Prostate Cancer Warning Signs & Prevention

December 28, 2020

What is prostate cancer?
Prostate cancer is the development of cancer cells in the prostate (a gland that produces semen). It is the most common cancer in men; some cancers grow slowly, while others are very aggressive and spread rapidly to other organs.

How does prostate cancer develop?
As with all cancers, prostate cancer begins when a large number of cells get out of control and begin to invade other tissues. The cells become cancerous due to the accumulation of defects or mutations in the DNA.

In most cases, cells are able to detect and repair DNA damage. If a cell is so severely damaged that it cannot repair itself, it undergoes what is known as programmed cell death or apoptosis. Cancer occurs when damaged cells do not grow, divide, and spread normally, instead of destroying themselves as they should.

Symptoms of Prostate Cancer
Symptoms of prostate cancer are varied, and some men have no symptoms until years after the cancer has developed. However, symptoms that may occur include the following.

Frequent urination
Difficulty starting or stopping urination
Interrupted or faint or slow urine flow
Blood in urine or semen
Discomfort (pain or burning sensation during urination or ejaculation).
Severe pain in the lower back, buttocks, or thighs, often when the prostate cancer is aggressive or has spread to other organs.

Prostate cancer or enlarged prostate?
There are two conditions that can cause some symptoms similar to those of prostate cancer described earlier.

Benign prostatic hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) is caused by an enlarged prostate. Benign prostatic hyperplasia is caused by an enlarged prostate that puts pressure on the bladder, urethra, or both, which causes symptoms. Benign prostatic hyperplasia is common in older men and is a relatively mild disease.

Prostatitis (inflammation or infection of the prostate gland)
In the case of prostatitis, the prostate tissue becomes inflamed, causing the prostate to swell. Any bacteria that can cause a urinary tract infection (UTI) can also cause prostatitis, which can be caused by sexually transmitted diseases (STDs), including chlamydia and gonorrhea.

Both of these conditions can be treated with medication, but some patients with BPH may require surgery.

Prostate cancer is distinguished from these conditions by the identification of cancer cells in a prostate biopsy.

Who is at risk for developing prostate cancer?
Advancing age in men (starting at age 50) is the greatest risk factor for benign prostatic hyperplasia and prostate cancer. In addition, the risk of prostate cancer doubles if the father or brother has prostate cancer; however, African-American men have the highest risk of prostate cancer. Studies have shown that most men age 70 have some form of prostate cancer, and most of them have no symptoms.

Preventing Prostate Cancer
Researchers believe that a diet low in fruits and vegetables but high in meat and fatty dairy products increases the risk of prostate cancer. The mechanism is under investigation, but current speculation suggests that meat and high-fat foods contain compounds that enhance the growth of cancer cells.

Can too much sex cause prostate cancer?
There are many myths about the causes of prostate cancer. However, there is no evidence that “too much sex,” masturbation, benign prostatic hyperplasia (BPH), or vasectomy increases the risk of prostate cancer or causes prostate cancer. Current research is investigating whether STDs, BPH, or alcohol consumption increase the risk of prostate cancer.

Prostate Cancer Screening Guidelines
Although screening tests for prostate cancer are not routinely performed, the American Cancer Society guidelines recommend that some men should be screened.

Screening Guidelines Based on Age and Risk
Men age 40 who have more than one close relative (father, brother, or son) diagnosed with prostate cancer at an early age.
African-American men age 45 or men whose father, brother, or son was diagnosed with prostate cancer before age 65
Men aged 50 years or older have an average risk and are expected to live at least 10 additional years.
However, not everyone agrees with these guidelines, and clinicians should explain that treatments may have serious side effects, may have little or no effect on the cancer, and that some cancers grow so slowly.

Digital Rectal Examination and PSA Testing
There are two tests that are particularly helpful in screening for prostate cancer.

Digital Rectal Examination (DRE)
A DRE is done to determine if the prostate is enlarged and is soft, lumpy, or very hard (hard prostate). In a digital rectal exam, the doctor checks the prostate for abnormalities with a gloved, lubricated finger (digital).

PSA Test
Another test involves testing a blood sample to determine the level of a protein produced by prostate cells (prostate-specific antigen or PSA). the PSA test may indicate that a person has a higher chance of developing prostate cancer, but the test is controversial (see slides below). Patients and physicians need to carefully consider the meaning and use of these test results.

PSA Test Results
In general, a PSA level of less than 4 ng/mL of blood is considered normal, while a PSA level greater than 10 ng/mL indicates a high risk of cancer. Unfortunately, some men have intermediate levels of PSA (5-9 ng/mL), making it more difficult to determine their condition. Worse yet, some men still have prostate cancer despite showing PSA levels below 4 ng/mL.

False Positive PSA Test
Benign prostatic hyperplasia and prostatitis increase PSA levels, leading to false positives.

False Negative PSA Test
Some medications may lower PSA levels and cause a false negative PSA test. Your doctor can help determine the significance of the PSA test and digital rectal test results and determine if other tests are needed.

Prostate Cancer Biopsy
If your doctor determines that the PSA and digital rectal exam indicate prostate cancer, he or she may recommend a prostate biopsy, depending on your age, medical condition, and other factors. A biopsy is performed by inserting a needle into the rectum, or the junction of the rectum and scrotum, and then removing a small sample of prostate tissue to examine it under a microscope for cancerous tissue. The biopsy can detect and determine the aggressiveness of prostate cancer cells.

Gleason Score for Prostate Cancer
A pathologist examines a biopsy sample of the prostate gland. The pathologist uses the sample to make a judgment about the aggressiveness of the cancer. This determination is called the Gleason score.

How is the Gleason score determined?
The pathologist grades the prostate biopsy tissue on a scale of 1 to 5, with 5 being the poorest tumor pattern. The pathologist then looks at the individual cells in the tumor pattern and grades the cell types from 1 to 5, with 5 being the most aggressive cancer cell type. The Gleason score is based on the sum of these two numbers (tissue grade and cell type grade).A Gleason score of 5+5=10 indicates a highly aggressive prostate tumor, while a low score (2+2=4) indicates a less aggressive tumor.

Imaging tests for prostate cancer
The spread of prostate cancer can be detected by several different tests, such as ultrasound, CT scan, MRI, and radionuclide bone scan. The doctor will help determine which test is best for each patient.

Staging of Prostate Cancer
Prostate cancer staging is a method of indicating how far the cancer has spread in the body and is used to help determine the best treatment for a patient. Cancer that has spread to other parts or organs of the body is called metastatic cancer.

Staging of Prostate Cancer
In the case of prostate cancer, the stages of the cancer are as follows.

Stage I: The cancer is small and remains confined to the prostate gland.
Stage II: The cancer is more advanced, but still confined to the prostate gland.
Stage III: The cancer has spread to the outside of the prostate and to the nearby seminal vesicles.
Stage IV: The cancer has spread to the lymph nodes, other nearby organs or tissues, such as the rectum or bladder, or distant sites, such as the lungs or bones.
Aggressive prostate cancers usually reach stage IV, but other less aggressive prostate cancers may never advance beyond stage I, II, or III.

Prostate Cancer Survival Rate
In most people, prostate cancer progresses slowly through the stages; approximately all people diagnosed with stage I to III prostate cancer survive for 5 years or more and have even better prospects for future survival with current treatment options.

Stage IV Prostate Cancer
Even at stage IV, the 5-year survival rate is about 31%, and with advances in treatment, this number may increase.

Treatment of Prostate Cancer. Watch and Wait
The term “watch and wait” is increasingly being used to describe a program of active surveillance for some prostate cancer patients who are not receiving other cancer treatments. This means that if your cancer is not aggressive (based on the Gleason score and cancer stage), treatment may be delayed and you may be checked regularly. This approach is used because the risk of urinary and sexual problems inherent in most prostate cancer treatments is serious, and treatment can be delayed or avoided if the cancer is not aggressive. However, aggressive prostate cancer will usually be treated even if the secondary complications of treatment are severe.

Treatment of Prostate Cancer. Radiation Therapy
Focused radiation in the form of beams can be used to kill cancer cells, especially those that have migrated (metastasized) from the prostate. Radiation beams can be used to relieve bone pain caused by invasive cancer cells.

Low Dose Rate Brachytherapy
In another type of radiation therapy, called low-dose-rate brachytherapy, radioactive particles the size of a grain of rice are inserted into the prostate.

High Dose-Rate Brachytherapy
High-dose-rate brachytherapy applies more radiation to the cancerous prostate temporarily.

Both methods have side effects, including erectile dysfunction, urinary tract problems, and diarrhea.

Prostate Cancer Treatment. Prostate Cancer Surgery
Radical prostatectomy is the surgical removal of the prostate gland. Usually, this treatment is performed when the cancer is located only in the prostate. New surgical techniques help avoid damage to the nerves, but the procedure may still have the side effects of erectile dysfunction and urinary control problems. However, these side effects may gradually improve in some patients. Today’s surgeons may use robotic technology to assist in surgery.

Tips for Coping with Urinary Incontinence
Urinary incontinence is a common complication in men after prostate cancer surgery, and the problem persists even up to 5 years after surgery. In a survey of 111 men published in 2003, 69% reported urinary incontinence after prostate surgery. Most of these men used pelvic muscle exercises (Kegel exercises) to help them. Many used control devices, including pads, special underwear, and sanitary napkins, to control incontinence.

Here are some tips for urinary incontinence after surgery.

Keep a diary of how much water you drink and when and how often you go to the bathroom. Record when you leak urine and consider if there is any cause for the leak, such as bending over in a certain way or drinking too much coffee or soda. The diary can be a powerful tool for your doctor and help further treatment.
Practice double urination, i.e., wait a minute after urinating and try again.
Drink less caffeine and alcohol. Both can stimulate the bladder and increase your need to urinate. Reducing or eliminating these two medications from your diet can help avoid frequent urination.
Avoid food triggers, which, for some men, include chocolate, artificial sweeteners, and spicy or acidic foods. Other men find that food plays little or no role in their incontinence problems.
Smoking cessation. In addition to many other health hazards, tobacco has been linked to increased urinary incontinence in men.

Prostate Cancer Treatment. Hormone Therapy
The goal of hormone therapy is to shrink or slow the growth of prostate cancer cells with drugs, but it does not kill prostate cancer cells. It works by blocking or reducing the production of testosterone and other male hormones (male sex hormones) to reduce the symptoms of prostate cancer and slow the spread of aggressive prostate cancer.

Side Effects of Hormone Therapy
Impotence
Breast Tissue Growth
Hot flashes
Weight gain

Prostate Cancer Treatment. Chemotherapy
The purpose of chemotherapy is to kill fast-growing cancer cells anywhere in the body, so it is often used when aggressive prostate cancer cells spread to other parts of the body. Typically, chemotherapy is a series of treatments administered over several months through a special intravenous line. There have been new developments in both hormonal and chemotherapy treatments for prostate cancer. Unfortunately, chemotherapy often kills other fast-growing body cells, such as hair cells, mucosal cells, and cells of the gastrointestinal tract. This can lead to unwanted side effects.

Side Effects of Chemotherapy for Prostate Cancer
Hair Loss
Mouth Sores
Nausea
Vomiting
Other physical ailments

Prostate Cancer Treatment. Cryotherapy
Cryotherapy is a treatment that kills cancer cells by freezing them and then ruptures them when they rewarm. This treatment is less invasive than surgery, but the long-term effects are still being studied.

Prostate Cancer Cryotherapy and Impotence
Unfortunately, freezing can damage nerves, sometimes including the nerves near the prostate that control erection. Many men (up to 80%) experience impotence after undergoing cryosurgery. Erectile dysfunction is a more common side effect after cryotherapy than after radical prostatectomy.

Prostate Cancer Treatment. Immunotherapy for Prostate Cancer
Note that prostate cancer immunotherapy is referred to as a vaccine, but this is somewhat misleading because it does not prevent prostate cancer in men. A prostate cancer “vaccine” is a highly individualized treatment designed to deliver immune cells from an individual patient’s own cells. These cells are lab-enhanced immune cells that become capable of killing or destroying the patient’s own prostate cancer cells.

Like hormone therapy, this “vaccine” does not kill all cancer cells and is currently used to slow the progression of aggressive cancers, especially those that do not respond to other therapies. Research is ongoing, and perhaps this or similar approaches will be developed to be more effective in the future.

Hope for Advanced Prostate Cancer
It is important to follow up a diagnosis of prostate cancer. Whether the decision is made to use a “wait-and-see” approach or any of the above treatments, prostate cancer may progress and additional testing, such as PSA testing or treatment, may be needed. In addition, follow-up can monitor how lifestyle changes (e.g., proper diet and exercise) reduce the risk of death from prostate cancer.

Prostate Cancer. Coping with Erectile Dysfunction (ED)
Erectile dysfunction (ED or inability to obtain or maintain an erection) is a very common side effect of most prostate cancer treatments. In some men, particularly those younger than 70 years of age, erectile function may improve within about 2 years after surgery. In addition, patients may benefit from a variety of ED medications and therapies, including several devices specifically designed for men with ED. Men with ED should discuss options with their physician and partner to determine the best individual treatment for them.

Cancer Prevention Diet
As mentioned earlier, a good diet and lifestyle can help reduce the risk of developing prostate cancer; this is also true for men who have been diagnosed with prostate cancer, as well as for those whose cancer has recurred. Therefore, diet and lifestyle changes should be reviewed.

Dietary Tips to Avoid the Recurrence of Prostate Cancer
Increase the frequency and portion size of fruits and vegetables, as a 2014 study of more than 40,000 Japanese men found that fiber (which is abundant in fruits and vegetables) may reduce the risk of prostate cancer.
Eat whole grains and avoid processed grains and white flour. As with fruits and vegetables, whole grains provide more fiber than processed grains. Adding more fiber may help reduce the risk of prostate cancer.
Reduce or stop eating high-fat dairy products and meats, especially processed meats such as bacon, sausage and pepperoni. The World Health Organization found in 2015 that a diet high in red meat was associated with an increased risk of prostate cancer. Consuming high amounts of high-fat dairy products also appears to slightly elevate the risk of prostate cancer.
Some studies suggest that spinach, orange juice, and other foods may reduce the risk of cancer; prostate cancer patients may receive additional dietary and lifestyle advice when they are followed up with their doctors.

Prostate Cancer. Beware of supplements
Patients with prostate cancer and other cancers should be very cautious about taking supplements and other items that are used as cancer prevention or treatment. Before taking any of these compounds, patients should discuss the compound with their physician. In addition, cancer patients should not self-administer or change the dose of any medication without first consulting their doctor.