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What to know about prostate cancer

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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. Experts do not know what causes it, but the risk increases with age.

The prostate has various functions. These include producing the fluid that nourishes and transports sperm, secreting prostate-specific antigen (PSA), a protein that helps semen retain its liquid state, and helping aid urine control.

Other than skin cancer, prostate cancer is the most common cancer affecting males in the United States. The American Cancer Society (ACS) predicts that in 2021 there will be around 248,530 new diagnoses of prostate cancer and approximately 34,130 deaths from this type of cancer.

Around 1 in 8 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. This is because of effective treatments in the early stages and the slow-growing nature of the cancer in later stages. Routine screening enables doctors to detect many cases of prostate cancer before they spread.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Signs and symptoms

There are often no symptoms during the early stages of prostate cancer, but screening can detect changes that may 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:

Advanced symptoms

People with advanced prostate cancer may also show no symptoms. Potential signs will depend on the size of the cancer and where it has spread in the body. In addition to the above, advanced prostate cancer can involve the following symptoms:

Causes

Researchers are unsure of the exact cause of prostate cancer. It develops when specific changes occur, usually in glandular cells. When prostate gland cells appear abnormal, a doctor may refer to these changes as 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

While doctors do not know exactly why prostate cancer occurs, the following risk factors may make it more likely:

  • Age: The risk of prostate cancer increases after the age of 50, but it is rare before 45.
  • Race or ethnicity: The condition is more common in Black people than in white people. Asian and Hispanic people have a lower risk than Black or white people.
  • Family history: A person with a close relative with a history of prostate cancer has a higher chance of developing it.
  • Genetic factors: Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk. Mutations in these genes also increase the chance of breast cancer. Men born with Lynch syndrome also have a higher risk of prostate and other cancers.
  • Diet: Some evidence suggests that high fat diets may increase the risk of prostate cancer.

Other possible factors

While more research is necessary to confirm their involvement, other factors that may influence prostate cancer risk include:

Click here to learn more about the links between alcohol and prostate cancer.

What about trans people?

People born with a prostate can develop prostate cancer. Individuals born without a prostate cannot develop prostate cancer.

Trans women who use hormone therapy such as estrogen may have a lower risk, but the risk is still present.

Anyone born with a prostate should speak to their doctor about screening for prostate cancer.

Treatment

Treatment will depend on the cancer stage, among other factors, such as the Gleason score and PSA levels. It is also worth noting that many treatment options may be applicable, regardless of cancer stage.

In the sections below, we list some treatment options for prostate cancer and explore what treatment may mean 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 or rebiopsy the prostate to see if the cancer has progressed, warranting action/treatment. Prostate cancer grows slowly, and the risk of treatment side effects may outweigh the need for immediate treatment.

Surgery

Should a person require surgery, a urologist will carry out the procedure. This is a surgeon who specializes in the treatment of urinary system disorders.

They may perform a radical prostatectomy to remove the tumor. In addition to removing the prostate, the procedure may also involve the removal of the surrounding tissue, seminal vesicles, and nearby lymph nodes. A doctor can perform this procedure using either open, laparoscopic, or robot-assisted laparoscopic surgery.

Radiation therapy

This treatment uses radiation to kill cancer cells or prevent them from growing. Options for early stage prostate cancer may include:

  • External radiation therapy: This method uses a machine outside the body to send radiation toward the cancer cells. Conformal radiation therapy is a type of external radiation that uses a computer to help guide and target a specific area, minimizing the risk to healthy tissue and allowing a high dose of radiation to reach the prostate tumor.
  • Internal radiation therapy: Also known as brachytherapy, this method uses radioactive seeds that a doctor implants near the prostate. A surgeon uses imaging scans, such as ultrasound or computed tomography to help guide the placement of the radioactive substance.

Treatment will depend on various factors. A doctor will discuss the best option for the individual.

Hormonal treatment

A medicinal hormonal blockade may also be part of treatment in the localized prostate cancer setting. Hormone therapy decreases the levels of androgens (male sex hormones) in the body or blocks their production. The main androgens in males are testosterone and dihydrotestosterone.

These androgens aid the development of the prostate and are necessary for prostate cancer to grow. Reducing or blocking circulating levels of these hormones can temporarily inhibit the growth of prostate cancer.

Doctors may prescribe this for a fixed time after the radiation therapy to decrease the chance of prostate cancer recurrence.

Advanced prostate cancer

As cancer grows, it can spread throughout the body. If it spreads, or if it comes back after remission, treatment options will change. Options can include:

  • Chemotherapy: This option uses drugs to help stop the growth of cancer cells. While it can kill cancer cells around the body, it may cause adverse effects.
  • Hormonal therapy: Blocking or reducing specific androgens appears to stop or delay the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most testosterone, or to take an injection or pill that biochemically mimics the removal of the testicles, causing a similar effect in testosterone depletion.
  • Targeted therapy: This method uses drugs or other substances that identify and attack specific cancer cells. For example, if somebody harbors a BRCA mutation, then a PARP inhibitor oral medication can target the mutation and kill cancer cells
  • Immunotherapy: This method uses a person’s immune system to help fight cancer. Scientists can use substances the body produces, or create them in a lab, to help boost or restore the body’s natural defenses against cancer.

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, surgery to remove either the prostate gland or the testicles 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 or extracting sperm directly from the testicles for artificial insemination.

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.

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Stages

Staging typically describes how much cancer is present in the body and how serious the cancer is. Knowing the stage of prostate cancer can help a person understand what to expect and will inform decisions about treatment.

Medical professionals often refer to cancer as either non-metastatic or metastatic. Non-metastatic cancer is only present in its original growth area, which doctors may call localized. Metastatic cancer is that which spreads to another part of the body from the site of origin.

Cancer staging is complex and accounts for many different factors. Usually, the lower the number, the less the cancer has spread. Stages may include:

  • Stage I: Cancer is only present in the prostate gland.
  • Stage II: Cancer has not yet spread from the prostate, but a person will have a higher PSA level.
  • Stage III: Cancer may have spread to nearby tissues.
  • Stage IV: Cancer may have spread to distant parts of the body.

Diagnosis

If a person has symptoms that may indicate prostate cancer, a doctor will likely:

  • ask about symptoms
  • ask about personal and medical history
  • perform imaging tests
  • 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.

Click here to learn more about prostate exams.

Further tests

If a doctor suspects cancer, they may recommend further tests, such as:

  • Transrectal ultrasound: This involves inserting a probe with a camera into the rectum.
  • 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

While prostate cancer is relatively common, doctors can detect most cases early and provide effective treatment. The ACS suggests a nearly 100% 5-year survival rate for people with localized or regional prostate cancer and a 30% rate for individuals with distant prostate cancer. Currently, the overall 5-year survival rate is 98%.

The best way to detect prostate cancer in its early stages is to attend regular screening. Depending on risk factors, it may be advisable for people to begin screening at 40. Anyone who has not yet attended screening should speak with a doctor about their options.


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