incontinence
• Pain during ejaculation
• Erectile dysfunction
• Back pain
• Bone pain (later stages)

Risk factors of Prostate Cancer:

Risk factors of prostate cancer are:

• Gender – Men
• Age above 50 years
• Family history of prostate cancer
• Inherited gene mutations

Obesity, smoking, inflammation of the prostate gland, sexually transmitted infections, and vasectomy may also increase the risk of prostate cancer. However, these factors have less clear effects on the risk of prostate cancer.

Complications of Prostate Cancer:

Prostate cancer affects the reproductive capacity in men and may lead to decreased semen production and erectile dysfunction.

Diagnosis:

A physical examination is performed initially to assess the symptoms. Digital rectal exam can be performed by inserting gloved and lubricated finger into the rectum to examine prostate.

Blood tests such as prostate-specific antigen (PSA) test is recommended. PSA is produced by prostate gland and high levels may indicate cancer.

Imaging tests such as ultrasound is performed by inserting a probe into the rectum. This test helps to visualize the prostate gland and detect changes in it. Positron emission tomography (PET) scan is performed if metastasis is suspected. This test helps to identify spread of cancer to other organs.

Diagnosis is confirmed by biopsy in which a sample of the tissue is obtained for histopathological examination.

Gleason score is given observing the biopsy of the sample. The sample is compared with normal tissue. Based on the histologic patterns in the patient cells, Gleason score is determined.

• Pattern 1: Small, uniform glands
• Pattern 2: More space between glands
• Pattern 3: Infiltration of cells from glands
• Pattern 4: Irregular masses of cancerous cells with few glands
• Pattern 5: Lack of or occasional glands, sheets of cells

Grading of the prostate cancer based on Gleason score:

• Grade 1: Gleason score ≤6; well differentiated and less aggressive
• Grade 2: Gleason score 7; moderately differentiated and more aggressive than grade 1
• Grade 3: Gleason score 8 – 10; poorly differentiated and aggressive

Treatment of Prostate Cancer
Treatment options for prostate cancer include:

Surgery: Radical prostatectomy is the standard treatment for prostate cancer if there is no metastasis. In radical prostatectomy, prostate gland along with the surrounding tissues are removed. It can be open or robotic surgery. Robotic surgery is minimally invasive, precise with negligible pain and blood less. Hence, it is considered safe and effective when compared to open surgery.  

Radiation therapy: High energy X-rays are directed towards the tumor to kill the cancer cells or interrupt with their growth.

Brachytherapy: It is a type of radiation therapy. In this procedure, radioactive materials are inserted into the prostate gland. These materials exert low energy radiation gradually destroying the affected prostate tissue.

Hormone therapy: This therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy (AST). Use of antiandrogens decreases testosterone levels in the body. Testosterone is necessary for growth of prostate cells. Therefore, deprivation of testosterone hormone can reduce the growth of tumor.

Chemotherapy: Medications are given orally or intravenously to interfere with the growth of cancer cells.