What is prostate cancer
Prostate cancer is the result of uncontrolled cell growth in the prostate gland, which is located between the penis and the bladder. It is the second most common cancer in men, after non-melanoma skin cancer.
More than any other type, it is considered a cancer of old age, as about 75% of cases worldwide occur in men aged 65 and older.
Some tumors can grow rapidly, spreading to other organs. However, most grow very slowly (taking about 15 years to reach 1 cm³), which does not give any signs during a man’s life or threaten his health.
Subtypes of prostate cancer
When a patient is diagnosed with prostate cancer, it is very likely that the oncologist will refer to adenocarcinoma, which accounts for 95% of cases of the disease, also known as prostate adenocarcinoma. This type of tumor develops from glandular cells.
There are other types of prostate cancer that originate from other cells in the prostate, but they are very rare. Small cell carcinoma, for example, accounts for less than 1% of cases but requires attention as it is considered a more aggressive subtype of the disease.
There are also neuroendocrine tumors and transitional cell carcinomas.
Symptoms and signs of prostate cancer
Prostate cancer, in its early stage, does not present signs and develops silently. Symptoms only appear when most tumors are in an advanced stage.
In this stage of the disease, the most common symptoms are:
- Feeling that the bladder has not emptied completely;
- Difficulty in starting urination or stopping urination;
- Need to strain to maintain the urine stream;
- Sensation of pain in the lower back or pelvis (below the testicles);
- Difficulty in achieving or maintaining an erection;
- Blood in the urine or semen (rare);
- Pain when ejaculating;
- Pain in the testicles.
Diagnosis of prostate cancer
Since it’s a tumor that develops silently, preventive exams are crucial for the early detection of prostate cancer. There are two exams used: the blood test and the clinical exam.
In the blood test, the level of prostate-specific antigen (PSA) is measured, an enzyme produced by the prostate cells. An increase in its concentration may indicate changes in the organ – besides cancer, it’s an indicator for other conditions such as prostatitis and benign prostatic hyperplasia. Therefore, the best diagnostic approach is to combine the blood test with the digital rectal exam.
Even though it’s painless, there’s still a lot of stigma around the digital rectal exam. However, it’s essential for detecting prostate problems. Through this exam, the doctor can feel the prostate and check for nodules (lumps) or hardened tissue, which are indicators of the disease in its early stages.
When there is suspicion of prostate cancer, other tests come into play to confirm not only the disease but also the stage it is in. These tests include:
- Biopsy – the removal of tissue samples from the gland for analysis is done with the help of ultrasound. There may be discomfort and presence of blood in the urine or semen in the days following the procedure. Prostate biopsy is the only test that confirms if the tumor is malignant;
- Imaging tests – computed tomography, magnetic resonance imaging, and bone scintigraphy may be requested to evaluate the extent of the problem and to check for the presence of cancer cells in other organs or bones.
Treatment for prostate cancer
The therapeutic options for addressing prostate cancer depend on the stage of the disease. The approach to be defined by the physician is always individualized.
In general, for localized disease that has only affected the prostate, the standard treatment is prostate cancer surgery and/or radiation therapy.
For locally advanced disease, the treatment protocol may include radiation therapy or surgery in combination with hormonal treatment.
In cases of metastatic disease, when the tumor has spread to other parts of the body, the most indicated treatment is hormonal therapy.
Prevention
There is no specific guidance for the prevention of prostate cancer. In addition to undergoing regular screening tests for early detection of the tumor, other recommendations are common to many cancer types. These include:
- Obesity – Excess body weight, which increases the risk of developing several cancers, is also associated with a higher risk of prostate tumors;
- Diet – There is no direct link between diet and prostate cancer, but there is evidence that excessive caloric intake and consumption of red meat and fats, as well as smoking and alcoholic beverages, increase the risk of developing the disease. On the other hand, consumption of fruits, vegetables rich in carotenoids (such as tomatoes and carrots), and legumes (such as beans, peas, and soybeans) has been associated with a protective effect;
- Age – Prostate cancer is rare in men under 40, but the risk of prostate cancer increases rapidly after age 50. Approximately 6 in 10 cases of prostate cancer are found in men over 65;
- Ethnicity – Prostate cancer develops more frequently in African-American men and in Caribbean men of African descent than in men of other ethnicities. And when it develops in these men, they tend to be younger. The reasons for these ethnic differences are not clear;
- Genetics – If there are other risk factors, such as heredity, the disease may appear in younger men. The main criteria for defining whether there is a higher risk associated with heredity are: three or more first-degree relatives affected or two first-degree relatives diagnosed before age 55 or when it occurs in three consecutive generations (grandfather, father, and son).
