Prostate Cancer: Overview

Symptoms

At first prostate cancer may not show any symptoms. Later it may come to the following non-specific symptoms such as trouble urinating, erectile dysfunction, bowel disorders, lower back, pelvic and thighs pain, as well as blood in urine or semen liquid.

Causes

As for now, the exact cause of the disease is unknown. However, the factor ricks were defined, among which the main factor is the age – almost all cases of prostate cancer are diagnosed at the age of over 50.

Treatment

Each case has an individual treatment, according to various factors and patient's preferences. Treatment might include surgery, external or internal radiation, hormonal therapy and chemotherapy.

Prognosis

Five-year survival rate in patients with prostate cancer is 89%, which is a very promising number comparing to other oncological diseases. Early diagnostics increase the recovery chances.

Background

Prostate cancer is one of the most common cancer type in men in Germany, Austria and Switzerland and is rated 3rd most common cancer type in Europe. Annually nearly 376.000 men in Europe are diagnosed with prostate cancer. The risks of development prostate cancer increase with age –after the age of 50 the chances are higher.

Prostate cancer is not be confused with benign prostatic hyperplasia, which also develops most often after the age of 50. It is found in 2 out of 10 men within the age of 50 to 59 and in 7 out of 10 men over the age of 70.

Symptoms

Symptoms of prostate cancer are evident only at late stages, when tumor spreads to nearby organs, such as your bladder, rectum or coccyx. Among the signs of prostate cancer are:

• trouble urinating, for example, pain while urinating, weak or intermittent stream of urine, urinary retention
• painful ejaculation or trouble ejaculating
• erectile dysfunction (weak erection or impotence)
• blood in the urine or the semen
• bowel disorders
• lower back, pelvic and thighs pain

These symptoms are non-specific for prostate cancer and might be caused by other reasons. For example, trouble urinating might be caused by benign prostatic hyperplasia and lower back pain might be coming from spine problems. If you have noticed any of the above mentioned symptoms, it is advisable to go see a doctor.

Reasons and risk factors

The exact reason of prostate cancer is unknown. However, some of the factor ricks were already defined.

Age

The main risk factor of prostate cancer is age. Normally, malignant prostate tumor does not develop until the age of 50. For instance, prostate cancer will develop in one out of 270 men within the age of under 50 and in every 17th men within the age of 75.

Genetic predisposition

The risk of prostate cancer is higher in those men whose close blood relatives (grandfather, uncle, brother, especially, if there are more than one) were diagnosed with prostate cancer. Moreover, if women in the family (mothers and grandmothers) had breast cancer, their sons and grandchildren have an increased risk of developing prostate cancer.

Nonetheless, prostate cancer in family is rare. According to experts, 90-90% of all prostate cancer cases develop without risk genes.

Ethnic factors

Considering prostate cancer cases in East and West, a huge gap between different countries has been noticed. A relatively high number of cases has been observed in the USA (especially among black people). On the contrary, in Asia a number of cases is significantly reduced. Worth mentioning, that population in Northern Europe are more often diagnosed with prostate cancer than population in Southern Europe.

The reasons might lie in different eating habits. In the USA the most common diet is based on high-fat foods and meat. In Asia, instead, the diet contains whole grains, vegetables and soy. The other reasons might also include social-economic as well as genetic factors.

Other risk factors

Experts have been researching a possible connection between nutrition and risk of developing prostate cancer. According to studies, phytoestrogens (plant estrogens, especially, those in soy) and lycopene (plant substance, found mainly in tomatoes) might decrease risk of developing the disease. However, the data available is yet not sufficient for any diet recommendations for prostate cancer prevention.

Early the male sex hormone testosterone was believed to increase prostate cancer development. However, nowadays many experts deny this theory. Even though testosterone does contribute to previously diagnosed prostate cancer growth, it does not cause cancer itself. Men with testosterone deficiency and without prostate cancer may be referred for hormone replacement therapy. According to the last data, the therapy does not increase the risk of prostate cancer development.

Theory that sexual contacts influence the risk of developing prostate cancer has also been refuted. The frequency of sexual intercourse, be it rare or often, does not play a role, according to the last researches.

Some studies show that there might be a connection between smoking, alcohol consumption and prostate cancer. However, this suggestion requires further researches. Besides, there is a possibility that sexually transmitted diseases and inflammation, such as prostatitis, might increase the risk of developing prostate cancer.

Screening and diagnostics

The earlier prostate cancer is detected, the better are the chances for recovery. However many people learn about their disease only at late stages, which is why men are highly recommended to undergo prostate cancer screening, preferably once a year.

Prostate cancer screening

Everybody who detected any prostate cancer symptoms should go as soon as possible go see an urologist. The doctor gathers medical history and then examines a patient by prostate palpation through rectum (digital rectal exam). The examination is completely painless and very important, as it helps to detect any enlargement and nodular indurations in prostate.

Digital rectal exams may find out even more significant changes in prostate, which might be a result of a developed carcinoma or have a more harmless origin. In this situation, it is a call for further examination.

PSA analysis

Apart from the palpation, it is important to define the PSA (prostate-specific antigen) level in the blood in order to diagnose prostate cancer. PSA is a protein produced by the cells of the prostate and it hardly ever can be traced in human blood. High level of this antigen is a sign of increased activity of prostate tissues — as in cases of prostate cancer, for example. That is why PSA level is used for early detection of prostate cancer and monitoring the patient’s state after the diagnosis.

Transrectal ultrasound

Besides rectal palpation and PSA test, additional examinations are required in order to diagnose prostate cancer. Transrectal ultrasound is one of them. It is an ultrasonic scanning of the prostate through the rectum, which gives the doctor a more accurate image of the shape and size of the prostate. Moreover, a prostate biopsy can be taken during the procedure.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) can be sometimes used as a method of visualization for prostate cancer detection. It enables a much more detailed images than transrectal ultrasound.

Biopsy

If all the examinations listed above indicate prostate cancer, a sample of prostate tissue is taken to be further studied in the laboratory (prostate biopsy). Only after these examinations are completed, the patient can receive the final diagnosis. This procedure is conducted during the transrectal ultrasound under anaesthesia.

Tissue samples analysis

Prostate tissue samples are studied by a pathologist under a microscope in order to detect cancer cells (histopathological examination). This study also shows all the changes (degeneration) of the tumor cells compared to healthy prostate tissue.

The extent of degeneration is determined by the Gleason-score, which is calculated with a special method. The tumor gets a score on the scale from 2 to 10 - the higher the score, the more aggressive the tumor is and the chance of recovery is lower. Another way to classify the tumors is the TNM system.

Staging

If the histopathological analysis of the tissue samples confirms the suspected cancer, it is necessary to evaluate if the cancer has spread to other organs. Thus, the doctor can define the stage of prostate cancer and find an individual treatment strategy.

Various studies are used to determine the stage of the disease:

• Magnetic resonance imaging (MRI) helps to locate the enlarged lymph nodes in the pelvis - possible signs of cancer cells in lymph nodes. A computer tomography (CT) is an alternative to MRI.
• Skeleton scintigraphy is a nuclear medical examination that allows to locate prostate cancer metastasis in the bones.
• PET/CT scans: detailed visualization obtained via computer tomography (CT) is combined with position emission tomography (PET), the procedure that allows to visualize metabolic activity of the cells (cancer cells are more active than the healthy ones).
• Abdominal ultrasound is used in order to detect prostate cancer metastasis in the liver. Possible urinary retention caused by tumor pressure on the urethra can also be revealed during the ultrasound.

In order to determine the stage of the cancer, doctors use the above mentioned Gleason-score or the TNM system. The abbreviation includes three indicators: T (tumor) stands for the size, N (nodis) - lymph node status, and M (metastasis) - metastasis presence in other organs. Each of these parameters gets a numerical value depending on the degree of tumor extension.

T1 is a small size prostate cancer that does not cause any symptoms, cannot be palpated or visualized, but can be detected via biopsy. T4 is at the other end of the scale. It is an advanced tumor, that has already invaded the surrounding tissues (e.g. rectum).

The N parameter can have two values: N0 means that the lymphatic nodes are not affected. N1 means that regional lymphatic nodes are affected by cancer cells.

The M parameter is also assigned 0 (metastasis negative) and 1 (metastasis positive) values.

Treatment

Prostate cancer treatment depends on a range of factors, the most important of which are the cancer stage and the age of the patient. The doctor also considers other factors such as comorbidity and patient’s preferences (such as refusal of chemotherapy).

If the cancer is detected at an early stage then the therapy is aimed at full recovery. Individual treatment strategy may include surgery, external or internal radiation, hormone therapy and/or chemotherapy. If the prostate cancer has significantly spread in the patient’s body, the main objective is to alleviate the symptoms and prolong the life of the patient (palliative care).

If an elderly patient’s tumor does not grow, or grows slowly and does not cause any discomfort, there might be an option of having no treatment, but the patient would have to get regular checkups.

Aftercare

Like any other cancer patients, prostate cancer patients should be regularly examined by specialists. First of all, it helps to detect any prostate tumor recurrences. Such examinations include physical exams and blood tests (for example, to determine PSA). Secondly, aftercare is essential for taking care of the possible consequences and side effects of the prostate cancer treatment. For example, if the man experiences impotence (erectile dysfunction) after the surgery, it can be treated with medication or special trainings.

Subsequent monitoring should be started no later than twelve weeks after the end of the treatment. During the first two years, examinations should be done every three months, then during the next two years - every six months. Starting from the year five, an urologist (preferably with a specialization in oncology) should examine the patient once a year.

The course of the illness and prognosis.

Malignant prostate tumors usually grow slowly and are easily treated, that is why the disease prognosis can generally be called favorable. However, there are cases when the tumor spreads quickly and aggressively, then the chances of full recovery are low.

The chances of healing of prostate cancer first and foremost depend on the stage of the tumor (if it is localized or metastasized) and the severity of the cancer cells spread.

According to the statistics, a five-year survival rate of prostate cancer patients is 89% (it means that five years after the diagnosis 89% of the patients are still alive). It is quite a good rate compared with other types of cancer.

When the prostate cancer is diagnosed, it is impossible to predict a course of the disease, but an experienced urologist can give a good estimation of full recovery.