Prostate Cancer Awareness: Understanding its Risks, Symptoms, and Management

What is a Prostate Gland?

The prostate is an inverted cone-shaped gland in a male reproductive system located just below the bladder in between the base of the penis and the rectum. It secretes an alkaline fluid which forms part of the semen – the fluid released from the penis during ejaculation.

What is prostate cancer?

Prostate cancer occurs when accumulated genetic changes (DNA mutations) in normal prostate cells transform them to abnormal cancer cells. The cancer cells grow uncontrollably and live longer than usual, infiltrating the surrounding tissue. Prostate cancer poses a significant health burden, being the most common cancer in males worldwide and the second commonest cause of cancer-related death in men after lung cancer.

In the majority of cases, prostate cancer is slow to develop such that most men diagnosed with the disease are more likely to die from other causes rather than prostate cancer. However, when not detected early or when there are aggressive forms, prostate cancer can invade nearby seminal vesicles or spread to more distant sites in the body, particularly the bone, often leading to death.

What are the risk factors for prostate cancer?

Both non-modifiable and modifiable factors play roles in the development of prostate cancer. The non-modifiable factors include age, ethnicity, family history and genetic predisposition of individuals. The condition is commoner in elderly men, black males and those with family history.

Genetic alteration (mutation) in some molecules in the body, such as the HOXB13 gene, has been shown to be associated with increased in the risk of hereditary prostate cancer. The mutation is found to be more common in men who develop the disease at a younger age and have a family history of the disease than in those who developed the disease at old age with no known family history of the disease. Mutation in a gene known as TP53 is also linked with aggressive forms of prostate cancer which have poor prognosis.

Certain environmental and lifestyle-related factors constitute modifiable factors in the origination and development of prostate cancer. These factors include exposure to cancer-causing agents (carcinogens), chronic infection or inflammation in the prostate, high-fat diet, obesity and excessive alcohol consumption.

What are the Signs and Symptoms of Prostate Cancer

You may have prostate cancer without developing any symptoms. When symptoms are present, they may include the following:

Difficulty in passing urine and straining during urination
Slow urinary stream
Passage of blood in urine (haematuria) or in semen (haematospermia)
Unexpected weight loss
Unexplained fever
Fatigue
Bone pain

How can you be screened for prostate cancer?

Screening helps in the early detection of prostate cancer with the potential to reduce death from the disorder. Methods adopted in prostate cancer screening include Prostate Specific Antigen (PSA), Digital Rectal Examination (DRE) and Magnetic Resonance Imaging (MRI). Prostate Specific Antigen is a protein produced in the prostate gland, which can become elevated when the prostate is enlarged, inflamed or cancerous. PSA is not specific for prostate cancer detection in that the level can be elevated in other conditions. In the UK, men who are older than 50 years are offered PSA because of the higher risk in this age group. However, PSA screening can be associated with unnecessary tissue sampling (biopsy) or treatment.

A digital rectal examination can also be done to screen for prostate cancer. In this procedure, a doctor inserts lubricated gloved finger into the rectum to feel for palpable abnormalities suggestive of prostate cancer. DRE is limited in that it cannot detect non-palpable abnormalities seen in some early-stage prostate cancers. A combination of PSA and DRE is more reliable for prostate cancer screening than either PSA or DRE alone.

In addition to PSA and DRE, a Multiparametric Magnetic Resonance Imaging (mp-MRI) has also been used to screen for prostate cancer. This imaging technique is valuable in localising suspicious areas in the prostate gland prior to biopsy, thereby increasing the likelihood of detecting cancers while reducing unnecessary procedures. In men who have elevated PSA but no cancer seen on biopsy, mp-MRI can serve as a valuable adjunct to PSA testing.

How is prostate cancer diagnosed?

A biopsy is taken to make a definite diagnosis of prostate cancer. A doctor (typically a urologist) or specialist nurse inserts a needle into the rectum under the guidance of an ultrasound probe to take a prostate tissue sample. The sample is processed in the laboratory and examined under the microscope by a specialist physician (histopathologist) to diagnose the presence of prostate cancer in the collected sample.

What options are available for the management of prostate cancer?

There are various options for treatment if you or someone you care for is diagnosed with prostate cancer. Factors that determine which treatment methods are adopted include the stage of the disease, the age of the patient, overall health and personal preferences.

The following modalities are available for the management of prostate cancer:

Active surveillance (watchful waiting): This method is indicated in elderly men, those with other morbidities, and those with disease confined to the prostate. It helps to avoid the side effects of aggressive treatment.
Surgery: Prostatectomy (a surgical procedure to remove the prostate) is done when cancer is localised to the prostate.
Radiation: High-energy radiation is used to kill the cancer cells. In external beam radiation, the radiation source is outside the body. Internal beam radiation delivers a high radiation dose directly to the prostate with limited exposure of surrounding tissue.
Chemotherapy: drugs are used to destroy the cancer cells
Hormonal therapy (Androgen Deprivation Therapy): The male hormones that support the growth of prostate cancer cells are blocked by this therapy, thereby slowing down the disease progression or resulting in remission.

How Can Prostate Cancer Be Prevented?

Prostate cancer can be prevented in several ways

Dietary modification: Diets rich in fruits, vegetables, and whole grains may reduce the risk of prostate cancer. A diet rich in antioxidants, such as the lycopene present in tomatoes, has been linked to a lower risk of prostate cancer. Reducing saturated fat consumption and limiting dairy products could be beneficial in prostate cancer prevention.
Physical Exercise and Bodyweight Management: Regular physical exercise and a healthy weight play roles in prostate cancer prevention, as these can help to mitigate against obesity. Obesity has been linked to a higher risk of aggressive prostate cancer and poorer outcomes.
Moderating Alcohol Consumption: Excessive alcohol consumption can increase the risk of prostate cancer, whereas moderate alcohol intake may not contribute to the risk of prostate cancer.
Smoking cessation: Researchers have found that smokers are more likely to acquire aggressive forms of prostate cancer than nonsmokers. Smoking cessation is an important preventive measure for prostate cancer.

Prostate cancer remains a significant health challenge. Regular screenings, healthy dietary choices, exercise, and avoiding smoking or excessive alcohol intake play important roles in its prevention. Management options for prostate cancer vary, ranging from active surveillance to surgery, radiation, and hormonal therapy. Raising awareness and promoting early screening can help improve outcomes and reduce mortality, empowering men to take control of their health.