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Prostate cancer is a type of cancer that begins in the prostate gland, which is part of the male reproductive system. Although it may develop slowly, it has the potential to spread rapidly. It often causes symptoms such as frequent urination, painful urination, and urinary incontinence. Treatment can be challenging, but early diagnosis significantly increases the chances of effective intervention.
What is Prostate Cancer?
Prostate cancer is a type of cancer that develops in the prostate, a gland located below the bladder and in front of the rectum in men. This gland plays a role in producing the fluid that mixes with semen, helping sperm to function during reproduction.
Prostate cancer begins as a malignant growth in the gland's outer portion, gradually infiltrating deeper into the prostate. Cancer confined solely within the prostate, not breaching its capsule, is termed "Localized Prostate Cancer." This disease, like other forms of cancer, has the potential to metastasize, first affecting nearby tissues or the seminal vesicle and eventually spreading to distant sites such as lymph nodes and bones.
What is Prostate?
The prostate is a gland about the size of a chestnut, situated in the male reproductive system between the bladder and the urethra—the tube that expels urine from the bladder to the exterior.
What are the Causes of Prostate Cancer?
The precise origins of prostate cancer remain unclear. The causes of prostate cancer can be listed as follows:
- Family history of prostate cancer
- Significant tobacco use
- Aging
- Consumption of foods cooked at high temperatures
- Diets high in animal fats and red meats
- Obesity
- Sedentary lifestyle
- Being of African descent
- Having relatives with prostate or breast cancer
- Elevated levels of male hormones
What are the Symptoms of Prostate Cancer?
Prostate cancer progresses insidiously; the symptoms usually appear in the later stages of the disease. For this reason, it is essential to have regular check-ups, especially after age 40, for early diagnosis. Although not characteristic, the most common symptoms:
- Difficulty urinating and inability to urinate frequent urination
- Continuation of urine flow drop by drop at the end of urination
- Difficulty during defecation blood in urine and semen
- Erection problems and pain during ejaculation
However, these symptoms may also be a precursor to other conditions, such as prostate enlargement and inflammation of the prostate. Because prostate cancer can often spread to the bone, it can cause severe pain in the lower back, hips, or legs. For this reason, it is essential to consult a specialist physician in case of possible symptoms and, more importantly, not to neglect regular check-ups.
What Tests are Used to Diagnose and Monitor Prostate Cancer?
Many tests can be done to detect and then stage (see the extent of spread) prostate cancer, but not all of them are necessary for every man.
Rectal Examination
It is a simple form of examination and is useful both in the diagnosis of cancer and in determining whether the tumor is localized in the prostate or has locally spread to the tissues around the prostate.
Prostate Specific Antigen (PSA) Test
It is a blood test that can provide indirect information about the presence of prostate cancer and, if cancer is present, information about its size and extent. The PSA test can sometimes be challenging to interpret because PSA is produced by both tumor cells and normal cells. However, PSA made by the normal prostate passes into the bloodless, while PSA made by tumor tissue passes into the blood in more significant amounts.
PSA 3 Letters can save your Life: PSA
This simple blood test detects the amount of prostate-specific antigen (PSA), a chemical that escapes from prostate tissue into the bloodstream in small amounts.
High levels of PSA indicate a prostate problem, such as an enlarged prostate, infection, or cancer. You should see a urologist for further examinations if your PSA level is high.
The American Cancer Society recommends regular annual PSA testing for people who:
- From the age of 40 for African American men.
- White men from age 40 if a father or brother has prostate cancer
- From age 50 to white men with no family history of prostate cancer. If you are in one of the above groups, make an appointment with a urologist immediately for a PSA test and a digital rectal examination of the prostate.
Transrectal Ultrasonography (TRUS)
It is the ultrasonography of the prostate directly from the rectum using a special ultrasonography probe.
It is an easy and safe way to view the prostate. With this examination, the size of the prostate is evaluated more clearly, and the nodules that are more likely to be cancer are better visualized. Most importantly, when a biopsy is required from the prostate, this procedure is much easier under the guidance of transrectal U.S., and biopsy is taken from suspicious nodules more easily and effectively.
Bone Scintigraphy
It is used to show whether the cancer has spread to the bones because the most common metastasis site of prostate cancer is the bones. It does not need to be done in all patients, especially in small cancers and patients with low PSA levels.
However, if a radical surgical treatment is considered, it should be ensured that there is no metastasis in the bones before such surgery.
Computed Tomography (CT)
It helps detect enlarged lymph nodes due to cancer rather than cancer in the mail. Usually, CT cancer is done with diffuse, high-grade grade, or high PSA.
Pathological Examination
The definitive diagnosis of prostate cancer can only be made by examining the biopsy samples taken from the rectum with a needle under a microscope by pathologists.
Patients who required Biopsy
- Those with high PSA.
- Stiffness and nodules were detected in digital rectal examination.
- Patients with a combination of 1 and 2 substances.
The extent and grade of the tumor in the biopsy and the patient's PSA level play a role in deciding the treatment.
How is Prostate Cancer Treated?
Watchful Waiting (Wait-and-See / Tracking Protocol)
This approach means monitoring the patient without treatment. Prostate cancer often grows slowly and may never cause symptoms in a man’s lifetime. For older men with small, low-grade tumors, this can be a reasonable choice. However, high-grade tumors can become life-threatening within ten years.
Active Surveillance
In this method, curative treatment is delayed until clear signs of progression appear. Patients are closely monitored with PSA tests, rectal exams, and repeated biopsies. If the disease shows progression, treatments like radical prostatectomy or radiotherapy are started. The goal is to avoid unnecessary treatment in low-risk cases.
Radical Prostatectomy (RP)
A surgical procedure to remove the entire prostate, its capsule, and seminal vesicles. If cancer is confined within the capsule, RP can cure the disease. After surgery, PSA levels should drop near zero. If cancer has spread beyond the capsule, PSA remains a key tool for follow-up. Risks include bleeding, cardiovascular events, urinary incontinence, and erectile dysfunction. The procedure can be done open, laparoscopically, or with robotic assistance.
Radiotherapy
An alternative to surgery, particularly effective when cancer is still localized or has just spread slightly beyond the capsule. Ten-year results are similar to surgery, though long-term outcomes may slightly favor surgery. Side effects can include urinary issues, bowel changes, reduced bladder capacity, and erectile dysfunction.
Hormonal Therapy
Used mainly when cancer has spread beyond the prostate. It reduces or blocks testosterone, slowing tumor growth but not curing it. This can be done surgically (orchiectomy) or with medications (LHRH analogs and anti-androgens). Side effects include hot flashes, loss of libido, and erectile dysfunction.
Frequently Asked Questions About Prostate Cancer
What are the causes of prostate cancer?
Although the exact causes of prostate cancer are not fully understood, certain factors are known to increase the risk. These include advanced age, obesity, and a history of prostate cancer. The condition is often linked to changes that occur in DNA.
What are the 5 warning signs of prostate cancer?
The first five early warning signs of prostate cancer include blood in the urine, difficulty urinating, pelvic pain, frequent urination, and a weak urinary stream.
What is the early stage of prostate cancer?
In the early stage of prostate cancer, the malignant cells are confined to the prostate gland. This stage is also referred to as localized prostate cancer.
How long can you have prostate cancer without knowing?
Prostate cancer is a slow-growing type, which means it may remain asymptomatic for many years. Over time, the signs can be subtle or resemble other conditions, making the disease difficult to detect.
Can a blood test detect prostate cancer?
Prostate cancer can be detected in asymptomatic men through blood tests. In this context, prostate-specific antigen (PSA) levels are measured in units called nanograms per milliliter (ng/mL).
Which department should be consulted for prostate cancer?
For prostate cancer, patients should consult the Urology department for diagnosis and initial management. During the course of treatment, Oncology department becomes involved to oversee and coordinate cancer-specific therapies.
