Prostate cancer is a type of cancer that develops when the cells in the prostate gland start to multiply in an uncontrolled manner. The prostate gland is part of the reproductive system in males. It is a small gland located below the bladder, and involved in making the fluids that are secreted along with the semen.
Although prostate cancer carries the potential to spread to the other parts of the body (metastasize) and cause significant morbidity and mortality, in most cases it stays inactive and restricted to the site of origin within the prostate gland.
All abnormal growths in the prostate gland are not prostate cancer. For example, benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland without the uncontrolled multiplication of the cells and the aggressive behavior associated with cancers. BPH makes it difficult to pass out the urine by squeezing the urethra but it does not increase the risk of cancer.
Another condition involving the abnormal growth of prostate cancer is prostatitis which is an inflammation of the prostate gland caused by a bacterial infection. It is the most probable cause of an oversized prostate gland in males younger than 50 years.
Almost all prostate cancers originate from the cells in the prostate gland that are tasked with making the fluids for semen. These are called adenocarcinomas. Still, some rare forms of prostate cancer are small cell cancer, neuroendocrine tumors, transitional cell carcinomas, and sarcomas.
Prostate cancer does not cause any symptoms during its early stages. However, when the tumor starts to grow, symptoms occur as a result of the direct effects of the growing tumor on the urinary and reproductive systems. In advanced stages, the involvement of other parts of the body is also manifested as pain in those areas.
Some common symptoms are:
Frequent urge to urinate, especially at night
Trouble in urinating
Weak urine force/stream
Blood in urine
Blood in semen
Pain in the bone
Pain in the lower back, hip, or chest
Unexplained weight loss
Fatigue and tiredness
Prostate cancer is usually detected during the screening test. The most common screening test is a digital rectal examination during which the healthcare provider inserts a gloved and lubricated finger into the rectum to feel the prostate gland. An enlarged or unusually hard prostate gland may indicate prostate cancer. Another screening test, called prostate-specific antigen (PSA) blood test, which measures the level of PSA in the blood. The prostate gland normally releases PSA into the blood but in disease conditions, including prostate cancer, the amount of PSA in the blood is higher.
If the prostate gland is growing at an alarming rate, more tests are performed to determine whether it is cancerous and further understand its nature. The first set of tests comprises imaging tools, such as ultrasound and magnetic resonance imaging (MRI). These imaging modalities help clinicians determine the size of the tumor. Its spread to the other parts of the body is assessed by positron emission tomography (PET) scans. Furthermore, images of the tumor and nearby parts of the body obtained at this stage help in deciding the best possible treatment.
To confirm the presence of the tumor, a small section of the prostate gland suspected of having the tumor is also obtained by biopsy and analyzed under a microscope as a histopathological examination. In this ultrasound-guided biopsy procedure, a thin needle is inserted into the prostate gland to extract a tissue sample. To prevent pain or discomfort, the patient is given local anesthesia that temporarily numbs the area in which the needle is inserted.
Biopsy helps evaluate the aggressiveness of the cancer by the tumor grading and staging. This also provides a basis for deciding the management strategies and selection of targeted therapy and immunotherapy drugs.
Prostate cancers are slow-growing and do not need active treatment in most cases. Therefore, the most common treatment strategy is active surveillance in which the tumor growth is monitored closely and interventions are given when it starts to show excessive growth or any symptoms.
Surgical removal of the prostate gland, called prostatectomy, is the most common treatment option for prostate cancer. It is often done through robotic arms which are controlled via a console. An alternative to surgical resection is radiation therapy. The radiation can be given directly to prostate cancer from outside the body or in the form of small radioactive seeds that are placed inside the prostate gland.
In cases where the cancer has spread to other parts of the body, systemic medications are given to destroy cancer cells. The most common systemic therapy is hormone therapy in which the medications are used to lower the level of testosterone that ultimately slows the growth of prostate cancer. Another option is to use chemotherapy which kills the cancer cells in the body.
Immunotherapy and targeted therapy are among the advanced therapies being used for the management of prostate cancer. Immunotherapy helps the body’s immune system to fight the cancer whereas targeted therapy selectively targets the cancer cells due to their distinct genetic mutations.
The high prevalence of prostate cancer is a cause of concern; however, the success rates of the current standard of care management are encouraging. The major goals of ongoing research are to enable timely detection and improve the quality of life of the patients.