Prostate Cancer: Causes, Symptoms, Stages, and Treatment

Prostate cancer is an uncommon disease in the Asian population. Most cases of prostate cancer develop in older men over the age of 65 years. In many cases, the cancer is slow-growing, does not reduce how long the patient lives, and may not need treatment. In some cases, it is more aggressive, spreads to other parts of the body, and may benefit from treatment. Generally, the more the cancer has grown and spread, the lower the likelihood of a complete cure. Still, treatment can often help slow its progression.

Prostate cancer differs from many other cancers because small cancerous areas within the prostate are quite common, particularly in older men, and may remain dormant or cause no issues for years.

What is the Prostate Gland?

The prostate gland (just called the prostate from now on) is only found in men. It lies just beneath the bladder. The tube that passes urine from the bladder is called the urethra. It runs through the middle of the prostate. The prostate’s main function is to produce fluid that protects and enriches sperm.

The prostate often gets bigger (enlarges) gradually after the age of about 50 years. By the age of 70 years, about 8 in 10 men have an enlarged prostate. It is common for older men to have urinary symptoms caused by a non-cancerous (benign) enlargement of the prostate. Some men also develop prostate cancer.

Causes

A malignant tumor develops from a single abnormal cell. The exact cause of this cellular abnormality is unknown. It is believed that certain factors damage or modify specific genes within the cell, causing it to become abnormal and multiply uncontrollably. While the precise cause is unknown, certain risk factors can raise the likelihood of developing prostate cancer. These include:

• Ageing – Most cases occur in older men
• Genetic factors and Family History – If a father or brother is diagnosed with prostate cancer before age 60, your risk of developing the disease is elevated. Additionally, if a form of breast cancer linked to a faulty gene exists in your female relatives, your risk of prostate cancer may be higher.
• Ethnic group – Prostate cancer is seen more often in African-Caribbean men and is comparatively rarer in Asian men.
• Diet could influence the risk of developing prostate cancer. Similar to other cancers, consuming a high-fat diet with few fruits and vegetables can increase the likelihood of developing it.
• Being exposed to the metal cadmium may increase the risk of prostate cancer.

Symptoms

Prostate cancer usually grows slowly, and in many cases, it may not cause any symptoms for several years. As the tumor enlarges, it may press against and irritate the urethra, potentially causing a partial obstruction of urine flow. At this stage, symptoms may appear and could include one or more of the following:

• Poor stream – Urine flow may become weaker, making it take longer to fully empty the bladder.
• Hesitancy – You might experience a delay before urine begins to flow when using the toilet.
• Dribbling – Some urine may leak out and soil your underwear shortly after finishing urination.
• Frequency – You might find yourself urinating more frequently than usual.
• Urgency – You might feel a sudden, urgent need to use the bathroom.
• Poor emptying – You might feel as though your bladder hasn’t fully emptied.

For most men, these symptoms are caused by a non-cancerous (benign) enlargement of the prostate rather than cancer. Nonetheless, it’s important to have any new symptoms evaluated by a doctor.

Stages

Prostate cancer is divided into four primary stages, depending on the extent of its spread. Understanding these stages helps determine the appropriate treatment plan and prognosis.

Stage 1 (Localized Prostate Cancer)

In this early stage, the cancer is small and confined to the prostate gland. It cannot be felt during a digital rectal exam (DRE) or detected through imaging tests. PSA levels are typically low, and the cancer cells appear less aggressive. Stage 1 prostate cancer usually grows slowly and may not cause noticeable symptoms.

Stage 2 (Localized but More Advanced)

At this stage, the cancer is still confined to the prostate but is larger and may involve more of the gland. It is classified into three substages:

• Stage 2A: The cancer affects one side of the prostate and has an intermediate PSA level.
• Stage 2B: The cancer may involve both sides of the prostate but remains contained. PSA levels may be moderate.
• Stage 2C: The cancer affects both sides of the prostate and may have a higher PSA level, indicating a greater risk of progression.

Stage 3 (Locally Advanced Prostate Cancer)

At this stage, the cancer has extended beyond the prostate gland into nearby tissues but has not spread to distant organs. It is further divided into three substages:

• Stage 3A: The cancer is still within the prostate but has a high PSA level, indicating a more aggressive form.
• Stage 3B: The cancer has spread to adjacent tissues, like the seminal vesicles or bladder, but has not reached the lymph nodes.
• Stage 3C: The cancer remains locally advanced but has a higher Gleason score, indicating more abnormal and aggressive cells.

Stage 4 (Metastatic Prostate Cancer)

In this advanced stage, the cancer has extended beyond the prostate, reaching distant organs or lymph nodes. It is divided into two substages:

• Stage 4A: The cancer has reached the nearby lymph nodes but has not extended to organs farther away.
• Stage 4B: The cancer has metastasized to other areas, such as the bones, liver, or lungs.

Identifying the stage of prostate cancer is crucial for selecting the most suitable treatment strategies and assessing the patient’s prognosis.

Diagnosis

• Examination of the prostate – Do a blood test to measure the level of prostate-specific antigen (PSA). PSA is a substance produced by both healthy and cancerous prostate cells. In general, higher PSA levels may indicate a greater likelihood of prostate cancer. However, a mildly to moderately raised PSA can occur in conditions other than prostate cancer. For individuals with confirmed prostate cancer, the PSA blood test is also used to track treatment progress; effective treatment that kills cancer cells will result in a decrease in PSA levels.
• Biopsy – to confirm the diagnosis. A biopsy is a medical procedure in which a small tissue sample is taken from the body for examination. The tissue sample is analyzed under a microscope to identify any abnormal or cancerous cells. A biopsy can usually confirm the presence of prostate cancer.
• Assessing the severity and spread of prostate cancer by examination of the biopsy samples under the microscope and by tests such as a bone scan, a CT scan, an MRI scan, a tummy (abdominal) ultrasound scan, or other tests. This helps determine the tumor’s size, whether it has penetrated the prostate wall into nearby structures like the bladder, spread to local lymph nodes, or metastasized to other parts of the body.

Treatment

Treatment options for prostate cancer may include surgery, radiotherapy, hormone therapy, and, less commonly, chemotherapy. Often, a combination of these approaches is used. Treatment may aim to cure the cancer, especially when detected at an early stage, which increases the likelihood of a successful outcome.

If a cure is not feasible, treatment can focus on controlling the cancer by slowing its growth or spread, helping manage symptoms, and maintaining quality of life for a period of time.

How to Avoid Prostate Cancer?

Adopting a healthy lifestyle and taking preventive steps can help greatly decrease the likelihood of prostate cancer.

1. Maintain a Healthy Diet

Eating a balanced, nutritious diet is vital for overall health and may reduce the risk of diseases like prostate cancer. Key foods that support prostate health include:

• Fruits and vegetables: Fruits and vegetables are packed with antioxidants that safeguard cells and may help decrease the likelihood of developing cancer. In particular, cruciferous vegetables like broccoli, cauliflower, and cabbage may have a protective effect against prostate cancer.
• Tomatoes contain lycopene, a powerful antioxidant that may help prevent prostate cancer. Tomatoes may be especially beneficial when cooked, since heating makes lycopene more easily absorbed by the body.
• Fish: Omega-3-rich fish like salmon, sardines, and mackerel may help protect against prostate cancer.
• Green tea: Green tea offers catechins, natural compounds with potential anti-cancer benefits, and research indicates it may help decrease prostate cancer risk.

2. Stay Physically Active

Regular exercise is important for maintaining good health and reducing the risk of many diseases, including prostate cancer. Exercise can help regulate hormone levels and reduce inflammation, both of which may play a role in the development of prostate cancer. Aim to get at least 30 minutes of moderate exercise most days of the week. Some examples of moderate exercise include:

• Brisk walking
• Jogging
• Cycling
• Swimming
• Dancing

3. Get Screened Regularly

Although prostate cancer cannot be completely prevented, detecting it early is key to effective treatment. It is recommended that men begin routine prostate cancer screenings at age 50, or sooner if they have a family history or additional risk factors. Prostate cancer screening usually includes a digital rectal exam (DRE) along with a prostate-specific antigen (PSA) blood test.

4. Limit Alcohol Consumption

Drinking too much alcohol may raise the risk of cancer, including prostate cancer. Men should limit consumption to no more than two drinks per day.

5. Quit Smoking

Smoking has been linked to the risk of several types of cancer, including prostate cancer. If you smoke, quitting is one of the best things you can do for your overall health. Talk to your doctor about strategies for quitting smoking.

6. Manage Stress

Prolonged stress can adversely affect your overall health, including the well-being of your prostate. Stress may trigger inflammation and compromise your immune system, raising the risk of cancer. Manage stress through exercise, meditation, or quality time with loved ones.

7. Consider Taking Supplements

Some supplements that may be beneficial for prostate health include:

Vitamin D: Research indicates that insufficient vitamin D levels may be associated with a higher risk of developing prostate cancer. Talk to your doctor about whether you should get your vitamin D levels tested or consider taking a vitamin D supplement.

Selenium: Selenium is a mineral that may have anti-cancer properties. Research suggests that taking selenium supplements may help lower the risk of developing prostate cancer.

Zinc: Zinc is a mineral that is important for prostate health. Research indicates that zinc supplements may contribute to lowering the risk of prostate cancer.

If there are concerns about prostate issues, a physician may refer you to a urologist who specializes in urinary tract problems. If prostate cancer is diagnosed, a specialist in cancer treatment (oncologist) or radiation therapy (radiation oncologist) may be recommended.

In rare cases where prostate cancer occurs in children or adolescents due to certain genetic conditions, consultation with a Paediatric Oncology specialist can ensure appropriate diagnosis and tailored treatment.

Frequently Asked Questions