Prostate cancer

Several elements can elevate the risk of prostate cancer:

Aging

The disease is more frequently observed in men over 50, with age being a dominant risk factor.

Ethnic Background

Men of African descent, especially from the Caribbean and certain parts of South America, face a higher risk.

Family History

Having close relatives like a father, brother, or son with prostate cancer increases personal risk.

Genetic Alterations

Inherited mutations, such as those in BRCA1, BRCA2, or associated with Lynch syndrome, raise susceptibility.

Additional Risk Factors

• Obesity
• High alcohol intake
• Diet rich in saturated fats, red or smoked meats, high calcium or dairy, and dietary choline
• Chemical exposure
• Prostate inflammation (prostatitis)
• History of STIs
• Vasectomy (a form of male birth control)
• Smoking

Note: Tobacco smoke carries over 60 carcinogens, and male smokers often have elevated androgen levels, which may contribute to the onset or progression of prostate cancer.

Healthcare providers generally recommend that men in their 50s consult their doctor about the pros and cons of prostate cancer screening. This conversation should include an assessment of individual risk factors and personal preferences regarding screening. The diagnostic process includes:

Screening Tests for Prostate Cancer

• Digital Rectal Exam (DRE): During this test, a physician inserts a gloved, lubricated finger into the rectum to feel for any irregularities in the size, texture, or shape of the prostate gland. If abnormalities are found, more diagnostic steps may follow.
• Prostate-Specific Antigen (PSA) Test: This blood test measures levels of PSA, a protein made by the prostate. Elevated levels can suggest infection, an enlarged prostate, or the presence of cancer.

Imaging Techniques

• Ultrasound: A probe uses sound waves to generate an image of the prostate. This is helpful for detecting irregularities and guiding biopsies.
• Magnetic Resonance Imaging (MRI): Provides high-resolution images of the prostate, aiding in cancer detection, evaluation of its spread, and guiding biopsy procedures.

Biopsy

A prostate biopsy is performed to determine if cancer cells are present. Using a fine needle, tissue samples are extracted from the prostate and analyzed for malignancy.

Tests to Check Cancer Spread

• Bone Scan
• CT (Computerized Tomography) Scan
• Ultrasound
• PET (Positron Emission Tomography) Scan
• MRI (Magnetic Resonance Imaging)

Grading of Prostate Cancer

After confirming cancer through a biopsy, the next step is grading the cancer to assess how likely it is to grow and spread. Higher grades suggest more aggressive cancer.

• Gleason Score: This system assigns a number from 1 to 10, with lower scores indicating less aggressive cancer and higher scores reflecting a more aggressive form.
• Genomic Testing: This evaluates cancer cells for genetic mutations, offering deeper insights into the cancer’s behavior and helping tailor treatment plans and predict outcomes.

If you’re concerned about your chances of developing prostate cancer, there are preventive steps you can consider:

Adopt a Healthy Diet

Include a wide range of fruits, vegetables, and whole grains in your meals. Although the direct impact of diet on prostate cancer prevention isn't conclusively proven, certain foods may help lower the risk:

• Soy
• Lycopene
• Green Tea
• Coffee
• Cruciferous Vegetables
• Omega-3 Fatty Acids
• Folate
• Vitamin D

Stay Physically Active

Regular physical activity is known to offer several health benefits and minimal side effects. A sedentary lifestyle has been associated with a higher risk of prostate cancer.

Keep a Healthy Weight

Maintaining optimal body weight helps reduce inflammation and hormonal imbalances that may be linked to prostate cancer. Diet and exercise are key to this goal.

Consult About Your Risk

Men with a higher risk profile should speak with their healthcare provider. Chronic conditions like hypertension and diabetes can increase the likelihood of prostate cancer.

Which Doctor to Consult

Men over the age of 40 experiencing potential symptoms of prostate cancer should seek medical attention. A general physician is a good starting point and may refer the patient to:

• Oncologist: Focuses on treating prostate cancer using chemotherapy, hormone therapy, and immunotherapy.
• Urologist: Specializes in diagnosing and treating diseases of the urinary and reproductive systems, including prostate cancer.
• Oncosurgeon: Performs surgical procedures such as prostatectomy to remove cancerous tissues from the prostate and nearby areas.

Managing prostate cancer involves a range of options including conventional therapies, watchful waiting, and active surveillance. The treatment approaches are as follows:

Surgical Procedures

• Pelvic Lymphadenectomy: In this procedure, lymph node tissues are removed and examined under a microscope to check for cancer. If cancer is detected in the lymph nodes, removal of the prostate may be avoided, and alternative treatments are considered.
• Transurethral Resection of the Prostate (TURP): Commonly used to manage symptoms from benign prostatic enlargement, TURP can also provide relief from tumor-related symptoms before other cancer treatments begin. A resectoscope—a slender instrument with a light and cutting tool—is inserted through the urethra to remove prostate tissue.
• Radical Prostatectomy: This surgery involves the removal of the prostate gland, surrounding tissues, and seminal vesicles, sometimes including nearby lymph nodes. The common types are:
• Open Radical Prostatectomy
• Radical Laparoscopic Prostatectomy
• Laparoscopic Radical Prostatectomy

Radiation Therapy

• External Radiation Therapy: Delivers targeted radiation from outside the body to the cancer site, minimizing damage to surrounding healthy tissues.
• Hypofractionated Radiation Therapy: A modified form of radiation therapy that administers higher doses over a shorter period, though it may carry an increased risk of side effects.
• Internal Radiation Therapy: This method places radioactive material inside the body using seeds, catheters, or needles implanted in or near the cancer site. Once placed, the radioactive seeds stay in the prostate while the insertion instruments are removed.

Radiopharmaceutical Therapy

This therapy utilizes radioactive substances that circulate in the bloodstream and attack cancer cells while minimizing harm to healthy tissues.

• Alpha Emitter Radiation Therapy: Designed to target prostate cancer that has metastasized to bones.
• Radium-223: A radioactive compound delivered via intravenous injection, which accumulates in bone metastases and kills cancerous cells.

Hormone Therapy

Hormone therapy, or androgen deprivation therapy (ADT), inhibits the growth of cancer cells by blocking or lowering hormone levels.

• Abiraterone Acetate: Suppresses the production of male hormones in prostate cancer cells.
• Orchiectomy: Surgical removal of one or both testicles to decrease hormone levels, especially testosterone.
• Estrogens: While capable of reducing testosterone production, estrogens are seldom used now due to adverse effects.
• LHRH Agonists: Drugs like Leuprolide, Goserelin acetate, and Buserelin reduce testosterone production.
• Antiandrogens: Medications such as Flutamide, Bicalutamide, Enzalutamide, Apalutamide, and Nilutamide inhibit the action of male hormones on prostate cancer cells.

Chemotherapy

1. This treatment uses drugs to stop cancer cell growth by either killing the cells or stopping them from multiplying. These drugs can be taken orally or administered by injection and travel through the bloodstream to target cancer throughout the body.
2. Immunotherapy
3. Immunotherapy enhances the body’s natural defenses to recognize and combat cancer cells. Substances produced by the body or synthesized in a lab are used to strengthen the immune response.
4. Bisphosphonate Therapy
5. For cases where cancer has spread to bones, drugs such as clodronate or zoledronate can help prevent bone degradation. Bone weakening is particularly common in patients who have undergone orchiectomy or are on antiandrogen therapy.

Experimental Treatments in Clinical Trials

• Cryosurgery: Destroys cancerous or abnormal cells using extremely cold temperatures.
• High-Intensity Focused Ultrasound (HIFU): Targets cancer cells with concentrated ultrasound waves to generate heat and destroy them, sparing nearby tissues.
• Proton Beam Therapy: A precise radiation technique using high-energy proton beams to damage cancer cells while preserving surrounding healthy tissue.
• Photodynamic Therapy (PDT): Involves a light-sensitive drug and laser light to selectively kill cancer cells with minimal impact on normal tissues.

If not detected or addressed early, prostate cancer may spread to adjacent tissues or distant parts of the body, leading to various complications. Below are some commonly associated issues:

Cancer Spread (Metastasis):

Prostate cancer can extend to nearby organs, such as the bladder. It may also reach the bones or distant organs through the bloodstream or lymphatic system, complicating treatment and prognosis.

Urinary Incontinence:

This is a frequent side effect of both prostate cancer and its treatments. The severity, type, and recovery potential determine the choice of treatment for urinary leakage.

Erectile Dysfunction:

The inability to achieve or maintain an erection suitable for sexual activity can result from prostate cancer or its treatment. It typically occurs due to effects on nerve function, hormone levels, or blood circulation.

Surgical Complications:

Post-operative issues after prostate cancer surgery may include:

• Infertility
• Urine leakage from the bladder
• Stool leakage from the rectum
• Penile shortening
• Inguinal hernia

Hormone Therapy Side Effects:

Possible side effects of hormone treatment may include:

• Hot flashes
• Reduced sexual function
• Loss of libido
• Bone thinning
• Diarrhea
• Nausea
• Skin itching

Complementary therapies can provide relief from certain symptoms but are not substitutes for professional medical care. Always consult your healthcare provider before beginning any alternative treatments.

1. Yoga:

Some research suggests yoga can ease fatigue caused by cancer treatments. Men undergoing therapy who practiced yoga twice a week reported fewer urinary and sexual side effects.

2. Meditation:

Practicing meditation or similar relaxation techniques may help cancer patients cope emotionally. Mindfulness has been shown to lower stress, anxiety, and depressive symptoms in men with prostate cancer.

3. Acupuncture:

This traditional technique involves inserting fine needles at specific body points. It may provide pain relief and enhance well-being in prostate cancer patients, according to some reports.

Though not a substitute for medical treatment, some natural substances may support prostate health. These should always be used with a doctor’s guidance:

• Soy Products: Rich in isoflavones, which may offer protective effects against prostate cancer.
• Pomegranate Extract: Contains antioxidants with properties that may inhibit cancer cell growth.
• Green Tea: Loaded with polyphenols, antioxidants that may help in cancer prevention.
• Tomatoes: High in lycopene, a compound associated with reduced risks of cancers including prostate, lung, and stomach.
• Cruciferous Vegetables: Vegetables such as broccoli, cabbage, and cauliflower may help lower the risk of aggressive forms of prostate cancer.

What to Avoid

• Omega-6 Fatty Acid-Rich Vegetable Oils and diets high in saturated fats may elevate prostate cancer risks.
• Processed Meats like sausages, bacon, and salami should be avoided due to their association with increased cancer risk.
• High-Temperature Cooking of meats (grilling or frying) may produce DNA-damaging compounds.
• Sugar and Refined Carbohydrates may have links to heightened prostate cancer risk.
• Foods Rich in Choline such as eggs, chicken/beef liver, and wheat germ have been associated with a greater chance of aggressive prostate cancer.
• Excessive Dairy or Calcium Intake may also increase prostate cancer susceptibility.

Note: The SELECT trial evaluated the effects of selenium and vitamin E supplements on prostate cancer prevention. Findings showed no benefit and advised against using high doses of selenium beyond recommended levels.

Coping with a prostate cancer diagnosis can be challenging. However, lifestyle adjustments may support physical and emotional well-being throughout treatment.

1. Address Physical Complications:

• Perform pelvic floor or Kegel exercises to improve bladder control.
• Consider bladder training, medications, or surgical options for incontinence.
• Seek help from specialists in male sexual health for customized therapies.

2. Support Your Mental Health:

• Address emotional struggles such as loss of masculinity with therapy or support groups.
• Practice stress-relief techniques like yoga or mindfulness.

3. Maintain Physical Wellness:

• Stay active to boost energy levels and physical strength.
• Eat a nutritious diet to help manage side effects and support recovery.

4. Build a Support System:

• Join prostate cancer support groups for peer advice and shared experiences.
• Communicate openly with loved ones and your medical team about your needs.

5. Manage Financial Challenges:

• Cancer treatment can be financially demanding.
• Seek assistance from social workers for help with grants, insurance, and financial aid programs.