Prostate Cancer: Symptoms, Diagnosis and Treatment

Prostate cancer is a fairly common form of cancer in older men. What exactly is prostate cancer, what are the symptoms and how is it diagnosed? What treatments are possible and what are the risks of late detection? Time to explain all facets in simple language.

What is prostate cancer?

In prostate cancer, a change occurs in the tissue of the prostate. The prostate is a gland of the male reproductive system, located below the bladder and in front of the rectum. It is about the size of a walnut. The prostate produces certain hormones and releases them into the body.
Prostate cancer, also called adenocarcinoma , starts in the gland cells. Cancer cells lose their ability to regulate cell growth or cell death, resulting in uncontrolled cell division. The cells then form a collection of abnormal cells called tumors. These tumors can be malignant and cause prostate cancer. The malignant tumor can spread to other tissues through the lymph nodes, causing metastases. Prostate cancer is usually a disease that develops slowly, which means it is not easy to detect. Some prostate tumors, on the other hand, develop more quickly and grow and spread quickly.

How common is prostate cancer?

Prostate cancer mainly develops in older adults, between the ages of 35 and 50. But because the disease usually develops so slowly, prostate cancer is often only diagnosed at a later age. The disease is relatively rarely diagnosed in men under 40 years of age. In 2008, 323,790 new cases of prostate cancer were registered in the EU. This number represents 24.4% of all cancer cases. More than two-thirds of prostate cancer patients are 65 years or older. For an 80-year-old man, the risk of developing prostate cancer is 15%.

What causes prostate cancer?

It is not yet known how prostate cancer can develop. Mutation of prostate cells causes a change in DNA (building blocks) that causes the cells to grow and divide faster than normal cells. The abnormal cells can spread to adjacent tissues or even other parts of the body. Prostate cancer can be hereditary. If a person has family members diagnosed with prostate cancer, they are 2 to 3 times more likely to develop the disease themselves.
Some studies show that consuming certain foods can increase the risk of prostate cancer. Research has been done on fat and meat, fruit and vegetables, vitamin E, green tea and soy. No definitive conclusions have yet been drawn. High amounts of calcium and dairy proteins are believed to increase the risk of cancer. On the other hand, there are also foods with components that can reduce the risk of prostate cancer. Tomatoes or tomato-based foods, for example, contain high concentrations of lycopene. The concentration is highest when the tomatoes have been cooked or otherwise processed. Another important substance is selenium, which is found in vegetables, fish, shellfish, caviar, sunflower seeds, nuts, some meats, grains, eggs and wheat germ.

What are the symptoms of prostate cancer?

In the early stages of prostate cancer, the disease usually causes hardly any complaints. As a result, in most cases prostate cancer is only discovered at an advanced stage. Some advanced prostate cancers can cause symptoms such as needing to urinate more often (especially at night), difficulty initiating urination, or difficulty continuing to urinate after starting. Other symptoms that can commonly accompany advanced prostate cancer include blood in the urine, pain during urination, pain during ejaculation and difficulty getting and keeping an erection. In advanced stages of prostate cancer, the patient may experience pain in the thighs, hips, pelvis, chest (ribs) or other areas, tired legs, and urinary or fecal incontinence. Pain in the bones may indicate that the cancer has spread to the bones.

How is prostate cancer diagnosed?

There are several ways to diagnose prostate cancer. One way is to perform a PSA (Prostate-Specific Antigen) test. This is a blood test that can show signs of prostate cancer in men who have no other complaints. The test can also be useful to diagnose prostate cancer in men who have complaints that may be caused by prostate cancer. When a high level of prostate-specific antigen is found, this can be an indicator of the presence of a prostate tumor.
Another way to diagnose the disease is through physical examination. This examination is called a digital rectal examination (DRE). During this procedure, the doctor wears gloves and inserts his finger into the rectum with some lubricant. He then scans the prostate surface to determine if there are any irregularities, such as bumps or hard spots. Some of these hard spots may be cancerous.
Depending on the results of the PSA and DRE studies, it may be necessary to perform another, more complex test, a prostate biopsy. This is the most certain way to diagnose prostate cancer. This involves taking a small part of the prostate tissue and examining it under a microscope. In this way, abnormal cells can be observed and a more certain diagnosis can be made.
Prostate cancer develops in various stages. There is a system by which a certain value can be assigned to cancer cells, in order to determine to what extent cancer cells look like normal prostate cells. These values are called Gleason values and consist of a scale from 1 to 5. The cells that most resemble normal cells are given a value of 1. Cells that are very abnormal are given a value of 5. The chance of aggressive growth is greatest with cells with the highest value. In general, cells with low values are likely to grow slowly. These cells are also less likely to spread to other parts of the body compared to cells with a high value.
Prostate cancer can develop so that different areas of the tumor have different Gleason values. In such cases, values are assigned based on the areas with the most abnormal cells. The relevant areas are usually two, but there may be more. The scores of these areas are then added and the outcome results in the Gleason score (or Gleason sum). Additionally, if an area with the highest score is a very large portion of the biopsy (e.g., 95%), that area’s value counts double toward the Gleason score. The score can be used to choose the most appropriate treatment.
An MRI scan is another method to visualize the development of cancer. This technology uses radio waves and strong magnets to pass harmless waves through the body to help form an image of the internal organs. An MRI scan is not suitable for people with certain implanted heart valves, pacemakers or other medical implants, because the magnetic waves can compromise the proper functioning of these implants. The scan not only shows the development of cancer in the prostate, but can also show metastases to other parts of the body.

What treatment methods are available for prostate cancer?

The available treatment methods for prostate cancer depend on the stage of the cancer. The cancer stage can therefore be divided into: early stage, non-metastatic cancer, and late stage, metastatic cancer. However, suitable treatment varies from person to person. This is because every patient is different and each case has its own specific characteristics.
Early stage cancer can be defined as low risk, especially when localized. Because the cancer can grow so slowly and sometimes no symptoms occur, the patient is carefully observed and attention is paid to the growth of the tumor. This approach is known as watchful waiting or active surveillance. However, surgery is often still recommended because of the risk of cancer growth in an adult young man.
For average-risk cancers, surgery is often the best solution, removing the prostate gland along with the tumor. External radiation therapy to the prostate can also be used. The same goes for high-risk cancer. Hormone therapy can be used in the period surrounding the operation. Serious treatment is also required for locally advanced prostate cancer, usually in combination with surgery and radiotherapy.
Cancer that has spread to other parts of the body cannot be treated. Fortunately, there are ways to control this by lowering testosterone levels (the “male hormone”). This form of hormone therapy can be administered in pill form (regularly taken several times a week) or via injections (once a month or quarter). Another way to lower testosterone levels is by removing the testicles. Using both hormone therapy and removal of the testicles can be an effective way to control the cancer for several years. If the cancer returns, chemotherapy and steroids may be the next steps. These may even help shrink the cancer for a while.
When the cancer has spread to the bones, radiation therapy may be the most effective treatment to relieve pain and strengthen bone tissue. The bone usually starts to repair itself after the end of radiotherapy.
New, promising drugs against prostate cancer are still in the testing phase.

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