Prostate cancer: symptoms, diagnosis and treatment

Prostate cancer is cancer that occurs in the prostate, a gland that is part of the male reproductive system. The main function of the prostate, which is located below the bladder, is to produce a fluid that mixes with sperm to form semen. Prostate cancer develops when cells in the prostate gland begin to grow uncontrollably. These cells can then spread to other parts of the body. Prostate cancer is one of the most common forms of cancer and is often treatable if detected at an early stage. Read on for more information about the symptoms of prostate cancer, screening, prevention, and treatment.

Table of contents

• What are the symptoms of prostate cancer?
• How is prostate cancer diagnosed?
  
• How is prostate cancer treated?
• What is the main cause of prostate cancer?
• How can I prevent prostate cancer?

What are the symptoms of prostate cancer?

Prostate cancer may cause few or no symptoms in its early stages. As the cancer progresses, the following symptoms may occur:

• Difficulty urinating

• Urinary incontinence

• Slow urine stream

• Frequent urination

• Erectile dysfunction

• Blood in the urine or semen

• Unexplained weight loss

Source: Mayo Clinic

How is prostate cancer diagnosed?

If you have symptoms that may be caused by prostate cancer, your general practitioner may consider one or more preliminary tests. This could include a blood test to check the level of prostate-specific antigen (PSA) or a physical prostate examination (digital rectal exam). Based on the results of these tests and other risk factors such as age, family history, and ethnic background, you may be referred to a hospital for further testing. It is also possible to test your PSA at home using a PSA blood test from Homed-IQ.

MRI scan

If your PSA level is elevated or if there are other possible signs of prostate cancer, your doctor will refer you to the hospital for an MRI scan of the prostate. If the scan shows no abnormalities, a prostate biopsy can often be avoided. In many countries, the use of MRI scans has replaced the older diagnostic guidelines, which recommended that individuals with a high PSA level undergo a prostate biopsy immediately. By using MRI scans, patients without cancer can avoid the pain and possible side effects of a prostate biopsy. In patients with cancer, MRI can indicate where the abnormalities are located in the prostate, which means fewer samples need to be taken during the biopsy (Radboudumc, 2020).

Prostate biopsy

A biopsy is a procedure in which small samples of the prostate are taken and examined under a microscope. If cancer cells are found, the samples can be used to determine how quickly the cancer is likely to spread. This is called “staging and grading” and determines the next steps in treatment.

A core needle biopsy performed by a urologist is the most common method of diagnosing prostate cancer. In this procedure, a hollow needle is inserted into the prostate through the rectal wall (transrectal biopsy) or through the perineum (transperineal biopsy). When the needle is withdrawn, it removes a small cylinder of prostate tissue (American Cancer Society, 2019). This procedure is usually performed twelve times on different parts of the prostate but can be reduced to three samples in patients who have previously had an MRI (Radboudumc, 2020). The biopsy procedure can be performed under local or general anesthesia and typically takes about 20 minutes.

What are the risks of prostate biopsies?

Although a biopsy can provide a definitive diagnosis of prostate cancer, there are certain risks involved. These risks include:

• Missing the cancer.

• Additional biopsies may be needed if symptoms persist.

• Detecting small, slow-growing cancers that do not require treatment. The discovery of such cancers may lead to anxiety or the choice to undergo surgery or treatments with little to no benefit for your health. These treatments may cause side effects such as incontinence and erectile dysfunction. In this case, the cancer diagnosis may be more harmful (causing side effects) than beneficial (did not save or extend the person's life). This is known as overtreatment and is an important consideration when deciding whether to undergo a prostate biopsy.

Source: NHS, 2021

What are the types of prostate cancer?

Nearly all types of prostate cancer are adenocarcinomas, a type of cancer that occurs in the glands lining certain organs. The most common form of adenocarcinoma in the prostate is acinar adenocarcinoma, which occurs in the gland cells lining the prostate. A less common form is ductal adenocarcinoma, which occurs in the ducts (channels) of the prostate. Ductal adenocarcinoma tends to spread more quickly than acinar adenocarcinoma (Cancer Research UK, 2022).

Other types of cancer that can occur in the prostate include small cell carcinomas, neuroendocrine tumors, transitional cell carcinomas, and sarcomas. However, these forms of cancer are rare. If you are diagnosed with prostate cancer, it is almost certainly an adenocarcinoma (American Cancer Society, 2019).

How is prostate cancer treated?

The treatment of prostate cancer depends heavily on the individual diagnosis, such as how large the cancer is and whether it has spread to other parts of the body. Many cases of prostate cancer do not require treatment at all. This is because they are unlikely to reduce life expectancy, and treatment may cause more side effects than benefits. Although there are many types of treatments for prostate cancer, the most common ones are summarized below. If you need treatment for prostate cancer, your care team will explain all available options.

Monitoring

For those who do need treatment, the doctor may recommend watchful waiting or active surveillance. Watchful waiting is a less intensive way of monitoring the cancer, without frequent tests or biopsies. It is sometimes used for older patients who are unlikely to have their lives shortened by prostate cancer or for those who do not wish to undergo treatment. Active surveillance involves closely monitoring the cancer and discussing treatment if it starts to grow (Cancer Research UK, 2022). This is sometimes used for cancer that is confined to the prostate gland and carries a low to intermediate risk.

Surgery

A radical prostatectomy is the surgical removal of the prostate gland. This treatment may cure cancer that is still confined to the prostate or has not spread far. Risks of prostate removal surgery include incontinence and erectile dysfunction. In addition, after this procedure you will no longer be able to ejaculate or have children (NHS, 2021).

Radiotherapy

Radiotherapy uses radiation to kill cancer cells. It can be used to cure prostate cancer that has not spread far and to slow the progression of cancer that has spread. Radiotherapy for prostate cancer can consist of external beam radiation or internal radiation (brachytherapy). External radiation is typically used for cancer in the prostate or that has spread to other parts of the body, as well as to kill remaining cancer cells after surgery. Brachytherapy is used to treat cancer that has not spread outside the prostate  (Mayo Clinic, 2022).

Hormone therapy

Hormone therapy is a treatment that stops the body from producing the male hormone testosterone. Prostate cancer cells depend on testosterone for their growth. Cutting off the testosterone supply can kill cancer cells or slow their growth. Hormone therapy is sometimes used alongside radiotherapy and may involve medication or removal of the testicles (Mayo Clinic, 2022).

Other treatments for prostate cancer may include:

• Freezing or heating prostate tissue (cryotherapy, cryoablation, or high-intensity focused ultrasound)

• Immunotherapy

• Chemotherapy

• Targeted drug therapies

How fast does prostate cancer spread?

In many cases, prostate cancer spreads very slowly. It can take years before it is detected and/or spreads to other parts of the body. Often, prostate cancer does not affect a man’s lifespan. However, no two cases of prostate cancer are the same. Some grow slowly, while others grow and spread quickly (Mayo Clinic, 2022). That’s why initial screening and monitoring are important if you are experiencing prostate-related symptoms. In this way, high-risk cases can be quickly identified and treated, while lower-risk cases may choose to monitor their cancer before starting treatment.

What is the survival rate for prostate cancer?

The survival rate for prostate cancer is individual, and population-level statistics may not reflect your specific situation. The prognosis of prostate cancer depends on many factors, and the doctor will give advice based on your particular circumstances. Prostate cancers that are localized to the prostate and nearby areas have a very high survival rate. According to U.S. data, the five-year survival rate for localized prostate cancer is nearly 100%, and the fifteen-year survival rate is 95% (Johns Hopkins, 2022). Many people diagnosed with prostate cancer will also be cured.

Prostate cancer that has spread to other parts of the body (metastasized) has a much lower survival rate than local or regional cancer. However, through screening, most prostate cancers can be cured before they reach this stage.

Can prostate cancer be cured?

Yes, most prostate cancers can be cured through early detection via screening. This is why the long-term survival rates for prostate cancer are quite high (Johns Hopkins, 2022).

Who is at risk of prostate cancer?

Anyone with a prostate gland is at risk of developing prostate cancer. This mainly includes men, but also transgender women and non-binary people who have a prostate gland. A person's risk of developing prostate cancer depends on several factors, including:

• Age: Prostate cancer is more common in older individuals.

• Ethnicity: Prostate cancer is more common in Black men than in White men, and least common in Asian men.

• Genetics and family history: Your risk of prostate cancer is higher if you have a close relative, such as a father or brother, who has had prostate cancer. Some inherited genes may also increase the risk of prostate cancer. These hereditary genes are rare and account for only a small number of prostate cancers.

Source: Cancer Research UK, 2022

What is the main cause of prostate cancer?

The cause of prostate cancer is not known. It is likely due to a combination of factors that vary from person to person. It is known that prostate cancer begins when cells in the prostate develop changes in their DNA. These changes tell the cells to grow and divide more quickly than normal cells. These cells are known as cancer cells (Johns Hopkins, 2022).

How can I prevent prostate cancer?

For people who are not at high risk of prostate cancer, it is recommended to follow a healthy lifestyle to help prevent disease in the future. This includes eating a healthy diet with fruits and vegetables, getting regular exercise, and maintaining a healthy weight. In addition, speak with your doctor about prostate cancer screening and seek medical attention if you experience prostate-related symptoms. If you are at high risk of prostate cancer, talk to your doctor about early or more frequent screening and preventative measures (Mayo Clinic, 2022).

It is now possible to screen for prostate cancer at home with the PSA blood test from Homed-IQ. While not all prostate cancers cause a high PSA level—and it is possible to have a high PSA without having cancer—the PSA test can be used to detect prostate cancer at an early stage and lead to further screening and/or diagnosis.