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What is prostate cancer?
The prostate is a small gland that produces seminal fluid that nourishes and helps transport sperm, located in the male pelvis at the base of the penis. Prostate cancer is when cancer cells have been detected within the prostate gland. If normal prostate cells mutate, cancer cells can form, grow, and multiply uncontrollably, forming a cancerous tumour.
Worldwide, prostate cancer is the most commonly diagnosed cancer, with well over a million newly diagnosed cases each year. Many men (estimated to be more than 80%) will develop microscopic evidence of prostate cancer by the age of 80, and 11.6% of men will develop “clinically significant” prostate cancer.1,2
Symptoms of prostate cancer
Most cases of prostate cancer, especially in the early stages, do not cause symptoms. However, when symptoms are apparent, they include: 7
- Frequent urination.
- Regularly waking to urinate (nocturia).
- Blood in the urine (haematuria).
- Pain or discomfort while urinating (dysuria).
If you have these symptoms, it does not mean you have prostate cancer, as these symptoms are also common in non-cancerous tumours of the prostate as well as in a condition called benign-prostate hyperplasia.
Late and more severe symptoms of prostate cancer include anaemia-induced fatigue, bone pain, insomnia, paralysis from the spread of cancer to the spine, and kidney failure from a blockage in the tubes that connect the kidney to the bladder. 7,8
Diagnosis of prostate cancer
Prostate cancer was conventionally diagnosed by a digital rectal examination, when a doctor examines the rectum to assess the size of the prostate gland and any abnormalities. More recently, the prostate-specific antigen (PSA) test has become the keystone for prostate cancer screening, with PSA being a common protein secreted into the blood by the prostate gland.
PSA levels above 4 ng/mL suggest that the patient needs further testing, as PSA levels between 4–10 ng/mL indicate the patient has approximately 25% chance of having prostate cancer, and PSA more than 10 ng/mL indicates over a 50% chance.9
A biopsy of the prostate is usually performed to confirm the presence of prostate cancer. This is when a needle is used to collect small tissue samples from the prostate gland, which can then be observed under a microscope. During a biopsy, the prostate gland is usually located with magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) devices.10
The results of a biopsy for prostate cancer will specify whether a patient is negative (no cancer cells detected), positive (cancer cells detected), or suspicious (abnormal cells detected that may be cancer cells).
Causes of prostate cancer
Prostate cancer has the highest heritability of any major cancer in men.11 Men with a first-degree relative (father or brother) with prostate cancer have twice the risk of the general population.12
In addition, patients with genetic or hereditary prostate cancer tend to develop their malignancies at an earlier age, have more rapid progression, are more likely to be locally advanced, and have a higher risk of recurrence after surgery.13
Although genetics are the strongly dominant risk factor for prostate cancer, other risk factors may include ethnicity (particularly African men), smoking, obesity, processed meat consumption and lack of exercise.14,15,16
Though more evidence is needed, a history of sexually-transmitted infections, such as chlamydia, gonorrhea, or human papillomavirus (HPV), has been associated with an increased risk of developing prostate cancer.17
Treatment of prostate cancer
When the cancer is limited to the prostate, it is considered localised and potentially curable.9 Patients with localised prostate cancer at a low to intermediate risk of recurrence generally have a favourable outcome of 99% overall survival for 10 years if the disease is detected and treated at an early stage.18
Treatment options for localised prostate cancer include surgical removal of the prostate gland (radical prostatectomy), implanting tiny pellets into the prostate that give off low-level radiation (brachytherapy), and a surgical procedure to temporarily freeze prostate tissue (cryotherapy).9
Many localised prostate cancers are low-risk, however, and the best response is often active surveillance, which involves the regular testing for cancer progression before starting treatment.
If the cancer has spread outside the prostate, it is considered advanced. Depending on the severity, however, similar treatments to those used for localised prostate cancer may be used, specifically radiation therapies such as brachytherapy and also the projection of radiation beams from a machine to the prostate (external beam radiation).
Other treatments for advanced prostate cancer include blocking testosterone production and other male hormones that fuel prostate cells (hormonal therapy), stimulating the immune system to fight cancer cells (immunotherapy or biological therapy), and using anticancer drugs that kill or inhibit the growth of cancerous cells (chemotherapy).9
Prognosis of prostate cancer
Among cancers, prostate cancer is one of the least aggressive. Most diagnoses of prostate cancer are slow-growing, lower grade, relatively harmless, and do not greatly increase the risk of death. In the United States, the overall 5-year survival rate is 99%.3
Typically, prostate cancer is more aggressive in men less than 50 years old, which comprise only 5% of all prostate cancer cases.4 However, as the disease is highly prevalent, total deaths related to prostate cancer are still high. Globally, prostate cancer is the sixth leading cause of cancer death in men, with 375,000 related deaths per year.1
In the United Kingdom and the United States, prostate cancer is the second most common cause of male cancer death after lung cancer.5
The severity of a patient's cancer, which affects their prognosis, can be graded by the Gleason Score. Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer, 7 the intermediate grade, and a score of 8 to 10 the high grade cancer.
The Gleason Score will then be used to assign the patient into 1 of 5 Grade Groups, with Grade Group 1 the least aggressive and Grade Group 5 the most aggressive.6
Questions to ask your doctor about prostate cancer
What is my PSA level? Does it indicate that I may have prostate cancer?
What is my Gleason score? What does it mean for my prognosis and treatment?
Are there additional tests I can do to better understand the stage and aggressiveness of my prostate cancer?
Do I need treatment or can I be monitored under active surveillance? If so, how does it work?
Has my cancer spread beyond the prostate? Can it potentially be cured?
What treatment options exist for this stage of cancer? Which one is best for me?
What side effects can I expect from treatment?
Should I speak with other specialists for a second opinion before making a final decision on my plan of action?
Is my cancer likely to come back based on what you know today?
How can I improve the success of my therapy? Are there lifestyle changes that will benefit me (diet/exercise/sleep/stress)?
Support & resources for postate cancer
As always, we recommend speaking with your local doctor about prostate cancer if you have any concerns. It is also possible to receive more information about prostate cancer and/or to speak with a health professional (via phone, email or live chat) about prostate cancer by visiting the following sites:
