Prostate Cancer: Causes, Symptoms, Treatment, and Prevention

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. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.

Prostate cancer is different from most other cancers because small areas of cancer within the prostate are actually very common, especially in older men. These may not grow or cause any problems for many years (if at all).

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 which 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.

What are the Causes of Prostate Cancer?

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. Although the exact cause is unclear, certain risk factors increase the chance that prostate cancer may develop. These include:

• Ageing – Most cases occur in older men
• Family history and genetic factors – If your father or brother had prostate cancer at a relatively early age (before the age of 60 years), then you have an increased risk. Also, if the type of breast cancer that is linked to a faulty gene runs in your female relatives, then you are at increased risk of prostate cancer
• Ethnic group – Prostate cancer is more common in African-Caribbean men and less common in Asian men
• Diet is possibly a risk factor. As with other cancers, a diet high in fats and low in fruit and vegetables may increase the risk.
• Exposure to the metal cadmium may be a risk.

Prostate Cancer Symptoms

Prostate cancer is often slow-growing. There may be no symptoms at first, even for years. As the tumor enlarges, it may press against and irritate the urethra, potentially causing a partial obstruction of urine flow. Symptoms may then develop and can include one or more of the following:

• Poor stream – The flow of urine is weaker, and it takes longer to empty your bladder.
• Hesitancy – You may have to wait at the toilet for a while before urine starts to flow.
• Dribbling – A bit more urine may trickle out and stain your underpants soon after you finish at the toilet.
• Frequency – You may pass urine more often than normal.
• Urgency – You may have to get to the toilet quickly.
• Poor emptying – You may have a feeling of not quite emptying your bladder.

Most men who develop the above symptoms do not have prostate cancer but have a non-cancerous (benign) enlargement of the prostate. However, it is best to have any new symptoms checked out by a doctor.

Stages of Prostate Cancer

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 advanced to nearby lymph nodes but has not metastasized to distant organs.
• 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.

How is Prostate Cancer Diagnosed?

• Examination of the prostate – Do a blood test to measure the level of prostate-specific antigen (PSA). PSA is a chemical that is made by both normal and cancerous (malignant) prostate cells. Basically, the higher the level of PSA, the more likely that you have cancer of the prostate. However, a mild-to-moderately raised PSA can occur in conditions other than prostate cancer. (If you have confirmed prostate cancer, the PSA blood test is also used to monitor treatment. If treatment is working and cancer cells are killed, then the level of PSA falls.)
• Biopsy – to confirm the diagnosis. A biopsy is a procedure where a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal 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 will give information about how much the tumor has grown and whether it has grown through the wall of the prostate and into nearby structures such as the bladder wall, whether cancer has spread to local lymph nodes, and whether cancer has spread to other areas of the body (metastasized).

Prostate Cancer Treatment

Treatment options which may be considered include: surgery, radiotherapy, hormone treatment and, less commonly, chemotherapy. Often a combination of two or more of these treatments is used.

Treatment may aim to cure the cancer. In particular, the earlier the stage of the cancer, the better the chance of a cure.

Treatment may aim to control the cancer. If a cure is not realistic, with treatment, it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.

How to Avoid Prostate Cancer?

Leading a healthy lifestyle and practicing preventive measures can greatly lower the risk of prostate cancer.

1. Maintain a Healthy Diet

A healthy diet is crucial for maintaining good health and reducing the risk of many diseases, including prostate cancer. Some foods that are particularly beneficial for prostate health include:

• Fruits and vegetables: Fruits and vegetables are rich in antioxidants, which can help protect cells from damage and reduce the risk of 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. Cooked tomatoes are thought to be particularly beneficial, as the cooking process increases the bioavailability of lycopene.
• Fish: Fish that are high in omega-3 fatty acids, such as salmon, sardines, and mackerel, may have a protective effect against prostate cancer.
• Green tea: Green tea contains compounds called catechins, which may have anti-cancer properties. Some studies have suggested that green tea may help reduce the risk of prostate cancer.

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

While there is no guaranteed way to prevent prostate cancer, early detection is crucial for successful treatment. Men should begin getting regular prostate cancer screenings at age 50 or earlier if they have a family history of the disease or other risk factors. Screening typically involves a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test.

4. Limit Alcohol Consumption

Excessive alcohol consumption has been linked to an increased risk of several types of cancer, including prostate cancer. Limit your alcohol intake to no more than two drinks per day for men.

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

Chronic stress can have a negative impact on your health, including your prostate health. Stress can cause inflammation and weaken your immune system, which can increase your risk of developing cancer. Try to find healthy ways to manage stress, such as exercise, meditation, or spending time with loved ones.

7. Consider Taking Supplements

Some supplements that may be beneficial for prostate health include:

Vitamin D: Some studies have suggested that low levels of vitamin D may be linked to an increased risk of 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. Some studies have suggested that selenium supplements may help reduce the risk of prostate cancer.

Zinc: Zinc is a mineral that is important for prostate health. Some studies have suggested that zinc supplements may help reduce the risk of prostate cancer.

What kind of doctor do you need for 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.

Frequently Asked Questions