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What you need to know about prostate cancer in 2021
Prostate cancer is a common type of cancer in males, but it is highly treatable in the early stages. It begins in the prostate gland, which sits between the penis and the bladder.
The prostate has various functions, including:
- producing the fluid that nourishes and transports sperm
- secreting prostate specific antigen (PSA), a protein that helps semen retain its liquid state
- helping aid urine control
Prostate cancer is the most common cancer to affect males in the United States.
In fact, in 2019, the American Cancer Society (ACS) predict that there will be around 174,650 new diagnoses of prostate cancer and around 31,620 deaths from this type of cancer.
Around 1 in 9 males will receive a diagnosis of prostate cancer at some point in their life. However, only 1 in 41 of these will die as a result of it.
This is because treatment is effective, especially in the early stages. Routine screening enables doctors to detect many cases of prostate cancer before they spread.
Symptoms
There are often no symptoms during the early stages of prostate cancer, but screening can detect changes that can indicate cancer.
Screening involves a test that measures levels of PSA in the blood. High levels suggest that cancer may be present.
Males who do experience symptoms may notice:
- difficulty starting and maintaining urination
- a frequent urge to urinate, especially at night
- blood in the urine or semen
- painful urination
- in some cases, pain on ejaculation
- difficulty getting or maintaining an erection
- pain or discomfort when sitting, if the prostate is enlarged
Advanced symptoms
Advanced prostate cancer can involve the following symptoms:
- bone fracture or bone pain, especially in the hips, thighs, or shoulders
- edema, or swelling in the legs or feet
- weight loss
- tiredness
- changes in bowel habits
- back pain
Treatment
Treatment will depend on the stage of the cancer, among other factors.
In the sections below, we list some treatment options for each stage of prostate cancer, as well as some new approaches and what treatment means for fertility:
Early stage prostate cancer
If the cancer is small and localized, a doctor may recommend:
Watchful waiting or monitoring
The doctor may check PSA blood levels regularly but take no immediate action.
Prostate cancer grows slowly, and the risk of side effects may outweigh the need for immediate treatment.
Surgery
A surgeon may carry out a prostatectomy. They can remove the prostate gland using either laparoscopic or open surgery.
Radiation therapy
Options include:
Brachytherapy: A doctor will implant radioactive seeds into the prostate to deliver targeted radiation treatment.
Conformal radiation therapy: This targets a specific area, minimizing the risk to healthy tissue. Another type, called intensity modulated radiation therapy, uses beams with variable intensity.
Treatment will depend on various factors. A doctor will discuss the best option for the individual.
Advanced prostate cancer
As cancer grows, it can spread throughout the body. If it spreads, or if it comes back after remission, the treatment options will change.
Options include:
Chemotherapy: This can kill cancer cells around the body, but it can cause adverse effects.
Hormonal therapy: Androgens are male hormones. The main androgens are testosterone and dihydrotestosterone. Blocking or reducing these hormones appears to stop or delay the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most of the body’s hormones. Various drugs can also help.
Lupron is a kind of hormone therapy that doctors use to treat prostate cancer. What does this treatment involve?
Most doctors do not recommend surgery in the later stages, as it does not treat cancer that has spread to other parts of the body. However, some experts have suggested that it may help in some cases.
New treatments
Some newer approaches aim to treat prostate cancer without the side effects that other treatment options can bring.
These include:
- cryotherapy
- high intensity focused ultrasound
After surgery, a doctor will continue to monitor PSA levels.
Effects on fertility
The prostate gland plays a role in sexual reproduction. Prostate cancer and many of its treatments affect fertility in several ways.
For example, if a male has surgery to remove either the prostate gland or the testicles, it will affect semen production and fertility.
Also, radiation therapy can affect prostate tissue, damaging sperm and reducing the amount of semen for transporting it.
Hormonal treatment can also affect fertility.
However, some options for preserving these functions include:
- banking sperm before surgery
- extracting sperm directly from the testicles for artificial insemination
However, there is no guarantee that fertility will remain intact after treatment for prostate cancer. Anyone who would like to have children after treatment should discuss fertility options with their doctor when they devise their treatment plan.
Causes
Prostate cancer develops when specific changes occur, usually in glandular cells.
Cancerous or precancerous cells in the prostate gland are called prostatic intraepithelial neoplasia (PIN).
Nearly 50% of all males over the age of 50 years have PIN.
At first, the changes will be slow, and the cells will not be cancerous. However, they can become cancerous with time. Cancer cells can be high or low grade.
High grade cells are more likely to grow and spread, while low grade cells are not likely to grow and are not a cause for concern.
Risk factors
Doctors do not know exactly why prostate cancer occurs, but the following risk factors may make it more likely:
Age: The risk increases after the age of 50, but it is rare before the age of 45.
Race or ethnicity: It is more common in black males than white ,ales. Asian and Hispanic males have a lower risk than black males or white males.
Family history: If a male has a close relative with a history of prostate cancer, they have a higher chance of developing it themselves.
Genetic factors: Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk. Mutations in these genes increase the chance of breast cancer in females, too. Men born with Lynch syndrome also have a higher risk of prostate and other cancers.
Other possible factors
There is some evidence to suggest that other factors may play a role, but scientists need more evidence to confirm their involvement:
- diet
- obesity
- smoking
- exposure to chemicals, such as the herbicide Agent Orange
- inflammation of the prostate
- sexually transmitted infections
- vasectomy
What about trans people?
People assigned male at birth can develop prostate cancer whether they remain male or not.
Trans women who use hormone therapy such as estrogen may have a lower risk, but the risk is still present.
Anyone assigned male at birth should speak to their doctor about screening for prostate cancer.
Stages
Knowing the stage of prostate cancer can help a person understand what to expect, and it will inform decisions about treatment. We list the stages below:
Stage 0: Precancerous cells are present, but they only affect a small area and are slow growing.
Localized (stage 1): Cancer is only present in the prostate gland. Effective treatment is possible at this stage.
Regional (stages 2–3): Cancer has spread to nearby tissues.
Distant (stage 4): Cancer has spread to other parts of the body, such as the lungs or bones.
Diagnosis
If a male has symptoms that may indicate prostate cancer, the doctor will likely:
- ask about symptoms
- ask about personal and medical history
- conduct a blood test to assess PSA levels
- carry out a urine test to look for other biomarkers
- carry out a physical examination, which may include a digital rectal exam (DRE)
During a DRE, the doctor will check manually for any abnormalities of the prostate with their finger.
Further tests
If a doctor suspects cancer, they may recommend further tests, such as:
A PCA3 test: This looks for the PCA3 gene in the urine.
A transrectal ultrasound: This involves inserting a probe with a camera into the rectum.
A biopsy: A doctor will take a tissue sample for examination under a microscope.
Only a biopsy can confirm the presence and type of cancer.
A person who needs monitoring rather than treatment may need a routine MRI or CT scan.
Outlook
Males with early stage prostate cancer have a good chance of effective treatment and survival.
Based on past statistics, the ACS expect the following percentages of people, on average, to survive for at least another 5 years after diagnosis:
Localized or regional cancer: Nearly 100% will survive at least another 5 years.
Distant: Around 30% will survive at least 5 more years if the cancer has affected other parts of the body.
With treatment, the overall 5 year survival rate for prostate cancer is 98%. Many people live longer than this, however.
The best way to detect prostate cancer in the early stages is to attend regular screening. Anyone who has not yet attended screening should ask their doctor about the options.
Q:
When should a male start having screening for prostate cancer?
A:
The American Urology Association recommend screening at 40 years for African American males and those with family history of cancers, and at 55 years for others.
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