Common Health Issues

Prostate Cancer: Risk Factors, Causes and Treatment Options

• By Rich Health Editorial Team
• March 17, 2021

Prostate cancer is the second most common cancer affecting men worldwide (1). Prostate is the gland of the male reproductive system located in the pelvic cavity, just beneath the bladder. Prostate cancer is abnormal growth in the healthy functioning prostate gland. It can be benign, which grows slowly and usually does not exceed beyond the prostate, or it can be aggressive, which grows rapidly and involves the surrounding areas too. 

 

Prostate Cancer Causes and Risk Factors

How does a healthy, functioning prostate suddenly becomes cancerous? Or what causes prostate cancer to develop? These are some questions that come to mind when an individual is diagnosed with prostate cancer.

Cancer is the mass of abnormally and rapidly dividing cells. Cell division is a complex process resulting in the production of two identical cells, having the same genetic material (DNA). The replication of genetic material often ends in mistakes, which are usually checked and removed before the cell matures. Sometimes, the genetic mistakes escape the checking process and then mature to become a cancerous cell. 

The cancer cell produces further replicates resulting in the mass of abnormal cells with lots of genetic mistakes. Further, in some individuals, genetic makeup is in such a way that the genetic mistakes occur easily, promoting cancer growth. This also signifies the importance of family history in cancer patients.

All types of prostate cancer arise in light of a certain genetic mutation causing the cells to become defected and multiply rapidly. Prostate cancer risk factors (2), that increase the probability of genetic mistakes, and ultimately lead to cancer are briefly mentioned below.

1. Prostate cancer risk increases with age.
2. The relatives of prostate cancer patients, particularly first-degree relative, are at high risk to get prostate cancer at some point in their life. The presence of BRCA1 and BRCA2 gene mutation in families also increases the risk of prostate cancer.
3. Smoking is the leading cause of many cancers in the body including prostate cancer. Furthermore, smoking increases the mortality in diagnosed prostate cancer patients.
4. Dietary factor has also been implicated in the development of prostate cancer. A study concluded that men who take a large amount of saturated fats, well-done meat and calcium in their diet are at greater risk of having prostate cancer (3)

 

Symptoms of Prostate Cancer

Through the prostate urethra traverses, which is the common outlet for urine and semen. Any abnormal growth of the prostate will constrict the urethra, and thus, produces urinary and sexual symptoms.  Depending on the extent of disease and the stage of cancer, the patient may be either completely asymptomatic or present with the following symptoms (4)

1. Difficulty in voiding
2. Frequency – frequent desire to void
3. Blood in urine
4. Weak urine stream
5. Discomfort in the pelvic region
6. Constant dull pain in the pelvic region
7. Painful ejaculation
8. Erectile dysfunction
9. Blood in semen

 

Diagnosis of Prostate Cancer

A prostate cancer diagnosis is made with the help of history, thorough examination, particularly digital rectal examination (DRE), and some laboratory test. DRE is the special test done by inserting a finger in the rectum through anus to palpate prostate, which lies at front of the rectum. The firm and hard consistency of the prostate felt by pressing the anterior rectal wall is the critical clue to reach towards the diagnosis of prostate cancer. 

The laboratory tests include(5):

1. Prostate – Prostate specific antigen (PSA) levels
2. Imaging – helps in the staging of the cancer
3. Biopsy – confirms the diagnosis

 

Treatment of Prostate Cancer

The treatment of prostate cancer is planned according to the stage and grade of cancer. Staging of cancer tells how extensively the cancer has spread, while, grading shows the nature of cancer, benign or aggressive. The treatment, therefore, is different for different individuals. The treatment plan is also influenced by the patient's choice. For instance, a patient needs surgery but not willing to have it will have other treatment modalities. 

Usually, prostate cancer patients may have one of the following done (6):

1. Surveillance
2. Surgery
3. Radiation therapy
4. Cryotherapy
5. Focal therapy
6. Hormonal therapy
7. Chemotherapy
8. Immunotherapy

Surveillance: 

This plan is for the patients whose disease is subclinical and not affecting sexual, urinary and bowel systems. The doctor just waits and watch, means closely follow the progression of the disease by different testing such as PSA, DRE and biopsies.

Surgery:

Surgery is offered to patients who have high-grade cancers spreading rapidly in the surrounding regions. The aim is to remove the cancerous prostate and preserve the healthy tissue and nearby organ(s). Patients on surveillance when suddenly shows a new cancerous lesion are also offered surgery.

Prostatectomy is the surgery that completely removes the prostate from the body. It is done by different methods. These are:

1. Perineal prostatectomy
2. Retropubic prostatectomy
3. Laparoscopic prostatectomy
4. Robot-assisted prostatectomy

Radiation therapy

This treatment is recommended either as a primary treatment or after surgery as an adjunct, if cancer persists or recurs. It involves destroying cancer cells by using high energy radiations. Radiation therapy can also halt the progression of cancer by decreasing the uncontrollable cancer cells growth.

 

Cryotherapy

Patients who are not fit for surgery and radiation therapy are recommended to have cryotherapy. The procedure works by inserting a needle-like probe in the body under anaesthesia. The probe reaches the prostate and targets the cancer cells to freeze them. The frozen cancer cells become metabolically inactive and the growth stops.

 

Focal therapy

The focal therapy works by specifically targeting the abnormal cells, destroying them and preserving the healthy tissue. It is offered to the patients in whom the disease is focal and confined to a small area of the prostate.

 

Hormone therapy

The prostate cells need testosterone for survival. The hormone therapy deprives the cancerous cell of the testosterone.  It is done by either removing testes that produce testosterone or testosterone suppressing drugs are given. The treatment is best for patients showing local recurrence after aggressive therapy. 

 

Chemotherapy 

In this treatment, highly toxic chemicals are administered in the body that destroy the rapidly dividing cells. The dose is adjusted very cautiously to minimize the harm to the normal rapidly growing cells of the body.

 

Immunotherapy

The principle of this therapy is to utilize the defending power of the body against the cancer cells. The drugs are given to enhance the immune system.

 

Clinical trials 

Clinical trials are researches on a large scale to find new modes of treatment, the body’s response to them and discrepancy of results in different individuals. Prostate cancer patients may be advised to enter clinical trials.

 

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References:

1. Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 68(6), 394–424.
2. Rawla P. (2019). Epidemiology of Prostate Cancer. World journal of oncology, 10(2), 63–89.
3. Leitzmann, M. F., & Rohrmann, S. (2012). Risk factors for the onset of prostatic cancer: age, location, and behavioural correlates. Clinical epidemiology, 4, 1–11.
4. Merriel, S., Funston, G., & Hamilton, W. (2018). Prostate Cancer in Primary Care. Advances in therapy, 35(9), 1285–1294.
5. Descotes J. L. (2019). Diagnosis of prostate cancer. Asian journal of urology, 6(2), 129–136.
6. Chen, F. Z., & Zhao, X. K. (2013). Prostate cancer: current treatment and prevention strategies. Iranian Red Crescent medical journal, 15(4), 279–284.