Prostate cancer: symptoms, causes, treatment and prognosis

Prostate cancer symptoms include difficulty urinating. Urination may be painful and/or difficult to urinate and/or urination more often and/or weak stream and/or dripping. These complaints also occur with a benign enlargement of the prostate. Initially, prostate cancer often does not cause any symptoms. Complaints only occur in the more advanced stages of prostate cancer and as the tumor grows they increase in severity. Prostate cancer is cancer that arises in the tissues of the prostate. The prostate is a gland about the size of a chestnut that is part of the male reproductive system. The prostate is located under the bladder, at the front of the rectum and around the beginning of the urethra. Prostate cancer usually occurs in older men. The disease is rarely fatal as most forms of prostate cancer grow very slowly.

  • What is prostate cancer?
  • Incidence of prostate cancer
  • Causes and risk factors of prostate cancer
  • Age
  • Ethnicity
  • Genetic factors
  • Infection
  • Diet
  • Chemical agents
  • Strong evidence linking height and prostate cancer
  • ‘Sexually transmitted bacteria may increase the risk of prostate cancer’
  • Sexual activity
  • Low selenium levels
  • Symptoms of prostate cancer
  • Complications
  • Metastases
  • Incontinence
  • Erectile dysfunction
  • Go to the doctor on time if you have any complaints
  • Diagnosis and treatment
  • Rectal examination or rectal examination
  • PSA test (blood test)
  • Transrectal ultrasound
  • Biopsy
  • Gleason score
  • Further investigation
  • Treatment of prostate cancer
  • Watchful waiting
  • Radical prostatectomy
  • HIFU
  • External radiotherapy
  • Internal radiotherapy
  • Hormone therapy
  • Chemotherapy
  • Radioactive radium-223
  • Independently or in combination
  • Power supply
  • Prostate cancer prognosis
  • Prevention

Location of the prostate / Source: Decade3d/Shutterstock.com

What is prostate cancer?

Prostate cancer is cancer that arises in the tissues of the prostate. The prostate is a gland, about the size of a chestnut, that is part of the male reproductive system. The prostate is located under the bladder, at the front of the rectum and around the beginning of the urethra. Prostate cancer usually occurs in older men.

Incidence of prostate cancer

Prostate cancer is, next to lung cancer, the most common cancer in men. In the Netherlands, prostate cancer has an incidence of approximately 95 in 100,000 men per year. More than 7,900 new patients are diagnosed with prostate cancer every year.

Causes and risk factors of prostate cancer

The cause of prostate cancer is not exactly known in 2023. Any man can get it. Hormonal, genetic, environmental and nutritional factors appear to play a role in the development of this cancer. The following risk factors are associated with prostate cancer:

Age

There is a strong correlation between increasing age and developing prostate cancer. The incidence of prostate cancer is steadily increasing with age. The older you are, the more likely you are to develop prostate cancer.

Ethnicity

US data shows that African-American men are 1.6 times more likely than white Americans to develop prostate cancer. They are also 2.4 times more likely to die from this disease compared to white men of the same age. Asian Americans, on the other hand, have a much lower chance of developing prostate cancer compared to white or African American men. However, no biological basis for this classification has been established. These differences in diagnosis and mortality rates between different population groups have more to do with other factors, such as nutrition and lifestyle. So it is not the case that a certain ‘breed’ is more susceptible to prostate cancer.

Genetic factors

There may be a hereditary predisposition if prostate cancer occurs in three or more family members and prostate cancer has been diagnosed in at least two first-degree relatives before the age of 55.

Infection

Recent data suggest that infection with sexually transmitted diseases (STD) is one of the causative factors for prostate cancer. People who have suffered from sexually transmitted diseases are 1.4 times more likely to develop prostate cancer compared to the general population.

Diet

A diet high in fat is associated with an increased risk of prostate cancer.

Chemical agents

Exposure to chemicals such as cadmium can contribute to the development of prostate cancer.

Strong evidence linking height and prostate cancer

There is strong evidence for a link between height and prostate cancer. Taller men get the disease more often than short men. The World Cancer Research Fund reports this based on an analysis of worldwide research into prostate cancer. Being overweight also increases the risk of prostate cancer, especially aggressive forms. Body size is also linked to other types of cancer. It is not yet clear why taller people are more likely to develop certain types of cancer. (Source: www.metronieuws.nl, 19-11-2014.)

‘Sexually transmitted bacteria may increase the risk of prostate cancer’

Prostate cancer could be a sexually transmitted disease caused by a common, but often unnoticed, bacteria. American scientists claim this based on research. Researchers from the University of California tested human prostate cells in a lab and found that the STD trichomonas stimulates the growth of cancer cells. The study results suggest how a sexually transmitted disease makes men more vulnerable to prostate cancer, but there is no conclusive evidence yet. Professor Patricia Johnson: ‘”Further research needs to be carried out because we still don’t know exactly what causes prostate cancer.” (Source: nationalezorggids.nl, 21-05-2014.)

Sexual activity

Men who experience an orgasm at least once a day have a lower risk of prostate cancer. Researchers from Harvard Medical School in Boston came to this striking conclusion in 2015.

Low selenium levels

The Maastricht University Medical Center (UMC) has discovered a link between selenium and prostate cancer. The mineral may have a protective effect against prostate cancer. Researchers from Maastricht UMC+ conducted a study among almost 60,000 men aged 55 to 69 years into the link between selenium intake and the risk of prostate cancer. This shows that men with higher concentrations of the mineral selenium in their bodies are less likely to develop advanced stages of prostate cancer. The risk compared to men with low selenium levels is 60% lower. The Maastricht study provides important additional evidence that a low selenium value is a risk factor for advanced prostate cancer. Further research is needed to determine whether higher selenium intake can effectively reduce the risk of prostate cancer in men with low selenium levels, the researchers said. (Source: www.nationalezorggids.nl, September 20, 2012)

A 2018 meta-analysis indicated that selenium most likely plays a protective role against the development of prostate cancer and its progression to advanced stages.[1] Therefore, selenium supplementation may be suggested for the prevention of prostate cancer, the researchers said.

Symptoms of prostate cancer

Not everyone experiences symptoms of prostate cancer. Often the signs of prostate cancer are first noticed by a doctor during a routine examination.

Some men experience changes in urination or sexual function that could indicate the presence of prostate cancer. The symptoms that may indicate prostate cancer are:

  • frequent urination, especially at night;
  • difficulty urinating;
  • weak or interrupted stream of urine;
  • drip;
  • painful urination or a burning sensation;
  • difficulty getting an erection;
  • painful ejaculation;
  • blood in the urine or semen;
  • frequent pain or stiffness in the lower back, hips, or thighs.

These symptoms may also indicate the presence of other diseases or conditions, such as an enlarged prostate, also called Benign Prostatic Hyperplasia (BHP), or inflammation of the prostate, also called prostatitis.

Complications

Complications of prostate cancer and prostate cancer treatments include:

Metastases

Prostate cancer can spread to nearby organs, such as the bladder, or through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other parts of the body, it may still respond to treatment, but curative treatment may not be possible.

Incontinence

Both prostate cancer and its treatment can lead to urinary incontinence. Treatment of incontinence depends on the symptoms and severity, and is likely to improve over time. Treatment options may include medications, catheters, and surgery.

Erectile dysfunction

Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation, or hormonal treatment. Medications or other treatment options are available to treat erectile dysfunction.

Digital rectal examination (prostate) / Source: Blamb/Shutterstock

Go to the doctor on time if you have any complaints

Most prostate cancers in the Netherlands are discovered too late, because patients suffer from complaints that they keep to themselves for too long. Nearly half of all men in the world are clenched when it comes to their prostate complaints. About 47 percent remain silent for too long about all kinds of symptoms, such as pain and urinary problems, that they experience. Many are ashamed of it. This is clear from global research by the International Prostate Cancer Coalition (IPCC), which was announced in 2016. In addition to severe or unexplained pain, indications of serious prostate problems, such as difficulty walking or climbing stairs, loss of bladder control, and also sleep problems, are largely ignored. However, it is important that men sound the alarm in time, because the sooner the cancer is detected, the better the treatment options.

Diagnosis and treatment

Prostate cancer can be diagnosed using different types of tests.

Rectal examination or rectal examination

The doctor uses a gloved finger to feel through your anus whether the prostate shows any abnormalities.

Blood collection / Source: Istock.com/anna1311

PSA test (blood test)

If there is a suspicion that you have prostate cancer, your doctor will usually first have your blood tested, during which the amount of PSA is measured. PSA stands for Prostate Specific Antigen . It is a protein that is only produced in the prostate. An increase in the PSA level in the blood can indicate prostate cancer.

Transrectal ultrasound

An ultrasound probe is inserted through your anus all the way to the prostate. The prostate becomes visible on a screen via sound waves, which allows the urologist to see whether there are any abnormalities in the prostate. Furthermore, this examination can determine the location and size of the tumor.

PSA test / Source: Istock.com/jarun011

Biopsy

A needle is inserted through an ultrasound probe to the prostate, after which the urologist removes pieces of tissue (biopsies) from various parts of the prostate for further examination.

Gleason score

Gleason score can be determined from prostate biopsies , which is an important prognostic factor in prostate cancer. The pathologist rates the tumor cells in two places with a number from 1 to 5 and the sum of these two ratings is called the Gleason score . The result is a minimum of 2 and a maximum of 10. The result indicates how much the tumor tissue differs from normal prostate tissue. It predicts how quickly the tumor will grow and spread. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to metastasize or spread.

Further investigation

If it has been determined that prostate cancer is present, further investigation is required to determine how extensive the tumor is and whether it has spread. This examination may include computed tomography (CT), Magnetic Resonance Imaging (MRI), etc.

Breakthrough in detecting prostate cancer
TU Eindhoven has invented a promising way to detect prostate cancer. A new method saves pain for the patient and leads to fewer complications. According to Eindhoven University, the new discovery could save tens of thousands of men in the Netherlands from painful examinations every year. The new method uses ultrasound scanners. These are devices that use sound to look inside the body. This allows the tumor to be detected more accurately. Currently, small pieces of tissue are removed from the prostate using a long needle. That examination is less accurate and painful. This is still a test. If all goes well, the method could be widely available in two years. (Source: TU/e, 08-03-2014.)

Treatment of prostate cancer

There are various treatments for prostate cancer. Which treatment is indicated depends on the staging, i.e. the extent to which the cancer has developed. This concerns the size and location of the tumor, the extent of growth of the tumor into the surrounding tissue and the presence of metastases. The patient’s age, personal circumstances, health and wishes also play a role in determining which treatment will be used.

The following treatments are distinguished:

Watchful waiting

Prostate cancer is a slow-growing cancer. In a large proportion of patients, the tumor grows little or not at all. If it does not cause any complaints, it is not necessary in all cases to switch to active treatment and one should proceed to watchful waiting, with the progress being monitored by periodic examinations. This includes follow-up measurements of the prostate-specific antigen (PSA) and prostate biopsies, often supported by MRI.[2]

Radical prostatectomy

This is a total removal of the prostate.

HIFU

HIFU (High Intensity Focused Ultrasound) is a relatively new method for the treatment of localized prostate cancer that is still within the capsule of the prostate, in a patient who cannot or does not wish to undergo radical prostatectomy. This technique uses ultrasonic sound waves that are concentrated from a small antenna at one point in the anus. A heat wave originates from this point, within which a local temperature of 85-95° C is reached. This kills all (tumor) cells on site.

Radiotherapy (irradiation) / Source: Adriaticfoto/Shutterstock.com

External radiotherapy

External radiotherapy, also called external beam radiation therapy (EBRT): This involves irradiating and destroying cancer cells from the outside through the skin.

Internal radiotherapy

Internal radiotherapy, also known as brachytherapy or curietherapy: Radioactive seeds or a radioactive source are introduced into the prostate (via needles). The seeds remain permanently in the prostate, while the source is removed from the prostate after treatment.

Hormone therapy

The growth of prostate cancer cells is fueled by the male sex hormone testosterone. Hormonal therapy is aimed at counteracting the effect of testosterone.

Chemotherapy

If there is a hormone-resistant prostate carcinoma, chemotherapy can be considered.

Radioactive radium-223

Terminal prostate cancer patients with metastases in their bones and who no longer respond to chemotherapy, who do not want chemotherapy or are too weak for it, can be treated with radioactive radium-223 since the beginning of 2014. The treatment extends their life by four to six months and it also reduces pain and ensures a better quality of life.

Independently or in combination

A therapy can be used independently, but also in a combination of therapies.

Better treatment for some prostate cancer patients
Men with prostate cancer with metastases should also receive chemotherapy in addition to hormone therapy. This significantly increases the chance of survival compared to treatment with hormones alone. This is evident from two studies published in the journals The Lancet and The Lancet Oncology . The authors conclude that hormone therapy (so-called castration therapy) combined with chemotherapy with the drug docetaxel should become the standard treatment for these patients. (Source: National Healthcare Guide, 28-12-2015)

Plant-based diet / Source: Bitt24/Shutterstock.com

Power supply

Red meat, dietary fat, and milk intake should be kept to a minimum as they appear to increase the risk of prostate cancer.[3] Fruits and vegetables and polyphenols (a group of chemical compounds found in plants) may be preventive in prostate cancer, but further research is needed in 2021 to draw firmer conclusions and clarify their role in patients diagnosed with prostate cancer. Research from 2008 further shows that patients with early-stage prostate cancer who make changes to their diet and lifestyle can avoid or delay conventional treatment for at least 2 years. Patients in the study were encouraged to eat a low-fat, plant-based diet, practice stress management, and attend support group sessions.[4]

Selenium and vitamin supplements cannot be recommended for the prevention of prostate cancer and higher doses may even be associated with a worse prognosis. There is no specific evidence regarding the benefits of probiotics or prebiotics in prostate cancer.

Prostate cancer prognosis

For a patient without tumor growth and without metastases, the chance of five-year disease-free survival is approximately 80-90%. Most prostate cancers grow very slowly, as evidenced by the fact that as many as 67% of men with prostate cancer survive for at least 10 years.

Healthy nutrition to prevent prostate cancer / Source: Oleksandra Naumenko/Shutterstock

Prevention

You can reduce the risk of prostate cancer by taking the following measures, among others:

  • Eat a varied and healthy diet with plenty of fruit and vegetables and avoid high-fat foods.
  • Get enough exercise. This improves overall health, helps maintain a healthy weight and is good for mood. There is evidence that people who do not exercise enough have higher PSA levels, while men who exercise regularly have a lower risk of prostate cancer.
  • Maintain a healthy weight.

Notes:

  1. Sayehmiri, K., Azami, M., Mohammadi, Y., Soleymani, A., & Tardeh, Z. (2018). The association between Selenium and Prostate Cancer: a Systematic Review and Meta-Analysis. Asian Pacific journal of cancer prevention : APJCP, 19(6), 1431–1437. https://doi.org/10.22034/APJCP.2018.19.6.1431
  2. Marco H. Blanker, Chris H. Bangma. Prostate cancer, but not actively treated. Ned Tijdschr Geneeskd. 2019;163:D3698
  3. Mandair D, Rossi RE, Pericleous M, Whyand T, Caplin ME. Prostate cancer and the influence of dietary factors and supplements: a systematic review. Nutr Metab (London). 2014 Jun 16;11:30. doi: 10.1186/1743-7075-11-30. eCollection 2014.
  4. Frattaroli J, Weidner G, Dnistrian AM, Kemp C, Daubenmier JJ, Marlin RO, Crutchfield L, Yglecias L, Carroll PR, Ornish D. Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology. 2008 Dec;72(6):1319-23. doi: 10.1016/j.urology.2008.04.050. Epub 2008 Jul 7.

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