Prostate Cancer

What is prostate cancer?

Prostate cancer is a disease that affects a large number of men, particularly those over the age of 55-60, with the incidence rate increasing with age. For individuals aged 55-65, the occurrence is around 10%, but this rises to nearly 30% or even 40% in older age groups, especially after 70.

More than 200,000 new cases and approximately 30,000 deaths are attributed to prostate cancer annually, according to studies conducted and officially published in the United States. The rate appears to be significantly higher among the African-American population, both in terms of disease occurrence and mortality. Conversely, lower rates of the disease are seen in regions such as Asia and Latin America.

Prostate cancer generally grows slowly and often presents no symptoms. In most cases—particularly when patients are not regularly monitored by a urologist—the disease is only detected after it has metastasized, or during examinations for other reasons, such as urinary difficulties potentially caused by an enlarged prostate.

Despite its slow progression, prostate cancer can sometimes accelerate rapidly (adopting an aggressive behavior), leading to local spread after infiltrating the prostate capsule (the last defense of the organ), as well as metastasis to other organs, primarily through the lymphatic system, spreading to pelvic lymph nodes and, via the bloodstream, to organs such as the skeletal system (bones of the pelvis and spine), lungs, liver, brain, etc.

When the cancer is diagnosed while still confined to the prostate gland, treatment can be curative. However, once it has spread outside the prostate capsule or metastasized to other organs, treatments cannot provide a complete cure but can still improve survival rates, often significantly enhancing the patient’s quality of life.

What causes prostate cancer?

As previously mentioned, the risk of prostate cancer increases dramatically with age. While the incidence rate in men under 50 is less than 1%, about 2 in 5 men over 65 will have the disease. Men with a family history of prostate cancer are at higher risk than the general population. Although the exact causes of the disease are not known, numerous studies have linked prostate cancer to diet. Men who consume large amounts of fat—especially red meat and other animal fats—are more prone to developing the disease.

The disease is more common in populations that consume significant amounts of animal fats and dairy products, while it occurs less frequently in populations with dietary habits centered on rice, soy products, and grains. Additionally, the way meat is prepared, particularly at high temperatures, can lead to the formation of carcinogenic substances. Furthermore, increased testosterone production due to excessive consumption of animal fats seems to play a role in the growth of cancer cells.

People exposed to toxic substances in their work environment, such as battery manufacturing plants, rubber factories, or copper metals, are also at a higher risk of developing the disease. Moreover, untreated prostate conditions like chronic prostatitis may play a multifactorial role in the development of cancer, a topic currently under significant molecular biology research.

When should we seek medical help?

You should see a urologist if you experience the following symptoms and signs:

Difficulty starting urination
Sudden interruption of urination
Frequent urination (more than 5-6 times a day)
Nocturia (urination that interrupts sleep at night)
Pain during urination
Pain during ejaculation
Swelling in the lower extremities
Hematuria (blood in urine)
Hematospermia (blood in semen)

When should we seek emergency examination from a urologist?

Seek immediate medical attention if you experience any of the following issues:

Symptoms of acute urinary infection, such as burning during urination, urgency, frequent urination, or fever.
Urinary retention, meaning difficulty or inability to urinate despite frequent attempts, accompanied by bladder pain.
Acute kidney failure, characterized by reduced urine output despite adequate water intake, along with general malaise.
Deep bone pain, for example, in the pelvis or lower back, particularly when it doesn’t subside.
Weakness in the legs, difficulty walking, fatigue, urinary issues, numbness in the lower abdomen or groin area, or the legs (possible spinal cord compression syndrome).

Who should undergo yearly urological examinations?

Men aged 50 and older.
Individuals in high-risk groups, such as those with a family history of prostate cancer.
People who have had chronic prostatitis in the past and did not treat it, even if they have no symptoms.
Obese individuals.
Those working in environments with exposure to toxic substances like paint, rubber, or metals.
Patients receiving hormone replacement therapy, such as testosterone supplements.
Patients on immunosuppressive treatments for various conditions, such as connective tissue diseases or organ transplants.

How should each individual be tested for prostate cancer diagnosis?

The proper examination of the prostate gland should include the following tests:

Digital Rectal Exam (DRE)

This allows the urologist to gather valuable information for diagnosing prostate conditions, such as:

Signs of chronic inflammation.
Detection of hard nodules or hard areas in the gland.
Palpation of the seminal vesicles to check for inflammation or cancer spread.
Evaluation of the size of the gland.
Presence of purulent or bloody prostatic fluid.

Laboratory measurement of prostate-specific antigen (PSA)

This test can provide valuable information about the prostate tissue. Elevated PSA levels require further investigation to differentiate between conditions like inflammation, benign enlargement, or cancer. Low PSA values does not mean the patient is safe nor is it enough of a reliable indicator.

Transrectal Ultrasound (TRUS)

This essential test should be performed by an experienced urologist with expertise in ultrasound imaging of the prostate. It provides crucial information about suspicious areas in the prostate that may warrant further investigation via biopsy.

How do we estimate if cancer has spread?

After diagnosing prostate cancer, the next step is to determine if the cancer cells have spread to other organs. Although many patients may not need further testing, additional diagnostic tests are recommended if there are clinical or test findings suggesting potential metastasis:

CT Scan
Bone Scan
MRI

These tests help stage the disease, which can range from T1 (early-stage cancer confined to the prostate) to T4 (cancer that has spread to nearby organs or distant sites).

Treatment options for prostate cancer:

The treatment approach depends on the stage of the cancer, the histological score (Gleason score), and the PSA level. Age and life expectancy are also important factors in deciding the best course of treatment.

T1 Stage: For early-stage cancer, the treatment is typically radical prostatectomy. For older patients with health problems, radiotherapy or careful monitoring may be considered.
T2 Stage: Options include radical prostatectomy, radiotherapy, and sometimes cryosurgery or other treatments.
T3 Stage: Treatment options include radical prostatectomy, radiotherapy with hormone therapy, or hormone therapy alone.
T4 Stage: When cancer has spread to other organs, treatments like hormone therapy, radiotherapy, or palliative care may be necessary.

Localized disease treatment options:

Surgery (radical prostatectomy): Options include open, laparoscopic, or robot-assisted surgery, depending on the available technology and expertise.
Radiotherapy (external beam radiation or brachytherapy): Involves targeted radiation to destroy cancer cells.
Cryosurgery and High-Intensity Focused Ultrasound (HIFU): These represent innovative and less invasive options for treating prostate cancer, especially in cases where the disease is localized or in patients who may not be ideal candidates for more traditional treatments like surgery or radiotherapy.

Recurrent Prostate Cancer:

Recurrence is not uncommon, and treatment depends on the initial method used. Options include additional surgery, radiotherapy, or hormone therapy. Hormone-resistant cancer may require chemotherapy or newer treatments such as immunotherapy or second-line hormone therapies.

Conclusions and Key Points:

Prostate cancer is a common disease in men over 65, but early detection and treatment can lead to successful outcomes. Regular urological checkups, a healthy diet, and addressing chronic prostate conditions like prostatitis are crucial in reducing the risk and detecting cancer early.